Dupuytren's contracture 

Introduction 

Illustration of Dupuytren's contracture

  1. bent finger
  2. abnormal nodules in the connective tissue beneath the skin
  3. normal connective tissue

Related conditions

Dupuytren’s contracture is related to a number of similar conditions that affect different areas of the body, including:

  • Garrod’s pads – nodules that develop on the back of the knuckles on the fingers
  • Ledderhose’s disease (plantar fibromatosis) – nodules and contractures that affect the foot
  • Peyronie’s disease – where the tissue of the penis is affected, causing it to become abnormally curved

These conditions can occur on their own, but some people are affected by several of them at the same time.

Dupuytren’s contracture is a condition that affects the hands and fingers. It causes one or more fingers to bend into the palm of the hand. It can affect one or both hands and it can sometimes affect the thumb.

Dupuytren's contracture occurs when the connective tissue in the palm thickens. Often the tissue thickens in one small area first and a “nodule” forms (a small, hard lump about 0.5-1cm) under the skin of the palm. The nodule sometimes feels tender to begin with, but this usually passes.

The nodules are non-cancerous (benign) and the condition is not life-threatening for those who develop it, although it can be a nuisance to live with.

Over time, the nodules can extend and form cords of tissue. These cords can shorten (contract) and, if the cords run along a finger or thumb, they can pull it so it becomes bent towards the palm. These contractures are often mild and painless, but they can get steadily worse over time.

Sometimes, the term Dupuytren’s disease (palmar fibromatosis) is used instead of Dupuytren’s contracture, because not everyone with the condition will develop contractures.

Read more about the symptoms of Dupuytren's contracture and diagnosing Dupuytren's contracture.

Why it happens

The exact cause of Dupuytren's contracture is unknown, but it’s thought to be related to your genes as it often runs in families.

If you have the gene that causes Dupuytren’s contracture, other factors such as diabetes, smoking and certain medications (for example, medication for epilepsy) may activate the condition. However, it is not clear how significant these factors are.

Read more about the causes of Dupuytren's contracture.

Who is affected

Dupuytren's contracture is fairly common. It can affect both sexes, but affects men more than women. The condition usually occurs during later life, although cases have been reported in children. Most cases occur in men over 50 and women over 60.

The condition seems to be more common in people of North European descent. It is thought that the gene associated with the condition was brought to the UK by the Vikings.

Preventing Dupuytren's contracture

As the exact cause of Dupuytren's contracture is unknown, it may not be possible to prevent the condition.

However, if you are at risk of developing the condition – for example, if you have had it in the past, or if you have a family history of it – stopping smoking (if you smoke) may help reduce your risk.

Treating Dupuytren's contracture

Many cases of Dupuytren's contracture are mild and don't need treatment. Treatment may be helpful if the condition is interfering with the normal functioning of your hand.

Non-surgical treatments include radiation therapy and injections with a medication called collagenase.

Alternatively, a minor procedure that involves using a needle to cut the contracted cord of tissue (needle fasciotomy) may be used in the early stages of the condition.

In more severe cases, surgery can help restore hand function. The two most common surgical techniques are:

  • open fasciotomy – where the shortened connective tissue is cut to relieve tension
  • fasciectomy – where the shortened connective tissue is removed

Surgery for Dupuytren's contracture cannot always fully straighten the affected finger or thumb and the contracture can recur after surgery. If a contracture does recur, further surgery may be possible.

Having surgery to remove the first nodule that appears will not stop the condition from progressing, as this will not stop the condition from occurring elsewhere in the palm. Therefore, it is usually best to avoid surgery until a contracture that interferswith use of the hand develops.

Read more about treating Dupuytren's contracture and recovering from Dupuytren's contracture surgery.

Ongoing research

Some treatments have been suggested for Dupuytren’s contracture for which there is not enough medical evidence to support their use.

For example, the National Institute for Health and Care Excellence (NICE) does not recommend the use of vitamin E cream or ultrasonic therapy. Trials into other possible treatments are currently underway.

Dupuytren’s contracture often runs in families and genetic research hopes to identify the genes responsible for the condition. This could lead to the development of treatments that prevent contractures occurring in the first place.




Page last reviewed: 25/07/2013

Next review due: 25/07/2015

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

triggafinga said on 23 September 2014

I have this on my left hand (I'm right-handed) and although I am not sure whether there is any connection, started developing the condition after increasing my golfing activities. When gripping the club I use this hand (I play left-handed) to overlay onto my right hand with my right index finger squeezed between my left hand ring finger (the most seriously affected) and the one next to it. I don't think the condition has adversely affected my golf but it can be tricky putting on gloves. There's no pain or other discomfort so I guess I'll live with it (I'm 65).

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antichondriac said on 22 August 2014

I got advice from an experienced acupuncturist. Dupuytrens can in theory be healed with acupuncture, so I had 15 sessions with up to 16 needles in each palm plus a 'circuit' around my body, in all about 45 needles at each session. This combined with warmth and rest over 45 minutes.

The result was as most would expect. The proposal was to have another 15 sessions to see if this might help. I then learned that I might require up to 100 sessions.

At that point I declined to continue. The contracture has continued to develop but I would say my quality of life is still brill.

I would still avoid open fasciotomy, but would certainly like to try collagenase as it is 'reversing the collagen build up that is the root of the problem.

any suggestions on trials would be considered. Left hand ring finger at 35 deg and right hand now near 10deg.

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tamesis said on 03 August 2014

I have the two middle fingers on each hand affected. They are not painful but inconvenient but as I can still type and sew I won't do anything about them until, and if, they get far worse.

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westie11 said on 12 May 2014

I have had chronic Dupuytens on 2 fingers of each hand for many years. They were operated on twice but the condition came back. Finally I was lucky to be among 50 people chosen by Gloucester Royal Hospital to have the Xiapex treatment on only 1 finger. Absolutely perfect, dead straight finger, only problem is that there is no more funding available for the other 3 fingers! The surgeon has offered me the treatment privately at £1750 per finger. I am severely restricted, anybody have any idea's?

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Kersie said on 21 April 2014

Helpful. My finger locked after doing work with my hands. I am 51 yrs old and this is the first time. It was interesting to read that Duputrens contracture can be geneti and was brought to the uk by the vikkngs. I have been diagnosed 20yrs ago with acute intermittent porphyria and that is also genetic, brought to the uk by the vikings
Possibly connected

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s7ev0 said on 10 January 2013

Apologies for the double post - mess up with activating registration on here.

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s7ev0 said on 10 January 2013

NICE has now approved radiotherapy for the initial stages of Durpuytrens. It's non-invasive and effective in the N stage, before contracture starts. In 87% of cases the nodules either stopped growing or reduced in size. Other treatments can still be undergone if contracture does occur later. More information, including reviews and links to the relevant studies, can be found on the dupuytren-online.info website, and the NICE codes can be found here: http://guidance.nice.org.uk/IPG368

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cuptop said on 08 May 2012

I have recently had the little finger of my right hand straighened. The procedure involved a local anaesthetic in the area around the little finger. The surgeon then perforated the cords below the skin with a needle and then snapped them progressively along the finger. The result is the finger is 95% straight, and after two weeks the small pin pricks on the skin have completely healed. I will have to wear a splint on the finger for a few weeks. This procedure is non invasive and is certainly not painful.

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spiderlegs said on 22 February 2012

i have had 2 oparation to help with this condition on my left hand first one done i was 46 and second one at 49 and now the condition now in my right hand will be operations as it gets worse as i am right handed

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British Dupuytrens Society said on 03 November 2011

The British Dupuytren's Society - Dupuytrens-society.org.uk - is a charity dedicated to providing information on the diagnosis and treatment of Dupuytren's Contracture and related conditions such as Ledderhose and Peyronies.

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ruthiepegs said on 03 September 2011

my Dad has had a large number of NHS operations for Dupuytrens on his hands - more than 5
such operations are not generally life threatening and so surgeons are keen to do such operations even if hands are not their specaiallity - also students are sometimes allowed to have a go!!!
this has resulted in my father having a number of very poor results and as anyone who has Duputrens knows the condition usually occurs as a response to a wound and so more cutting causes the condition to worsen.

He realises now that he should have done more research into the skill and relevent experience of the surgeon.
I have one finger affected and I will not make this mistake!

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ruthiepegs said on 03 September 2011

my Dad has had a large number of NHS operations for Dupuytrens on his hands - more than 5
such operations are not generally life threatening and so surgeons are keen to do such operations even if hands are not their specaiallity - also students are sometimes allowed to have a go!!!
this has resulted in my father having a number of very poor results and as anyone who has Duputrens knows the condition usually occurs as a response to a wound and so more cutting causes the condition to worsen.

He realises now that he should have done more research into the skill and relevent experience of the surgeon.
I have one finger affected and I will not make this mistake!

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User486045 said on 10 September 2010

Thanks for this useful information. I'm a well insured American, age 70, who has been having something that I can now identify as possibly either trigger finger or Dupuytren's contracture .

I'm trying to avoid over treatment. But I was already talked into 2 (negative) prostate biopsies (based on rising PSA,s) and two angioplasties with stents following a mild coronary.

I've decided not to have any more prostate biopsies witrhout a much better indicator and any further heart attacks would lead to one at most CABG.

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Bert Senior said on 18 August 2010

Delighted to find such an excellent diagnosis and interesting prognosis regarding surgery and risk of repeat of condition! Easy to access site NHS Direct, very grateful. Meant to rate this 5* but hit the wrong button and couldn't retract first star, such is life for computer illiterates such as myself!

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