Dupuytren's Contracture

Dupuytren’s contracture (sometimes called Dupuytren’s disease) affects a layer of tissue called the fascia, which lies under the skin of the palm. In this condition the fascia slowly thickens and tightens, forming firm lumps and cords. As the cords tighten, they can pull one or more fingers inward so they no longer straighten fully.

It usually develops slowly, often over years. It most commonly affects the ring finger and little finger, and both hands may be involved, though often not to the same degree. It is usually painless, although some people notice tenderness in the early stages.

The exact cause is not known. It is more common as people get older, is more common in men, and can run in families. It has also been associated with diabetes, epilepsy, smoking and drinking a lot of alcohol. It is not caused by anything a person has done wrong.

The first changes are usually in the palm, and may include:

• A small, firm lump or nodule in the palm, often near the base of a finger.
• Dimpling, puckering or a pitted appearance of the skin over the lump.
• Thickened skin that feels tougher than the surrounding palm.
• Ridges or firm cords running from the palm towards a finger.
• Occasional tenderness or itching in the early stages, which often settles.

A useful check is the “table-top test”: place your hand flat, palm down, on a table. If your hand will not lie completely flat, it is worth mentioning this to a GP.

Over months or years the cords can shorten and tighten. This pulls the affected finger, or fingers, in towards the palm — a bend that cannot be straightened out, known as a contracture.

Progress varies a great deal between people. For some, the condition stays mild for many years and never needs treatment. For others, the bend increases and begins to interfere with the use of the hand. It is not possible to predict for any one person how quickly it will change.

Symptoms do not usually go away on their own, and the finger will not straighten with stretching or exercises alone.

Because it is generally painless, it is often the practical effects that people notice most:

• Difficulty laying the hand flat on a table or a bed.
• Trouble putting a hand into a pocket or a glove.
• Awkwardness washing the face, or catching the finger when getting dressed.
• Difficulty gripping a steering wheel, tools, a walking frame or handrails.
• Problems holding cutlery, a cup, a comb or a razor.
• Difficulty shaking hands, typing or using a phone.
• Catching the bent finger on clothing or bedding.

An occupational therapist can often suggest practical aids and adaptations, and a GP can advise on referral. Our GP Services page explains how appointments and referrals usually work.

Not everyone needs treatment. If the condition is mild and the hand still works well, a GP or hand specialist may simply monitor it. Treatment is usually considered when the bend in the finger is affecting daily activities.

NHS England publishes a shared decision-making guide so that patients and clinicians can weigh up the options together, including the benefits, risks and likely recovery of each approach.

Watchful waiting

If the changes are mild, the usual advice is to keep an eye on the hand and return if the finger bends further or the hand becomes harder to use. Treating too early does not stop the condition returning.

Needle fasciotomy (needle aponeurotomy)

A fine needle is used, under local anaesthetic, to cut and divide the tight cord through the skin, allowing the finger to be straightened. It is a quick procedure, usually done as an outpatient, with no surgical wound to heal and a fast return to everyday activities.

It is generally suited to a well-defined cord in the palm. The condition is more likely to come back sooner after needle fasciotomy than after open surgery, and it may not be suitable for every type of contracture. There is a small risk of injury to nerves, blood vessels, tendons or the skin.

Surgery (fasciectomy)

Surgery involves an incision in the palm or finger to remove the thickened tissue. It is usually done under local, regional or general anaesthetic as a day case. In more severe or recurrent cases, the surgeon may also remove the overlying skin and use a skin graft (dermofasciectomy).

Surgery generally gives a longer-lasting correction than needle treatment, but it involves a wound, a longer recovery and hand therapy afterwards. Possible risks include infection, scarring, stiffness, numbness, nerve or blood vessel injury, and rarely a persistent painful, stiff hand.

A hand surgeon will explain which options are appropriate for your hand, and what each would involve. There is no obligation to decide at the first appointment.

After needle fasciotomy, most people can use the hand for light activities within a few days. After surgery, recovery takes longer — the wound needs time to heal and hand exercises, often guided by a hand therapist, are important to regain movement.

Recovery commonly involves:

• Keeping the hand raised at first to reduce swelling.
• Wound care and dressing changes as advised by the hospital team.
• Exercises taught by a hand therapist or physiotherapist.
• Sometimes a splint, especially at night, for a period after surgery.
• Gradually building back to driving, work and hobbies as advised by the team.

Recovery times vary from person to person. Some stiffness, tenderness or altered sensation may take several months to settle, and full hand function is not guaranteed.

Dupuytren’s contracture can come back. No treatment cures the underlying condition — treatment corrects the bend that has already developed. The tissue can thicken again in the same finger, or the condition can appear in another finger or the other hand. Recurrence tends to happen sooner after needle fasciotomy than after surgery, and is more likely in people who developed the condition at a younger age or who have a strong family history. If it returns, further treatment can usually be discussed.

• NHS — Dupuytren’s contracture
• NHS England — Dupuytren’s contracture decision-making support tool
• NHS inform (Scotland) — Dupuytren’s contracture
• nidirect (Northern Ireland) — Dupuytren’s contracture
• NHS — Find a GP
• Versus Arthritis — Dupuytren’s contracture
• NICE Clinical Knowledge Summaries — Dupuytren’s disease: Prevalence
• British Society for Surgery of the Hand — Dupuytren’s disease

Important notice: This page provides general information only. It is not a diagnosis, medical advice, or a substitute for assessment and treatment by a qualified healthcare professional. Always speak to a GP or another qualified health provider about your own symptoms and circumstances. In an emergency, call 999.