Adult
Dupuytren’s contracture
Palm · contracture
What it is
The fascia is a fibrous layer lying just under the skin of the palm. In Dupuytren’s disease this fascia thickens and shortens, forming nodules and then cords that gradually pull the fingers toward the palm.
It is worth understanding that this is not a tendon problem: the tendons are normal and move underneath the cord. The disease has a strong hereditary component; it is more common in men, in people of northern European descent, and with age. There are associations with diabetes, smoking and alcohol.
Symptoms
A firm lump appears in the palm, often painless, sometimes with dimpling of the skin. A cord becomes palpable, then visible when the finger is straightened.
The finger then stops straightening fully — the ring and little fingers first. The difficulties are concrete: laying the hand flat, slipping it into a pocket, putting on a glove, washing the face, shaking hands.
Non-operative treatment
An isolated nodule, with no contracture, needs no treatment — only monitoring. This is worth saying, because worry sometimes prompts treatment too early.
Splints do not reverse an established contracture. Two less invasive options exist for suitable cords: needle fasciotomy, which divides the cord through the skin, and collagenase injection. Both allow a fast recovery, at the cost of a higher recurrence rate than open surgery.
Surgical treatment
Fasciectomy means removing the diseased cord through a zigzag incision. The usual threshold is easy to check yourself: when the hand can no longer be laid flat on a table, or when the middle joint of the finger starts to contract, it is time to discuss it.
In aggressive or recurrent disease the skin itself is involved, and a skin graft may be needed to prevent the contracture returning.
Recovery expectations
A dressing and a splint are applied, and therapy starts early. The night splint is worn for several months.
Straightening the joint at the base of the finger is reliable. Straightening the middle joint is less so, particularly if the contracture has been present a long time — which is the reason not to leave it too late. Finally, Dupuytren’s is a condition rather than a one-off event: recurrence over the years is expected in a proportion of patients, and it does not mean the surgery failed.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.