Loading...
Loading...
Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Medical Information & Treatment Guide
Dupuytren's contracture (ICD-10: M72.0) is a progressive hand condition where the connective tissue under the skin of the palm thickens and tightens, eventually causing one or more fingers to curl toward the palm and limiting hand function.
Prevalence
5.0%
Common Drug Classes
Clinical information guide
Dupuytren's contracture, also known as Dupuytren's disease, is a benign (non-cancerous) fibroproliferative disorder of the palmar fascia (the layer of connective tissue between the skin and the tendons in the palm). The pathophysiology involves the abnormal proliferation of fibroblasts (cells that produce collagen) which transform into myofibroblasts. These cells produce excessive amounts of Type III collagen, leading to the formation of thickened nodules and cords. Over time, these cords contract, pulling the affected fingers—most commonly the ring and small fingers—into a permanent flexed position toward the palm. This process is not an inflammatory condition but rather a disorder of the wound-healing mechanism within the hand's connective tissue.
Dupuytren's contracture is significantly more prevalent in individuals of Northern European descent, often colloquially referred to as 'Viking disease.' According to research published in the Journal of Hand Surgery (Lanting et al., 2014), the global prevalence varies widely, affecting approximately 3% to 6% of the general population in Western countries. The National Institutes of Health (NIH, 2023) notes that the condition is most common in men over the age of 50, with the incidence increasing significantly with age. While it occurs worldwide, it is notably less common in populations of Asian and African descent.
Clinical severity is typically classified using the Tubiana Staging System, which measures the total extension deficit (the inability to straighten the finger) across all affected joints:
Additionally, the disease can be categorized as 'Typical' (limited to the hands) or 'Diathesis' (aggressive form). Dupuytren's diathesis is characterized by early onset, bilateral involvement, and associated fibromatosis in other areas, such as the feet (Ledderhose disease) or the penis (Peyronie's disease).
The condition can profoundly impact quality of life as it progresses. Simple tasks like washing one's face, putting on gloves, shaking hands, or reaching into a pocket become difficult or impossible. In professional settings, it can impair manual dexterity required for typing, operating machinery, or performing surgery. Relationships may also be affected by the inability to hold hands comfortably or the psychological distress associated with a visible deformity.
Detailed information about Dupuytren's Contracture
The first indicator of Dupuytren's contracture is often the appearance of a small, firm lump (nodule) in the palm of the hand, usually near the base of the ring or small finger. This nodule may initially feel tender or sensitive to pressure, but this discomfort typically resolves over time. Patients may also notice 'pitting'—small indentations in the skin of the palm caused by the tethering of the skin to the underlying fascia.
As the condition progresses, the following symptoms are typically observed:
Answers based on medical literature
Currently, there is no permanent cure for Dupuytren's contracture because it is a genetic condition that affects the way your body produces connective tissue. While various treatments like surgery, enzyme injections, or needle aponeurotomy can effectively straighten the fingers and restore function, they do not address the underlying genetic cause. This means that the condition can recur in the same finger or develop in other fingers later in life. Management focuses on maintaining hand function and intervening when the deformity interferes with daily activities. Ongoing research into the genetic pathways of the disease may one day lead to more definitive therapies.
No, surgery is not always necessary and is typically reserved for more advanced cases where the finger cannot be straightened. Many patients with mild nodules or pits can be monitored for years without needing any intervention if their hand function remains intact. Minimally invasive options, such as enzyme injections (Collagenase Clostridium Histolyticum) or needle aponeurotomy, are often preferred as first-line treatments for many patients. These procedures have shorter recovery times than traditional surgery and can be performed in an office setting. Your doctor will recommend the best approach based on the severity of your contracture and your overall health.
References used for this content
This page is for informational purposes only and does not replace medical advice. For treatment of Dupuytren's Contracture, consult with a qualified healthcare professional.
In some cases, patients may experience:
In the proliferative stage, nodules are the dominant feature. In the involutional stage, the nodules begin to align into cords. In the residual stage, the nodules disappear, leaving only thick, non-cellular cords that cause the permanent contracture.
> Important: While Dupuytren's is rarely an emergency, seek immediate medical attention if you experience:
> - Sudden, severe pain in the hand.
> - Signs of infection (redness, warmth, pus) after a medical procedure or injection.
> - Total loss of sensation in the fingers.
> - Rapid swelling that restricts blood flow (compartment syndrome symptoms).
In men, symptoms typically appear earlier (often in the 50s) and tend to progress more rapidly and severely. In women, the onset is often later (60s or 70s), and the disease may follow a more indolent (slow-moving) course. However, women are more likely to report localized pain or discomfort during the early nodular phase compared to men.
The exact cause of Dupuytren's contracture remains partially unknown, but it is widely recognized as a genetic disorder with an autosomal dominant inheritance pattern with variable penetrance. Research published in the New England Journal of Medicine (Dolmans et al., 2011) identified nine genetic loci associated with the disease, many of which are involved in the Wnt signaling pathway, which regulates cell growth and tissue repair. This genetic predisposition leads to an overactive wound-healing response where fibroblasts are inappropriately triggered to become myofibroblasts.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS, 2023), the 'classic' patient profile is a male over 50 of Northern European descent with a history of tobacco use or diabetes. Those with 'Dupuytren's Diathesis' (early onset before age 40) are at the highest risk for aggressive progression and recurrence after treatment.
There are currently no proven methods to prevent Dupuytren's contracture in those with a genetic predisposition. However, managing modifiable risk factors—such as quitting smoking, limiting alcohol, and maintaining optimal blood sugar levels—may slow the progression. Early screening is recommended for individuals with a strong family history, particularly if they notice palmar nodules.
The diagnosis of Dupuytren's contracture is primarily clinical, meaning it is based on a physical examination and medical history. Most patients are diagnosed by a primary care physician or an orthopedic hand specialist without the need for extensive laboratory testing.
During the exam, the healthcare provider will:
While usually unnecessary for diagnosis, some tests may be used to rule out other conditions:
Diagnosis is confirmed when there is evidence of palmar fascial thickening (nodules or cords) associated with a fixed flexion deformity that cannot be passively corrected. Clinicians often use the Tubiana staging to document the baseline severity for future monitoring.
Several conditions can mimic Dupuytren's, including:
The primary goals of treatment are to restore hand function, reduce the degree of finger contracture, and improve the patient's ability to perform daily activities. It is important to note that treatment does not 'cure' the underlying disease process, and recurrence is common.
For early-stage disease (Stage 0 or N) where hand function is not impaired, the standard approach is observation or 'watchful waiting.' Clinical guidelines from the American Academy of Orthopaedic Surgeons suggest intervention when the contracture reaches 30 degrees at the MCP joint or any degree of contracture at the PIP joint that interferes with function.
Needle Aponeurotomy (NA) is a minimally invasive procedure where a doctor uses a needle to percutaneously weaken the cord. It is often preferred for patients who are not candidates for surgery or who have MCP joint involvement.
Monitoring typically involves follow-up every 6 to 12 months to assess for progression. Post-surgical recovery can take 6 to 12 weeks, including physical therapy.
> Important: Talk to your healthcare provider about which approach is right for you.
While no specific diet can cure Dupuytren's, managing metabolic health is crucial. Research in Diabetes Care suggests that maintaining stable glycemic levels can reduce the risk of connective tissue complications. A diet rich in antioxidants (Vitamin C, E) and anti-inflammatory omega-3 fatty acids may support overall tissue health, though specific evidence for Dupuytren's is limited.
Passive stretching of the fingers and palm can help maintain flexibility in the early stages. However, aggressive stretching of a mature cord is generally ineffective and may cause micro-trauma. Post-treatment, specific 'tendon gliding' exercises are vital to prevent scar tissue from binding the tendons.
If a patient has undergone a procedure, wearing a night splint as prescribed is critical for preventing the finger from curling back during sleep. Ensuring the hand is in a neutral, relaxed position can reduce morning stiffness.
Living with a progressive deformity can be stressful. Techniques such as mindfulness, progressive muscle relaxation, and cognitive-behavioral strategies can help patients cope with the functional limitations and the potential for multiple surgeries.
Caregivers should assist with tasks requiring fine motor skills during recovery. Encouraging compliance with hand therapy exercises and monitoring for signs of post-surgical infection or nerve changes is essential.
The prognosis for Dupuytren's contracture is generally good regarding hand function, provided treatment is sought before the contracture becomes too severe. However, the disease is chronic and progressive. According to a study in the Journal of Hand Surgery (2017), recurrence rates after needle aponeurotomy are approximately 50% at 3-5 years, while recurrence after surgical fasciectomy is lower, around 20-30%.
If left untreated, the contracture can become permanent as the joint capsule itself tightens. Complications from treatment include:
Long-term management involves regular self-monitoring using the 'Tabletop Test.' Patients should maintain a relationship with a hand specialist, as early intervention for recurrence is often more successful than waiting for a total contracture.
Adaptive tools, such as built-up handles for utensils, key turners, and large-grip pens, can help maintain independence. Joining support groups can provide emotional relief and practical advice from others navigating the condition.
Contact your healthcare provider if you notice a new nodule, if a previously treated finger begins to curl again, or if you experience a sudden decrease in hand sensation or strength.
Yes, Dupuytren's contracture has a very strong genetic component and is often passed down through families in an autosomal dominant pattern. If one of your parents has the condition, you have a significantly higher risk of developing it yourself. Research has identified specific genes, particularly those involved in the Wnt signaling pathway, that predispose individuals to this fascial thickening. It is most common in people of Northern European or Scandinavian descent, which is why it is sometimes called 'Viking disease.' Understanding your family history can help you identify early signs and seek treatment sooner.
While general hand exercises are excellent for maintaining joint mobility, they cannot 'fix' or reverse the thickened collagen cords once they have formed. Because the contracture is caused by a biological change in the fascia rather than simple muscle tightness, stretching alone will not straighten the finger. In fact, aggressive stretching of a mature cord can sometimes lead to micro-tears and more inflammation, potentially worsening the condition. However, hand therapy and specific exercises are absolutely critical after a medical procedure to ensure the finger remains straight during the healing process. Always consult a hand therapist for a guided exercise plan.
The earliest sign is usually the appearance of a small, firm, painless lump or nodule in the palm of the hand, often near the base of the ring or pinky finger. You might also notice small indentations or 'pits' in the skin of the palm, which occur when the underlying fascia begins to pull on the skin. Some people report a slight aching or itching sensation in the palm during this initial phase, though it is rarely severely painful. Another early indicator is the 'Tabletop Test,' where you find you can no longer place your hand completely flat on a hard surface. Recognizing these signs early allows for better monitoring and more treatment options.
For most people, Dupuytren's contracture is not a painful condition, though the initial nodules can be tender or sensitive to pressure when they first appear. As the disease progresses into the cord and contracture stages, the discomfort usually disappears, leaving only the physical deformity. However, the inability to straighten the fingers can lead to secondary pain, such as strain in other parts of the hand or difficulty performing tasks. Some patients may also experience 'tenosynovitis' or inflammation of the nearby tendons, which can cause discomfort. If you experience sudden or severe pain, it may indicate a different condition or a complication.
Yes, both smoking and excessive alcohol consumption have been clinically linked to an increased risk and faster progression of Dupuytren's contracture. Smoking causes narrowing of the small blood vessels in the hand (microvascular changes), which may trigger the abnormal fibroblast activity that leads to fascial thickening. Alcohol consumption is also a known risk factor, although the biological reason for this link is less clearly understood. Quitting smoking and moderating alcohol intake are two of the most effective lifestyle changes you can make to potentially slow the disease. These changes also improve your body's ability to heal if you eventually require surgery.
The rate of progression for Dupuytren's contracture varies significantly from person to person and is highly unpredictable. In some individuals, the condition may stay in the nodular stage for decades without ever causing the fingers to curl. In others, particularly those with a strong family history or early-onset disease, the contracture can progress from a small lump to a bent finger within a few months. Generally, the younger a person is when symptoms first appear, the more aggressive the disease tends to be. Regular check-ups with a hand specialist are the best way to track the speed of your specific case.
Yes, the same biological process that causes Dupuytren's in the hands can occasionally affect other areas of the body containing similar connective tissue. When it occurs in the arches of the feet, it is known as Ledderhose disease (plantar fibromatosis), which causes firm lumps on the bottom of the foot. It can also be associated with Peyronie's disease, which involves the development of fibrous tissue in the penis. When a patient has involvement in multiple sites, it is referred to as 'Dupuytren's Diathesis.' This form of the disease is typically more aggressive and more likely to return after treatment.
Whether Dupuytren's contracture qualifies as a disability depends on the severity of the contracture and how it impacts your specific job requirements. If the condition affects both hands and prevents you from performing essential tasks like typing, gripping tools, or manual labor, you may be eligible for workplace accommodations or disability benefits. In the United States, the Social Security Administration evaluates hand disorders based on the loss of 'fine and gross movements' in both hands. You will need extensive documentation from your hand specialist regarding your range of motion and functional limitations. Consulting with a vocational expert or disability advocate can help you navigate the application process.
Prednisone
Prednisone
Prednisone Tablets, Usp, 20 Mg
Prednisone
Prednisone Tablets, Usp, 5 Mg
Prednisone
Prednisone Tablets, Usp, 10 Mg
Prednisone
P- Pack Prednisone 20mg, 7- Day Tapering Dose Pack
Prednisone
Prednisone D/p
Prednisone
Prednisone Delayed Release
Prednisone
Prednisone Intensol
Prednisone
Triamcinolone Acetonide
Triamcinolone Acetonide
Careone Allergy Relief
Triamcinolone Acetonide
Triamcinolone Acetonide Nasal
Triamcinolone Acetonide
Leader Nasal Allergy
Triamcinolone Acetonide
Nasal Allergy
Triamcinolone Acetonide
Kourzeq
Triamcinolone Acetonide
Up And Up Nasal Allergy
Triamcinolone Acetonide
+ 75 more drugs