Understanding Dupuytren’s Contracture: Causes, Stages, and Treatment Options

Dupuytren’s Contracture is a chronic and progressive hand condition that affects the connective tissue beneath the skin of the palm. Over time, this tissue thickens and tightens, pulling the fingers—most often the ring and little fingers—into a bent position. When left untreated, it can significantly impact hand function, making routine activities like gripping objects, putting on gloves, or shaking hands difficult or impossible.

At Nebraska Hand & Shoulder, we help patients understand the nature of this condition and provide expert care to restore hand movement and improve quality of life.

What Is Dupuytren’s Contracture?

Dupuytren’s Contracture, sometimes called "Viking disease" due to its higher prevalence in people of Northern European descent, was first described in the 1800s by French surgeon Baron Guillaume Dupuytren. It primarily affects the palmar fascia (palmar aponeurosis), a fibrous layer of tissue just beneath the skin of the palm. 

In the early stages, patients often notice a small, tender lump or nodule in their palm. Over time, this can develop into a rope-like cord that pulls the finger downward into a bent position.

While the exact cause of Dupuytren’s is unknown, it is thought to be linked to genetics, age, and certain lifestyle or health factors. The condition is more common in men over age 50, and may progress more rapidly in individuals with diabetes, epilepsy, or a history of alcohol or tobacco use.

Recognizing the Stages of Dupuytren’s Contracture

Understanding the progression of Dupuytren’s is key to managing the condition early. The disease typically develops slowly over months or years:

• Early Stage:  A small, tender lump or nodule forms in the palm. This may feel like a callus and is often mistaken for a cyst or minor injury.
• Cord Formation:  The nodule begins to thicken into a visible cord beneath the skin, which may feel tight or firm to the touch.
• Finger Contracture:  As the cord shortens, one or more fingers (usually the ring or little finger) begin to bend toward the palm, often without pain.
• Advanced Stage:  The finger(s) become fixed in a bent position. You may no longer be able to lay your hand flat on a table or perform daily tasks comfortably.

Once the contracture affects joints beyond the first knuckle (the metacarpophalangeal or MP joint), it becomes more challenging to restore full range of motion, even with surgery.

When to Seek Treatment

If you can still lay your hand flat on a tabletop, there is usually no urgent need for treatment. Many patients choose to monitor the condition for progression.

However, if your fingers start to bend downward or you can no longer flatten your hand, it’s important to consider treatment before contracture worsens.

At Nebraska Hand & Shoulder, we recommend early evaluation to determine the best course of action before the condition reaches an advanced stage.

Treatment Options for Dupuytren’s Contracture

While there is no cure for Dupuytren’s, there are several treatments can help restore hand function:

There are three primary treatment approaches:

     1.  Surgical Removal (Fasciectomy):

• • The most effective long-term solution.
  • Involves surgically removing the diseased tissue.
  • Low recurrence rate if fully excised.

     2.  Needle Aponeurotomy:

• • A minimally invasive office procedure using a needle to release the cord.
  • Quicker recovery but higher recurrence because the cord remains.

     3.  Collagenase Injection:

• • A chemical (collagenase) is injected to weaken the cord.
  • The cord is then manually ruptured.
  • This option is more expensive and has a similar high recurrence rate.

At Nebraska Hand & Shoulder, Dr. Ichtertz generally recommends surgical removal for patients with significant contracture. Needle release may be used as a temporary measure or to prepare the tissue for easier removal later.

One of the greatest challenges of Dupuytren’s Contracture is that the condition worsens silently over time. Advanced cases can lead to permanent finger stiffness. If untreated, it becomes impossible to fully straighten the finger, limiting daily activities like shaking hands, reaching into pockets, or using tools.

Early diagnosis and treatment improve outcomes and can reduce the need for more complex procedures such as skin grafts.

If you are concerned about a lump or tightening in your hand, don’t wait. Nebraska Hand & Shoulder offers advanced treatment options and personalized care to restore your hand function.

Get Expert Care for Dupuytren’s Contracture

If you’re noticing changes in your hand—like a lump in your palm or difficulty straightening your fingers—don’t ignore the signs. The team at Nebraska Hand & Shoulder offers comprehensive evaluations and personalized treatment plans to help you regain control and comfort.

Contact us today to schedule an evaluation and discuss your options.