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8 October, 2008

Home > Fact sheets by category > Diseases and conditions > Bones muscles and joints > Feet and hands > Dupuytren's contracture.

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Dupuytren's contracture

The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren's contracture is a thickening and shortening of this web of fascia that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little finger are usually targeted, but any finger can be affected. The disease tends to progress in fits and starts, and may take decades to finally limit the functioning of the hand. The exact cause is unknown, but the incidence of Dupuytren's contracture is higher among certain groups including:

Older men
People with diabetes
People with epilepsy who are treated with phenytoins
People who abuse alcohol.

Dupuytren's contracture can sometimes run in families, which suggests a genetic susceptibility. Treatment depends on the severity of the condition, but may include injections of corticosteroids into the palm and surgery.

Symptoms
The features of Dupuytren's contracture include:

A lump or nodule on the palm, usually close to the base of the ring or little finger.
The appearance of a thickened cord running along the palm to the fingers.
Over time, as the contracture develops, the fingers become clawed as they are pulled towards the palm.
The hand bows.
The fingers are completely pulled against the palm.
Often, the skin of the palm is dimpled and puckered.
There is rarely any associated pain.

The cause is unknown
The exact trigger that causes the palmar fascia to thicken and contract is unknown. However, contributing factors may include:

Age - the condition is more common in middle to later years of life.
Gender - 10 times more men than women are affected.
Heredity - the condition tends to run in families.
Ancestry - those with Celtic or Scandinavian ancestry are at increased risk.
Certain medical conditions - people with diabetes and epilepsy have a higher incidence of the condition.
Alcoholism - the contracture tends to be common, and comparatively more severe, in alcoholics.

Associated conditions
In most cases, only the hands are affected. Other associated difficulties can include:

Garrod's pads - the finger joints on the same hand may enlarge and thicken.
Ledderhose disease - thickening and shortening of the fascia in the palms of the feet.
Peyronie's disease - thickening and shortening of tissue in the penis.

Treatment options
Treatment depends on the severity of the condition. In its earlier stages, treatment may include injections of corticosteroids into the fascia. These medications reduce the localised tenderness and may help to delay subsequent thickening of the tissue. In severe or advanced cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional. Surgery is then the best option. Dupuytren's contracture can sometimes return after surgery, either at the same site or elsewhere on the palm. Usually, the contracture progresses at the same speed as previously.

Surgical techniques
Depending on the severity of the condition, the surgery options may include:

Cutting the fascia bands through small incisions in the palm.
Removing the thickened fascia.
Removing the fascia and associated skin, and using a skin graft to seal the palm.
Amputation of an affected finger, if the contracture has returned so many times that corrective surgery is no longer possible.

Occupational therapy
Occupational therapy is needed after surgery to speed recovery and reduce the risks of the contracture returning. Techniques may include:

Splints worn at night for a few months to straighten the finger
Sometimes, a splint worn during the day is needed as well
Special hand exercises to encourage flexibility
Gentle massage with moisturising handcream.

Where to get help

Your doctor.

Things to remember

Dupuytren's contracture is a thickening and shortening of tissue in the palm, resulting in clawed fingers as they are pulled towards the hand.
The cause is unknown, but risk factors include advancing age, Scandinavian and Celtic ancestry, and certain conditions such as epilepsy, alcoholism and diabetes.
Treatment options include injections of corticosteroids into the palm and surgery.

Related topics:

Carpal tunnel syndrome

You might also be interested in:
Carpal tunnel syndrome.

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This page has been produced in consultation with, and approved by:

North East Valley Division of General Practice

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