Dupuytren’s Contracture
Recognising the Symptoms of Dupuytren’s Contracture
Dupuytren’s Contracture
Lumps and cords in your palm causing fingers to bend? It could be Dupuytren’s contracture. Dupuytren’s is a condition that affects the connective tissue in your palm. I specialise in treating Dupuytren’s contracture, offering both non-surgical and surgical options to restore hand function.
Ali Phillips | Hand & Wrist Specialist
What is this hard lump in my palm?
I'm Ali Phillips. Noticing a lump in your palm or finding you can't flatten your hand can be worrying. I'm here to provide clear, trustworthy information about what might be happening and to work with you to find the best way forward.
Book a ConsultationWhat is Dupuytren's Disease?
Don't let the word "disease" scare you! It's not contagious. Dupuytren's (pronounced "doo-pwee-TRANZ") is a condition where the layer of tissue under the skin in your palm, called fascia, gets thicker and tighter. Think of it like a string getting knotted up under your skin.
This thickened tissue can form hard lumps (nodules) and tough cords. Over time, these cords can slowly tighten and pull one or more of your fingers in towards your palm, making it difficult to straighten them. This bent position is called a 'contracture'.
The exact cause is unknown, but it often runs in families and is more common in men and people of Northern European descent. It is not caused by an injury.
What are the symptoms of Dupuytren's?
Lumps in the Palm
The first sign is often a small, firm lump (nodule) under the skin of your palm. It might feel like a tiny pebble and can sometimes be tender.
Thick Cords
Over time, the lumps can develop into thick, rope-like cords of tissue that you can feel stretching from your palm towards your fingers.
Bent Fingers
The cords can tighten and pull your fingers (most often the ring and little fingers) into a bent position, making it hard to flatten your hand.
Ready to Straighten Things Out?
If these symptoms sound familiar, you don't have to just live with them. An accurate diagnosis is the first step towards getting your hand function back. Let's talk about your options.
Find Out Your OptionsDoes this sound like you?
David's Story: The Early Lump
David, a 60-year-old retired engineer, noticed a small, hard lump in his palm just below his ring finger. It didn't hurt, but it felt odd when he gripped the steering wheel or a golf club. Worried, he came to see me. After an examination, I reassured him it was a classic early sign of Dupuytren's. Since his fingers were still straight, no treatment was needed yet. We discussed monitoring it, and I explained that radiotherapy could be an option to slow things down if it started to progress, which gave him peace of mind.
Susan's Story: The Bent Finger
Susan, a 68-year-old grandmother, found it increasingly difficult to put on gloves or give her grandchildren a proper high-five. The cord in her palm had tightened over a few years, pulling her little finger into a bent position. It was getting in the way of her daily life. We discussed surgery, and she decided to have a partial fasciectomy. The procedure went smoothly, and after a period of healing and working with a hand therapist, she was delighted to be able to straighten her finger again and fully open her hand.
How will I diagnose your hand?
Usually, I can diagnose Dupuytren's simply by examining your hand and listening to your story. No special tests are normally needed. A simple way to see how much the condition is affecting you is the "Table Top Test". You can try this at home.
1️⃣
Find a flat surface, like a table or desk.
2️⃣
Turn your palm facing down.
3️⃣
Try to place your hand completely flat on the surface.
If you can't get your hand and fingers to lie completely flat because a finger is bent, this is a positive test and a sign that the contracture is affecting your hand's function. This is often the point when we start discussing treatment options.
Can't flatten your hand?
If the Table Top Test shows that your finger is bent, it's a clear sign that Dupuytren's is impacting your life. Don't wait for it to get worse. Let's create a plan together.
Book Your AppointmentHow can I help you get better?
Unfortunately, there's no cure for Dupuytren's, but treatment focuses on improving your hand function. Any intervention is simply to get your finger into a more functional position.
Observation If the condition is mild and not affecting your hand function, we may just decide to keep an eye on it.
Stretching & Hand Therapy Gentle stretching exercises may help to maintain flexibility and slow the progression of the contracture.
Radiotherapy For early-stage disease, before fingers have started to bend, radiotherapy can be a successful option to delay the contracture from developing. It cannot reverse a finger that is already bent.
Surgery is considered when your hand function is significantly limited. The more the fingers are bent, the more complex the surgery and the higher the risks, so it's good to get advice early.
What does the surgery involve?
The most common surgery is a Partial Fasciectomy. I make an incision in your hand and carefully remove the thickened cords that are causing the contracture. My aim is not to remove every last bit of the disease, but to improve your function and get your finger into a better position. For more severe or recurrent cases, a Dermofasciectomy (which includes a skin graft) may be necessary.
Benefits
- Improved ability to straighten fingers
- Better hand function for daily tasks
- Reduced stiffness and discomfort
Small Risks
- Nerve damage causing numbness (about 1 in 20 cases)
- Infection (less than 1 in 50 cases)
- Wound healing problems (about 1 in 10 cases)
- The disease can come back over time
The decision to have surgery is one we make together. I will ensure all your questions are answered so you feel confident in our plan.
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always explore other treatment options, or decide on no treatment at this time. The decision is yours and will be respected.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
While surgery can be very helpful, I want you to be fully aware of the potential issues. The more contracted the fingers are, and if you've had surgery before, the higher the risks. Potential issues include:
- Nerve Damage: This can cause numbness or tingling in the finger and occurs in about 1 in 20 cases. Very rarely is the numbness permanent.
- Infection: This happens in a small number of patients (less than 1 in 50) and can usually be treated with antibiotics.
- Wound Healing Problems: Sometimes an incision doesn't heal as expected. This happens in about 1 in 10 cases in my practice, but it's often minor and settles down on its own.
- Finger Still Bent: Some stiffness or remaining bend is possible, especially in complex cases. My aim is to improve your function, not necessarily to get the finger perfectly straight at all costs.
- Recurrence: The disease can come back over time, as surgery treats the effect of the disease (the cord), not the disease itself.
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Frequently Asked Questions
Unfortunately, there's no cure for the underlying disease. All treatments focus on managing the symptoms (the bent fingers) and improving your hand's function.
In the early stages, the lumps or nodules can be tender or sore, but the condition isn't generally considered painful. Any aching is usually related to the stiffness and limited movement in the later stages.
Yes, because surgery removes the problematic cord but not the underlying tendency to form them, the disease can recur in the same or a different area of the hand over time.
Full recovery can take anywhere from a few weeks to several months, depending on the complexity of the surgery. A simple procedure might see you back to most things in a few weeks, while a more extensive operation with a skin graft could take three months or more. Hand therapy is very important for the best outcome.
No, there's no known way to prevent it from starting. However, managing risk factors like smoking and diabetes might be beneficial for your overall health.
Yes, people with Dupuytren's have a higher chance of having similar tissue thickening on the soles of their feet (Ledderhose Disease) or on their knuckles (knuckle pads).
Test Your Knowledge!
Dupuytren’s Contracture FAQs
Dupuytren’s disease (say it like Doo-pwi-trahns) involves a thickening of the tissue just beneath the skin of your palm. This creates tough cords that can gradually pull one or more fingers into a bent position, and that can really get in the way of daily life.
We don’t have a definite answer as to why this happens, but it often runs in families. Some things like health conditions or hand use might play a role, but sometimes it seems to come out of nowhere.
The first sign is often a small, firm lump or thickened area in your palm. Over time, these tough cords might develop, restricting your ability to straighten your fingers fully. Thankfully, it’s usually not painful.
Unfortunately, Dupuytren’s typically doesn’t improve on its own. The progression can be slow, but those cords tend to gradually contract more over time. The good news is there are treatments to help when it starts interfering with things you do.
Stretching exercises can sometimes help slow the progression and keep your fingers as flexible as possible. It’s best to learn some safe, effective exercises specifically for Dupuytren’s from a hand therapist.
While splints likely won’t reverse the condition, they can help slow the tightening of the cords, especially at night when we might accidentally curl our hands tightly.
An injection of special enzymes can sometimes break down the tough cords in your palm without the need for open surgery. It’s not suitable for everyone, but often offers a less invasive approach.
When Dupuytren’s prevents you from using your hand comfortably, surgery can be very effective. The goal is carefully removing or releasing those contracted cords to let your fingers straighten again.
Most people regain significant hand function after surgery. Your doctor or hand therapist will guide you through a recovery plan involving exercises and perhaps further splinting for the best outcome.
There is a chance the contractures might recur after treatment, which is why monitoring after any intervention is important. But many people experience long-term improvement with a single treatment.
While Dupuytren’s can affect both hands, and sometimes the soles of the feet, it won’t spread from your hand to other body parts.
Both can affect hand function, but the cause is different. Arthritis is joint inflammation, whereas Dupuytren’s is this specific thickening of tissue under the skin. Carefully describing your symptoms will help with proper diagnosis.
There seems to be some connection, as people with diabetes have a slightly increased risk of developing Dupuytren’s. While frustrating, we can work together to manage both conditions effectively.
The best place to start is often with your primary care doctor. They can assess your hands and may refer you to a hand surgeon or an orthopedic specialist with expertise in hand conditions.
Your doctor will know local specialists that handle Dupuytren’s. There are also resources online dedicated to finding doctors specializing in hand conditions. We’ll collaborate to find the right help for you, you don’t have to go through this alone.
