Dupuytren's contracture is a condition causing a thickening of the deep tissue (fascia) that sits immediately under the skin of the palm and fingers, making the tissue less flexible. Symptoms typically begin as an area of thickening under the skin of the palm. While this may be tender in the early days, for most patients, this is a painless condition. Patients may notice nodules (lumps), pits (indentations), or cords (longer tight bands of tissue) running from the palm up towards and into the fingers. Many patients feel like this thickening is the tendon to their fingers, however it is completely separate to the tendons.

As it progresses, Dupuytren's disease can cause one or more fingers to bend permanently inwards. When a joint cannot be fully straightened because of this, it is known as a contracture. Dupuytren's mainly affects the ring and little fingers, but can impact any part of the palm side of the hand. In some patients, particularly those who are younger and have a strong family history, it may progress over months. In other patients, it may progress very slowly, over the course of years. The condition is more common in men, and in those of Scandinavian or northern European background.

What are the signs and symptoms?

• Dimples or ridges on the palm.
• A firm lump of tissue on the palm (usually painless).
• Cords of tissue pulling fingers back towards the palm.
• A finger stuck in a bent position.
• Difficulty placing the hand flat on a surface.
• Difficulty grasping large objects, or items like golf clubs, spades, or door handles.
• Fingers catching when putting the hand in a pocket or narrow spaces.

Treatment options

It is important to understand that there is no cure for Dupuytren's disease. Unfortunately, early intervention cannot prevent the condition recurring or progressing over time. The decision to treat is always made balancing risk versus benefit.

Needle fasciotomy — A needle is inserted into the Dupuytren's disease along the palm and finger to break up the thickened areas. This may permit the finger to be straightened. While this is a less invasive approach, with a quick recovery (approximately two weeks), it is associated with a higher risk of recurrence.

Fasciectomy — an incision or multiple incisions is made along the palm and/or affected finger(s) to allow the surgeon access and surgically remove the affected tissue. The fingers may be fully or completely straightened, depending on how bent they were before surgery, how long they have been in the bent position, and which joints are affected. There is a lower rate of recurrence than needle fasciotomy. The recovery time is significantly longer (up to six weeks), and hand therapy is essential.

Dermafasciectomy — similar to fasciectomy, but an additional area of skin is removed and replaced with a skin graft. This procedure is required where there is a shortage of skin owing to the finger being in a contracted position for a long period of time, or because of scarring from previous surgery. The recovery time is approximately six weeks, and hand therapy is essential.