A small, firm lump in the palm is how most cases of Dupuytren's contracture begin. Months or years later, a finger may start to curl toward the hand and refuse to open all the way. The condition is common, slow and usually painless, which is partly why people put off getting it looked at. Below, we cover what is happening under the skin, how the condition behaves, and what treatment can and cannot do.
Quick Answer
Dupuytren's contracture occurs when the layer of tissue under the palm skin, called the palmar fascia, thickens and forms tight cords that pull the fingers into a bend. The ring and little fingers are affected most often. Nothing available today stops the tissue from having this tendency, so treatment is about keeping the hand useful. Early lumps are usually just watched. A finger that no longer lies flat, or that gets in the way of everyday tasks, can be treated with a needle procedure, an enzyme injection where it is available, or surgery. A hand surgeon can examine the hand and recommend what fits.
What is Dupuytren's contracture?
Under the skin of your palm lies a thin, tough sheet of connective tissue called the palmar fascia. Its job is to anchor the skin so you can grip without the skin sliding about. In Dupuytren's contracture, patches of this sheet thicken and scar. The first signs are small nodules. Some of these later turn into cords that run from the palm into a finger, and as a cord shortens it draws the finger down with it. People often assume a tendon problem or arthritis. Neither is behind this. The tendons that bend your fingers run deeper and are usually healthy. The pull comes from the thickened tissue lying above them.
What does it look and feel like?
Typically you notice a firm lump in the palm, often near the base of the ring finger. It can feel like a pebble under the skin. A little tenderness in the early stage is common, though plenty of people feel nothing at all. Over time the skin may pucker or dimple, and a hard band appears running toward a finger. Eventually the finger sits partly bent, and pressing it flat with your other hand does not fully straighten it.
Which fingers are affected?
The ring and little fingers take the brunt. The middle finger is sometimes involved. The thumb and index finger are less often affected. Both hands can be involved, and one is usually worse.
Does it hurt?
Mostly it does not. The usual complaint is that the finger will not open, not that it aches. A painful, swollen, clicking or locking finger points elsewhere, to trigger finger or arthritis for example, and should be examined.
What is the table-top test?
Put your palm flat on a table. If your palm and all your fingers cannot touch the surface together, the tissue has tightened enough to be worth noting. Surgeons use this as a rough check, and it cannot replace an examination.
Why does it happen?
The honest answer is that nobody knows the full story. Cells in the palmar fascia begin laying down extra collagen and contracting, and genes seem to decide who this happens to.
Who is more likely to get it?
Age is the biggest factor, and most people notice it in middle age or later. It is more common in men and tends to run in families. It is classically linked to Northern European ancestry, but it occurs in people everywhere, including in India. Diabetes, smoking and heavy alcohol use are also associated with it, as are certain neurological conditions. None of these is a verdict. Plenty of people with several risk factors never develop it, and others with none do.
Did my job or an old injury cause it?
Patients often ask this. Heavy manual work, vibrating tools and hand injuries have all been blamed over the years, but the evidence is mixed and the condition is not generally thought to come from how you use your hands. It isn't contagious, and nothing you did caused it.
Does it link to problems elsewhere?
Some people also develop firm pads over the knuckles of their fingers, known as Garrod's pads. Similar thickening can appear in the soles of the feet (Ledderhose disease) or in the penis (Peyronie's disease). They share some biology with Dupuytren's. Having one does not mean you will get the others, but tell your doctor if you notice them.
How is it diagnosed?
A hand surgeon can usually make the diagnosis by looking at the hand and feeling it. Scans and blood tests are rarely needed. The surgeon checks each finger's position, feels for nodules and cords, and tests sensation and blood supply. What matters most is how much each joint is bent. The knuckle where the finger meets the palm is the metacarpophalangeal (MCP) joint. The middle joint of the finger is the proximal interphalangeal (PIP) joint. How far each one is bent steers the treatment choice. An X-ray may be arranged if arthritis, an old fracture or a tendon problem is a possibility.
Will it keep getting worse?
Sometimes, but there is no fixed script. One person's small nodule sits unchanged for a decade. Another person's finger tightens noticeably within months. Starting young, a family history, involvement of both hands, and involvement of the little finger or thumb have been linked with more active disease, though none of them settles the question for an individual. That unpredictability is the reason early lumps are often left alone and reviewed from time to time.
When does it need treatment?
If you have a lump or a slight bend and nothing you do is affected, watching is a perfectly reasonable plan. Many hand surgeons begin to think about treatment once the finger will not lie flat and starts to cause trouble with ordinary things, such as putting on gloves, washing your face, shaking hands or sliding your hand into a pocket. The amount of bend at the MCP and PIP joints counts too. The PIP joint gets extra attention. A middle joint that stays bent for a long time can stiffen, and it may not open fully even after the cord has been released. That is why bending at this joint is often looked at sooner.
Are there treatments that don't involve an operation?
No cream, tablet, exercise or splint has been shown to dissolve the cords or reliably halt the disease. Massage and stretching can keep the rest of the hand supple, but they won't loosen a cord. Treat any product that promises a cure with suspicion. Two minimally invasive procedures may suit some patients.
Needle fasciotomy
In needle fasciotomy, also called needle aponeurotomy, the surgeon uses a fine needle through a tiny skin opening to divide the cord, usually under local anaesthetic. With the cord weakened, the finger is then straightened. Since there is no big incision, recovery can be quick. It works best on clearly defined cords in the palm that are bending the MCP joint. Contracture at the PIP joint, or a cord lying close to a nerve, makes it a poorer fit. The cord can return, and risks include skin splits and injury to a nerve or tendon.
Collagenase injection
Collagenase is an enzyme that can be injected into a cord to weaken it. A day or two later, the finger is gently manipulated straight. Availability of this treatment has shifted over the years and differs by country, so ask whether it is an option for you. It is not my first choice of treatment Swelling, bruising, pain and skin tears are the common effects. Tendon or nerve problems are rare. The disease can still recur.
What about radiotherapy?
Low-dose radiotherapy has been tried for very early disease in a few centres. The evidence is limited and it is not routine in most places. If you are offered anything outside the usual options, it is fair to ask what evidence backs it and what it can realistically do. Again it is not a choice I offer as there are safer options.
What does surgery involve?
Surgery is the usual route when contracture is advanced, when the PIP joint is involved, when cords are spread across the hand, or when a needle or injection does not suit. The goal is to release or remove the diseased tissue so the finger straightens as far as can safely be managed, while sparing the nerves, blood vessels and tendons that run right alongside it.
Which operations are used?
The best-known operation is a limited, or selective, fasciectomy. The surgeon works through an incision in the palm and finger, removes the diseased tissue and leaves healthy tissue behind. If the skin itself is affected, as it can be in severe or returning disease, a dermofasciectomy may be chosen. Skin is removed along with the diseased tissue and the area is covered with a skin graft, which brings the surgery into the territory of reconstructive hand surgery. As a hand surgeon, I combine excising the diseased cord with multiple Z plasties of the affected skin which provide adequate length of skin.[Z-plasty: the skin is cut in a zigzag and rearranged, so the scar lengthens as the finger straightens.] In some patients the cord is simply divided through a small cut without taking out much tissue. For very stiff or repeatedly recurrent fingers, work on the joint is sometimes discussed. The right choice depends on how many fingers are involved, which joints are bent, the quality of the skin, whether this is a first or repeat operation, and your own health and priorities.
What anaesthesia is used?
Some operations are done with the whole arm numbed (regional anaesthesia), with or without sedation. Others need general anaesthesia. The surgeon and anaesthetist decide based on the operation and your general health. Many hand operations are day-case surgery, depending on the person and the hospital.
What can go wrong?
Dupuytren's surgery is demanding because the diseased tissue often wraps around the nerves and blood vessels of the finger. Possible problems include a numb patch on a finger from nerve injury, damage to a blood vessel that can in uncommon cases affect circulation to the finger, wound healing trouble or infection, and stiffness, swelling or long-lasting pain, including a condition called complex regional pain syndrome. A tender scar is common. Some fingers do not straighten completely, especially at the PIP joint. And the disease can come back in the same finger or appear elsewhere in the hand. No outcome can usually be promised. A surgeon should go through these risks with you in the context of your own hand. However, post surgery rehabilitation and dynamic splints are extremely beneficial in optimizing good results.
What is recovery like?
After a needle procedure, most people are back to light use of the hand quickly. After an operation, the wound needs time to heal and the hand needs protecting for a while. A splint is often used after surgery, sometimes at night, to help keep the finger straight as the tissues settle. Hand therapy may be advised to restore movement, bring down swelling and soften the scar. Instructions differ between patients, so follow what your own surgeon and hand therapist say rather than a generic timetable. Movement and feeling improve over weeks to months, By and large, most movement returns in about three weeks, and rehabilitation may continue for about 3 months or more to optimize more movements.
Can it come back?
Yes, and it is better to hear that before treatment than after. Every treatment above can release or remove the cords that are causing the bend. None of them changes the tissue's tendency to thicken again. New nodules and cords may form in the same finger or elsewhere in the hand. Reported recurrence rates vary between treatments and between studies, so ask your surgeon what to expect in your hand. Some people need a second treatment at some stage, which is why follow-up is part of long-term care. In my experience, recurrence is uncommon in Indian patients, though it cannot be ruled out.
Does waiting cause permanent stiffness?
Waiting is not always harmful, which is why watching is such a common plan. The worry centres on the PIP joint. If that middle joint stays bent for a long time it can stiffen, and it may not open fully even after the cord is treated. When a finger is curling steadily, an assessment helps you and your surgeon settle on timing.
When should I see a hand surgeon?
Book an appointment if you notice a lump or band in the palm that is growing or spreading, a finger that will not lie flat on a table, or trouble with everyday tasks like wearing gloves, washing your face or gripping a steering wheel. Also go if the bend seems to be increasing month by month, if the condition runs in your family and you have spotted early changes, or if you are unsure whether you are dealing with Dupuytren's, trigger finger, arthritis or something else. Dupuytren's contracture is not normally an emergency. Seek urgent medical attention for a sudden painful, red, hot or swollen hand, a cold, pale or blue finger, or a sudden loss of movement or feeling. Those signs point to a different problem.
Questions worth asking your surgeon
Which of my joints are bent, and by how much? Is it reasonable to watch this for now? Which treatments suit my hand, and why? What are the risks and the chance of recurrence with each? Will I need a splint or hand therapy? How long might I be off work or driving? What follow-up will I need?
Key Takeaways
Dupuytren's contracture comes from thickened tissue in the palm that tightens and pulls fingers into a bend. The tendons and joints are not the source. It often progresses slowly, and many people are simply monitored until it begins to affect daily tasks. No cream, exercise or splint has been shown to remove the cords. Needle procedures, enzyme injection where available, and surgery are the main treatments, and the choice depends on the finger, the joint and how far the disease has spread. My preference is surgical excision of the cord and combine with Z plasty of the skin. The disease can return after any treatment, so follow-up matters and combine with adequate period of dynamic splinting.
Final Thoughts
A finger that is slowly curling can be unsettling, especially once it begins to interfere with work or hobbies. The condition is well recognised and has established treatments, and many people do well when the plan fits their hand. Timing varies from person to person, and a clear assessment is where it starts. Patients seeking a hand surgery consultation in Pune can contact Jindal Hand Surgery through the official website.
