Dupuytren's Contracture: Causes, Progression, and Treatment

What Is Dupuytren's Contracture?

Dupuytren's contracture is a condition in which the fascia — the layer of connective tissue lying just beneath the skin of the palm — gradually thickens and contracts. Over time, this abnormal tissue forms firm nodules and cord-like bands that tether the skin and pull the fingers toward the palm. The ring and small fingers are most commonly affected, though any digit can be involved.

The condition progresses slowly, often over years, and is not painful in most cases. The primary problem is functional: as the contracture advances, the affected fingers cannot be fully straightened, making everyday tasks like putting on gloves, shaking hands, or placing your hand flat on a surface increasingly difficult.

Dupuytren's contracture is more common than many patients realize. It affects roughly 8 percent of adults globally, with higher rates among those of Northern European descent.

Who Develops It and Why

The exact mechanism that triggers abnormal fascial thickening in Dupuytren's disease is not fully understood, but several risk factors have been established:

Genetics — Family history is the strongest risk factor. Dupuytren's follows an autosomal dominant pattern with variable penetrance, meaning it runs in families but does not affect every generation equally.

Age and sex — The condition becomes more common after age 50 and is significantly more prevalent in men than women. When women develop it, it tends to appear later in life and progress more slowly.

Diabetes — People with diabetes have an elevated risk, likely related to metabolic changes in connective tissue.

Alcohol use and smoking — Both are associated with higher rates of Dupuytren's in epidemiologic studies, though the mechanism is not well characterized.

There is no evidence that specific occupational activities or hand use causes Dupuytren's, despite historical assumptions to the contrary.

How the Disease Progresses

Dupuytren's typically begins with a small, firm nodule in the palm — often near the base of the ring finger. This nodule may feel tender initially but usually becomes painless as it matures. The overlying skin may appear puckered or dimpled.

Over months to years, the nodule develops into a fibrous cord that runs along the tendon toward the finger. As the cord shortens, it draws the finger into flexion. In mild cases, the contracture may remain stable for extended periods. In others, it progresses steadily until the finger is fixed in a significantly bent position.

The rate of progression varies considerably between individuals and cannot be reliably predicted.

Treatment Options

Treatment is generally recommended when the contracture reaches 30 degrees at the finger's primary knuckle (MCP joint) or any degree of contracture at the middle knuckle (PIP joint), because PIP joint contractures respond less well to treatment the longer they are present.

Collagenase clostridium histolyticum (Xiaflex) injection — An enzyme is injected directly into the fibrous cord, which breaks down the collagen and weakens the cord. The following day, the surgeon manipulates the finger to rupture the cord. This is an office-based procedure with minimal downtime, though recurrence rates are higher than with surgery.

Needle aponeurotomy (percutaneous fasciotomy) — A needle is used to puncture and divide the cord repeatedly until it breaks. This is also performed in the office, with rapid recovery, but carries a higher recurrence rate than surgical fasciectomy.

Surgical fasciectomy — The fibrous cord and affected fascia are excised through an incision in the palm and finger. This is the most definitive treatment and has the lowest recurrence rates. Recovery involves a period of splinting and hand therapy.

The right treatment depends on the severity of the contracture, which joints are involved, your overall health, and your preferences. A hand specialist can evaluate your hand and discuss which approach is most appropriate for your situation.

If you've noticed tightening in your palm or difficulty straightening a finger, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).