This article is about Dupuytren's Disease of the Hand and Dupuytren's Contracture. It is divided up into sections which look at the condition and its symptoms, the causes and the treatment options. The information is also presented in video format below.
What is Dupuytren's Disease ?
Dupuytren's Disease is a type of fibrous dysplasia. Fibrous refers to the type of tissue affected, in this case its something called the Palmar Fascia. We’ll get into the details of what that is later. Dysplasia comes from the Ancient Greek with 'dys' meaning ‘abnormal' and ‘plasia’ meaning 'growth'. So Dupuytren's disease is an Abnormal Growth of the Palmar Fascia.
The tissues that make up the palm occur in layers. Deepest are the bones of the hand, then above that we have the working parts such as the tendons, muscles and nerves. Then we then have the palmar fascia and finally the layers of fat and skin.
In normal hands the palmar fascia is a thin but very strong sheet of fibrous tissue that binds down the working parts of the hand and helps create the typical bowl shape of the palm. We don’t have this layer on the back of hand which is why the skin is so freely mobile here as opposed to palm, which is firmer and with more structure.
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| The Palmar Fascia shapes the Palm |
The symptoms of Dupuytren's disease are a thickening of the palmar fascia. This can occur anywhere in the palm and the base of the fingers but its much more common over the little finger side, usually near to the base of the little and ring fingers.
Dupuytren's tissue can feel like small firm nodules which can eventually become visible. Sometimes it cause a pinch in the skin which we call a Dupuytren's Pit. Most commonly though it occurs in a Dupuytren's Band or Cord which often gets mistaken for a tight tendon but is in fact nothing to do with the tendons which are usually safe and sound underneath these bands in the deep layers of the palm.
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| A Dupuytren's Nodule |
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| A Dupuytren's Pit |
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| A Dupuytren's Band |
Sometimes the condition will stop with some nodules or bands that don’t cause any problems, but sometimes the Dupuytren's Tissue will start to shrink along its length causing the fingers to bend. This usually occurs very slowly, often over years, but eventually it can lead to bent fingers. At this stage it is referred to as a Dupuytren's Contracture. The ring finger, the little finger and the middle finger are most commonly affected. The condition can be painful in the early stages but any pain usually settles down over a few months, and in most people it is completely painless.
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| A Dupytren's Contracture of the Ring Finger |
In summary, everyone with Dupuytren's Disease will have nodules, bands or just generally thickened palmar tissue. Some people will then go on to develop the bent fingers associated with a Dupuytren's Contracture.
What is the Cause ?
Dupuyten's disease is thought to be an inherited condition although the exact gene is yet to be found. Some researchers think it was derived from the vikings, as it’s much more common in countries where the vikings travelled to, and is especially common in the Scandinavian countries. As a result, it has an alternative name of Viking Hand.
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| Viking Hand |
For a genetic condition its behaviour is quite unusual. Most inherited conditions show their symptoms in early life, often at birth, but not so with Dupuytren's. The symptoms don’t tend to occur until much later in life, often over the age of 60.
So if you have Dupuytren's disease then it is thought that you have inherited it through one or both parents. This might be news to you but there are a few reasons why this might be so. Firstly your parent might have hidden it. Keeping a closed fist will disguise the condition from onlookers, and people of an older generation may have chosen not to tell anyone. Or they might have had the condition but thought it was something else. So called ‘segs’ or callouses in the palm are often the early signs of Dupuyten's Disease. The other scenario is that your parent might have passed away before the condition would have shown its symptoms.
As a rule, the later in life it presents, the less aggressive it tends to be. So if you first notice symptoms in your 80’s then chances are it will never progress beyond some small lumps in the palm. However, if it presents in your 30’s then it’s much more likely to cause bent fingers and need treatment.
Treatment of Dupuytren's Disease without Contracture (Straight Fingers)
If you have the lumps in the palm or fingers but your fingers are straight, then you usually don’t need any treatment. Cutting the lumps out surgically at this stage will be pointless, because they are part of your genetics and will just grow back. About the only thing you can do at this early stage is to keep the palmar skin healthy with regular use of hand cream and do some basic daily finger stretches like the prayer stretch shown below.
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| The Prayer Stretch |
The exception to this rule is if you are very young (under 40) or if the condition is persistently painful.
If persistent pain is a problem for you then a cortisone injection into the painful tissue can be helpful. It will not dissolve the nodules or bands, or effect their appearance in any way but it can help with pain.
If you are much younger then normal when the symptoms first develop (under 40) then is it likely that the condition be be more aggressive and lead to finger contractures which require multiple surgeries. In this case there is the option of prophylactic treatment. Using targeted radiotherapy (ionising radiation treatment) can slow the progression of the disease and potentially prevent or slow down the development of contractures. Once the fingers have become bent though, this type of treatment is less effective and other treatments aimed at straightening the fingers are required. If you want to know more information about Radiotherapy for Dupuytrens's Disease then see the video below.
Treatment of Dupuytren's Contacture (Bent Fingers)
Treatment usually only becomes necessary when the fingers start bending do the degree where they are causing problems with hand function, usually when you can no longer get your hand in your pocket or you're poking your finger in your eye when washing your face. This normally occurs when the fingers are bent to about 20 degrees. A good test is the try to get your hand flat on a table. If you can’t do this, and the gap is big enough to easily slide a pencil under, then it might be time to see a hand surgeon.
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| The Pencil Test |
The treatment options depend on where the finger bend occurs. If it occurs at the knuckle joint then there is the option of needle fascioteomy. This is a procedure where the surgeon will numb your hand and then use the tip of a needle like a scalpel to carefully cut through the dupuytrens band. It’s done as a simple out-patient procedure and can be very effective if your finger bend isn’t too severe.
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| Needle Fasciotomy |
Another option is a collagenase injection. This is a drug that is injected into the tight Dupuyren's tissue. It targets the specific collagen type affected by Dupuytren's Disease and dissolves it. Again, it’s done as a simple out patient procedure usually over a few days. The first day, you have the injection which breaks down the band over 24-48 hours. You go back in a day or 2 and the surgeon will stretch the finger out, hopefully until its straight again. You then have to wear a splint for a few weeks to keep the finger straight. It works best for bends at either the knuckle joint or the finger joint but usually not both together. At the time this article was written in 2025, due to supply issues, collagenase injections are currently not available in Europe or Australia.
If you have a bend in both of these joints then usually, the only option is surgery. He procedure is called a palmer fasciectomy and it can be done under local or general anaesthesia depending on the amount of finger bend and the numbers of fingers involved. The surgeon carefully cuts though the bands which are causing the finger to be bent. This will leave a scar and you will usually need to wear a splint for a few months afterwards in order to get the best result.
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| Palmer Fasciectomy - picture from teachmesurgery.com |
Because this is a genetic condition, the fingers can become bent again after any of these procedures, but hopefully this won’t be for many years. If you are younger patient and the conditions is very aggressive then the surgeon has the option of performing a dermo- fasciectomy. This is where the surgeon performs the normal fasciectomy operation but then take a small skin graft, usually from a hairless region of the forearm, and places it over the palm. This seems to slow the recurrence rate down considerably but it is a more involved procedure and will leave you with an area of skin over the palm that looks very different.
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| The scar from a Dermo-fasciectomy procedure |
With all of the procedures, its best not to leave it too late to see a hand surgeon. This picture below shows the ideal time as the result is likely to be fairly good.
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| A Mild Dupuytren's Contracture of Ring and Little Fingers |
However, if you leave it to get to stage below then the surgeon is going to have a much more difficult job and it’s unlikely they will be able to get the finger fully straight.
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| Severe Dupuytren's Contracture |
Key Points
1) Dupuytren's Disease is a harmless inherited condition.
2) The condition can cause lumps and bumps in the palm and fingers.
3) The condition only needs treatment if :-
a) You are under 40 when symptoms first occur.
b) You have persistent pain (this is rare).
c) You have bent fingers (Dupuytren's Contracture) which are causing functional problems.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.