Causes and Treatment of Dupuytren's Contracture

Dupuytren's contracture is a condition that causes tightening, or contracture, of the palmar fascia, the connective tissue that lies beneath the skin in the palm of your hand. Because of the contracture, the fingers can become permanently bent down, and the function of your hand is impaired.

The palmar fascia is a thick tissue that lies above the tendons and below the skin of the hand. The fascia is attached both to the skin above and to structures below. The palmar fascia helps provide a tough, gripping surface for the hand and fingers.

Dupuytren's Contracture


No one really knows what causes Dupuytren's contracture, but it is well known that it runs in families—60 percent to 70 percent of individuals have a family history of the condition. Other factors have been suspected of causing Dupuytren's contracture, such as trauma, diabetes, alcoholism, epilepsy, and liver disease, but there is no clear relationship.

The condition is most common in older (usually after age 40), men (more common than women), with North European ancestry. One group commonly cited is those with Viking ancestry, and it may be called Viking's disease.

There is evidence that trauma may contribute to the development of Dupuytren's contracture. It has been investigated if specific traumatic events or a history of manual labor may contribute to this problem. Microscopically, there is evidence of bleeding within the affected tissues, evidence that trauma may contribute to this condition. That said, Dupuytren's is often seen in both hands, and found just as often in dominant and non-dominant hands—evidence that this problem is not the result of repetitive trauma.

What to Expect

The first clinical signs of Dupuytren's contracture are usually small, painless nodules in the palm. The nodules may begin to coalesce, and the skin becomes puckered. Eventually, in the later stages of the disease, the skin and underlying fascia contracts, causing an impairment of hand and finger function. People with Dupuytren's contracture have fingers that are bent down towards their palm.

While all fingers can become involved, Dupuytren's contracture most commonly affects the ring and little fingers. The progression of Dupuytren's tends to be in rapid bursts, followed by periods of little change. Dupuytren's contracture is seldom painful but can be a great nuisance. Dupuytren's is usually limited to involvement of the hand but can also involve other parts of the body, most commonly the soles of the feet. About five percent of patients with Dupuytren's contracture also have a similar condition of the soles of the feet called Lederhose's disease.

Dupuytren's Contracture vs. Disease

Most people, physicians included, use these terms interchangeably. Technically speaking, Dupuytren's disease refers to the proliferation of the cells that cause the formation of the nodules and contractures. Dupuytren's contracture is the result of this cell proliferation and a common manifestation of Dupuytren's disease. Treatment of Dupuytren's contracture may be considered when the condition causes difficulty performing normal daily tasks.

Prognostic Factors

Heredity A history of this condition within your family is an indication that it will be more aggressive.
Sex Dupuytren's usually begins later and progresses more slowly in women.
Alcoholism or Epilepsy These conditions are associated with Dupuytren's that is more aggressive and more likely to recur.
Location of Disease When in both hands, or when there is associated foot involvement, the progression tends to be more rapid.
Behavior of Disease

More aggressive Dupuytren's is more likely to recur after surgery and continue to be aggressive.

For many years, treatment in the early stages of Dupuytren's contracture was a watch-and-wait situation. Because surgical treatment is invasive and may require a protracted recovery and rehabilitation, it was often reserved as a last resort option if symptoms started to interfere too much with daily activities.

Recently, less-invasive treatment options have given some hope that Dupuytren's contracture can be well managed, especially if treated in the earlier stages of the problem. We do know that the worse the contracture, the harder it will be to ever have normal hand function again. Therefore, many people are looking for less-invasive treatment options, especially for early-stage Dupuytren's contracture.


There are four primary options for treatment currently available for the treatment of Dupuytren's contracture:

  1. Observation: Observation is often considered in the early stage of Dupuytren's contracture. This is usually the best option for people who are not impaired by their hand function. This may include people with minimal contracture or people who do not use their hands and can perform all their usual activities.
  2. Needle AponeurotomyNeedle aponeurotomy is a procedure developed in France, that has only recently become more popular in the United States. Using no incisions, a needle is used to separate the Dupuytren's cords and restore some or all of finger motion. Needle aponeurotomy is most successful in the earlier stages of Dupuytren's contracture.
  3. Collagenase InjectionsCollagenase is an enzyme that is produced by a bacteria that is injected into a Dupuytren's cord. The enzyme works to dissolve the tight Dupuytren's tissue. One day after the injection, after the enzyme has done its work, you return to the doctor to have the finger manipulated to break up the tightened tissue, and restore finger mobility.
  4. Surgery: Surgery is performed to remove the palmar fascia from the palm of the hand. Surgery can be effective at restoring function and may be necessary in the later stages of Dupuytren's contracture. The surgery usually has a prolonged rehabilitation.


In some patients, less-invasive treatments may not be appropriate. Also, not all doctors are aware that a needle aponeurotomy is a treatment option for Dupuytren's contracture. There is a controversy about the use of this treatment, and therefore not all doctors recommend needle aponeurotomy. If you want to discuss needle aponeurotomy with a physician, you can find a list of the physicians performing this procedure on the Dupuytren's-Online website.

The surgical procedure for Dupuytren's contracture is known as a fasciectomy, where segments of the palmar fascia are removed. The downside of surgery is that there are significant risks associated with the procedure. The most common is that scar tissue can form after surgery, leading to a problem similar to Dupuytren's contracture, but with scar tissue formation. Also, the Dupuytren's can return, and doing surgery a second time is fraught with problems. Other problems with surgery include nerve injury, infection, and prolonged healing.


Rehabilitation after needle aponeurotomy is relatively quick. Usually, patients can resume normal activities immediately and are instructed to refrain from sports and heavy labor for about a week. Depending on the type of contracture, a removable splint may be given to be worn a few hours each day.

Rehabilitation after surgery varies significantly. Patients with minimal contractures may be able to resume normal activities one the incisions heal, within a few weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue formation.

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