Dupuytren’s contracture is a condition where thick tissue forms in the palm of your hand, gradually pulling one or more fingers into a bent position you can’t straighten. It develops slowly over years, starting as a small lump in the palm and eventually making it difficult to fully open your hand, grip large objects, or lay your hand flat on a surface. The ring finger and little finger are most commonly affected, though any finger can be involved.
What Happens Inside the Hand
Beneath the skin of your palm lies a layer of connective tissue called the palmar fascia. In Dupuytren’s contracture, cells in this tissue begin multiplying abnormally. Normal connective tissue cells transform into a more active type that produces excessive amounts of collagen, the structural protein that gives tissue its firmness. A signaling molecule called TGF-beta drives much of this process, triggering the cells to keep producing collagen when they normally wouldn’t.
The disease moves through three phases. In the first, cells multiply rapidly and form small, firm lumps (nodules) in the palm. During the second phase, these cells begin to contract, pulling the surrounding tissue with them. In the final phase, the cellular activity dies down, but what’s left behind is a dense, collagen-rich cord running from the palm into the affected fingers. These cords act like tightened ropes, pulling the fingers toward the palm and locking them there.
How It Progresses
Dupuytren’s contracture typically starts as a painless nodule near the base of the ring or little finger, right at the crease where the palm meets the fingers. Many people notice it as a small, firm bump they can feel when pressing on the palm. At this stage, the hand still works normally.
Over months to years, the nodule extends into a cord you can feel running along the palm and into the finger. As the cord thickens and shortens, the finger begins to curl inward. The bending happens at the knuckle joint where the finger meets the palm, and sometimes at the middle joint of the finger as well. Contractures at the middle joint tend to be harder to treat and more likely to cause lasting stiffness.
The progression is unpredictable. Some people have a nodule for decades that never worsens. Others experience steady contracture over just a few years. The condition itself is usually painless, though some people report mild tenderness in the nodules early on. The real problem is functional: difficulty wearing gloves, washing your face, putting your hand in a pocket, or gripping round objects.
Who Gets It
Dupuytren’s contracture has a strong genetic component. Several genes involved in cell growth and specialization have been linked to the disease, and it runs clearly in families. The global prevalence is estimated at about 8.2%, but the condition disproportionately affects people of Northern European descent, which is why it has historically been called “Viking disease.”
Men are affected significantly more often than women, and the risk climbs with age. Most people develop symptoms after age 50, and the condition becomes increasingly common into the 70s and 80s. Beyond genetics and aging, several other factors raise your risk:
- Smoking and heavy alcohol use
- Diabetes, which is one of the strongest non-genetic risk factors
- Liver disease
- High cholesterol and thyroid problems
- Certain anti-seizure medications
- Previous hand injury, particularly in older men who do heavy manual work or contact sports
Having one or more of these risk factors doesn’t mean you’ll develop the condition, but the more that apply, the higher your likelihood.
How It’s Diagnosed
Doctors diagnose Dupuytren’s contracture through a physical exam. No blood tests or imaging are needed. The combination of nodules, cords, and finger contractures is distinctive enough to identify on sight and touch.
A classic screening method is the tabletop test, described by surgeon R.L. Hueston in 1982. You simply try to place your hand flat on a table with all fingers extended. If you can’t get your palm and fingers to touch the surface, the test is positive. This test also serves as a practical threshold for when treatment should be considered: if you can’t flatten your hand, the contracture is significant enough to warrant intervention.
Doctors classify severity using systems that measure the total degree of contracture across the affected joints. A mild contracture might be 20 to 30 degrees of bending, while severe cases can pull a finger past 90 degrees, curling it tightly into the palm.
Treatment Without Surgery
For mild contractures, observation is reasonable. If the nodules aren’t causing functional problems, there’s no urgency to treat. But once the contracture begins interfering with daily tasks, several options can help.
Enzyme injections work by breaking down the collagen in the cord. A small amount of a collagen-dissolving enzyme is injected directly into the cord, and the next day a doctor manipulates the finger to snap the weakened cord and straighten the joint. In a major clinical trial published in the New England Journal of Medicine, this approach reduced contractures by an average of 79% compared to just 9% with placebo. Range of motion nearly doubled, improving from about 44 degrees to 81 degrees. At the knuckle joint, 92% of treated contractures improved enough that they no longer met the criteria for surgery.
The most common side effects are localized swelling, bruising, and pain at the injection site, along with temporary tenderness in nearby lymph nodes. Serious complications were rare but included two tendon ruptures and one case of chronic pain syndrome out of 308 patients. Grip strength was not affected by the treatment.
Needle aponeurotomy is a less invasive option where a doctor uses a needle tip to perforate and weaken the cord through the skin, then straightens the finger. It can be done in an office setting with local anesthesia and has a quick recovery. The trade-off is durability: recurrence rates for needle aponeurotomy run between 50% and 58%, the highest of any treatment approach.
Surgical Options
When contractures are severe or have come back after less invasive treatment, surgery becomes the more reliable choice. The most common procedure is a partial fasciectomy, where a surgeon removes the diseased tissue from the palm and fingers through an incision. This allows the fingers to straighten and restores hand function.
Recovery after fasciectomy takes longer than other approaches. You can expect pain, swelling, and stiffness for several weeks, and some tingling or numbness that can take months to fully resolve. Depending on what you do for work, you may need anywhere from two to 12 weeks off. The benefit is that fasciectomy tends to produce longer-lasting results than needle procedures or injections, with recurrence rates between 12% and 39%.
Enzyme injections fall in the middle for durability, with recurrence rates of 10% to 31%. The pattern is clear: more invasive procedures generally last longer, but all treatments carry a meaningful chance that the contracture will return.
Recovery and Rehabilitation
Regardless of which treatment you receive, rehabilitation plays a major role in your outcome. Hand therapy after any procedure focuses on reducing swelling, managing scar tissue, and maximizing finger movement. Sessions are tailored to your specific situation, and your therapist will guide you through exercises to maintain the range of motion gained from treatment.
Night splinting is widely recommended after contracture release. Most surgeons prescribe a static splint worn only at night for up to six months, though practices vary and some recommend shorter durations. The splint holds your fingers in an extended position while you sleep, helping prevent the contracture from creeping back during the healing period. A UK survey found that 84% of surgeons recommended night splinting, though they disagreed on exactly how long.
The goal of rehabilitation isn’t just to keep the finger straight. It’s to restore enough function that you can comfortably grip, pinch, and use your hand for daily activities. Most people see significant functional improvement after treatment and rehab, even if the finger doesn’t return to a perfectly straight position.
Living With Dupuytren’s Contracture
Dupuytren’s contracture is a chronic condition. Even after successful treatment, the underlying tendency to form excess scar tissue in the palm remains. Recurrence in the same finger, or new contractures in other fingers, is common over a lifetime. Many people go through more than one treatment cycle.
The condition isn’t dangerous and doesn’t spread to other parts of the body, though a small percentage of people develop similar thickening in the soles of the feet (Ledderhose disease) or other connective tissues. Catching the progression early and treating it before severe contracture develops tends to produce better outcomes, particularly at the middle finger joint, where advanced contractures are harder to fully correct.