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Dupuytren’s disease
Dupuytren’s disease causes the tissue under the skin of your palm and/or within your fingers to thicken and tighten, which can slowly bend one or more fingers in towards your palm.
What is it?
A thickening of the tissue (fascia) under the skin of the palm
Common symptoms
A firm lump in the palm, a cord you can feel, and fingers that slowly bend inwards
Who it affects
More common with age, in men, and where it runs in the family
Is it serious?
Not dangerous and not a cancer, but it can affect hand function over time
Treatment options
Observation, needle fasciotomy, or surgery
First step
A consultation to assess the stage and discuss indications for treatment
What is Dupuytren's disease?
Dupuytren’s disease affects the layer of tissue just under the skin of your palm, called the palmar fascia. In Dupuytren’s, this tissue thickens and forms firm lumps (nodules) and, over time, tight bands called cords. As a cord tightens, it can pull a finger down towards the palm so that it no longer fully straightens. This is called a contracture (“Dupuytren’s contracture”).
It most often affects the ring and little fingers, but any finger can be involved, and it can affect one or both hands. The disease is not a cancer and is usually not painful, although a nodule can feel tender or itchy when the disease is active.
Dupuytren’s tends to progress slowly, over months to years. The rate is very different from person to person. Some people only ever have a small lump that never causes trouble, while others develop a contracture that affects how they use the hand and recurs multiple times after treatment.
Causes and risk factors
The exact cause is not fully understood, but several things make Dupuytren’s more likely:
- Family history. Dupuytren’s can run in families and has a genetic link or predisposition.
- Ancestry. It is more common in people of Northern European descent, which is why it is sometimes called “Viking hand.”
- Age. It usually appears after the age of 50, but can occur in the 30s or 40s.
- Sex. It is more common in men.
- Other associations. Diabetes, smoking, and higher alcohol intake are linked to a higher risk, but it can occur in the absence of any such factors.
Some people also develop related thickening elsewhere, such as on the soles of the feet (Ledderhose disease). More aggressive patterns are sometimes termed “Dupuytren’s diathesis”. In this context it tends to start at a younger age, affect both hands, and come back more readily after treatment. Frozen shoulder is more common in individuals who have Dupuytren’s disease.
Symptoms and how it presents
Dupuytren’s usually develops in a recognisable order, though not everyone goes through every stage:
- A firm lump (nodule) appears in the palm, often near the base of a finger.
- A thick cord forms under the skin, running from the palm towards the finger.
- The cord gradually tightens and begins to pull the finger in towards the palm.
- The finger can no longer be fully straightened (a contracture).
It is usually painless although there may be discomfort, tenderness or itch. The ring and little fingers are most commonly affected. A simple sign that a contracture is developing is no longer being able to lay your hand flat on a table.
How is it diagnosed?
Dupuytren’s is almost always diagnosed by examination. There is no specific scan or blood test to confirm the diagnosis. At your appointment Dr Tomlinson will feel for nodules and cords, check how far each affected finger can straighten, and assess the degree and functional impact of any contracture.
A commonly described check is the “tabletop test”: placing your hand flat on a table. If your hand will not lie flat, it suggests a contracture significant enough to consider treatment. Dr Tomlinson advises patients that they should seek surgical review when they have a contracture to a degree that bothers them. The degree of contracture that bothers an individual will vary from one person to another.
Treatment options
There is no treatment that cures Dupuytren’s or stops it returning altogether. The two treatment options aim to straighten the hand, and are used when an individual has a contracture to a degree that hand function is adversely affected. Treatment is matched to the stage of disease and how much it affects your hand. Options range from no treatment to extensive surgery.
- Monitoring (watchful waiting) Early Dupuytren’s with a lump but no contracture, or only a mild one, often does not need treatment. If the hand still works well, no procedure is needed. You can return to see a surgeon when you have developed a contracture to a degree that bothers you.
- Needle fasciotomy (needle aponeurotomy) A minimally invasive option done under local anaesthetic, in which the tight cord is divided using a fine needle so the finger can be straightened. Recovery is quick and there is no incision. Dr Tomlinson is one of relatively few surgeons in Australia offering this technique and performing it frequently. It is best suited to readily palpable cords and contractures, and the disease can return sooner than after surgery. → Read more: Needle fasciotomy
- Surgery (fasciectomy, sometimes with a skin graft) An operation to remove the diseased cord and fascia. It is more involved than needle fasciotomy and recovery is longer, with hand therapy and splinting afterwards, but the disease tends to return less readily. Dr Tomlinson generally performs open surgery for individuals who have aggressive and/or extensive Dupuytren’s contracture and it is common for her to recommend a full thickness skin graft in this setting, to reduce the likelihood of recurrent contracture in the treated area during your lifetime → Read more: Fasciectomy with skin graft
Choosing between them: In general, the less invasive the treatment, the quicker the recovery but the sooner the disease may return. More involved surgery means a longer recovery and a higher risk of complications, but a more durable result. Which option suits you depends on the cords involved, the joints affected, your general health, and what matters most to you. We discuss all of this at your consultation.
A note on collagenase (Xiaflex) injection: this was an injection treatment for Dupuytren’s, but it was withdrawn from the Australian market in 2020 and is no longer available here.
When to see a hand surgeon
It is worth being assessed if:
- A finger is starting to bend in and will not fully straighten.
- You can no longer lay your hand flat on a table.
- The disease is progressing quickly.
- A lump or cord is affecting how you use your hand.
Early lumps without any contracture are often simply monitored, so an early review can also be reassuring.
What to expect at your appointment
At your first visit Dr Tomlinson examines your hands, assesses any contracture, and explains which options are appropriate for your stage of disease. There is no obligation to proceed to a procedure. Some discussions can be done by telehealth (melbhandsurg.doxy.me), though a hands-on examination is often needed to plan treatment and assess the likelihood of a successful outcome.
Watch: Understanding Dupuytren's Disease
Understanding Dupuytren's disease
This page covers the essentials. The download goes further: how the condition behaves over years, why family history is an unreliable guide, and the related conditions it can travel with (Ledderhose disease, Peyronie’s disease, frozen shoulder).
Frequently Asked Questions
Is Dupuytren's disease a cancer?
No. It is a benign thickening of the tissue under the skin and does not spread like a cancer.
Will it come back after treatment?
Usually not. A nodule can feel tender, itchy or sore early on, but the contracture itself is generally painless.
Is it hereditary?
It often runs in families and has a strong genetic link, but Dr Tomlinson observes that only around half of the patients that she sees can identify an ancestor or relative who has the disease.
Can I prevent it?
There is no proven way to prevent Dupuytren’s or to stop it progressing.
Will it affect my other hand?
It can affect both hands, though often one is worse than the other.
Do I need surgery straight away?
No. If you do not have a contracture, or your contracture is not at a degree that it bothers you then you do not need to have a needle fasciotomy or surgery.
What is Dupuytren's disease?
A thickening and tightening of the tissue (fascia) layer under the skin of the palm, which can pull one or more fingers into a bent position over time. Benign, not cancer, not an infection.
What causes it?
Largely genetic predisposition, more common with age, more common in men, and in people of Northern European ancestry. Not caused by hand use, injury, or occupation.
What can I do myself?
Not much to change the course of the disease itself. There’s no proven way to slow or stop progression through exercise, stretching, or topical treatment, and it’s reasonable to monitor a mild lump or cord without doing anything. Most people don’t need treatment until it’s affecting hand function.
What can a hand therapist do?
After an interventional treatment (needle fasciotomy or open surgery) a hand therapist is vital to assist with splinting, wound care advice, range of movement exercises, scar management, non surgical management of Boutonnière’s deformity and strengthening.
What can a hand surgeon do?
The two treatments that a surgeon can provide are needle fasciotomy (aponeurotomy) and open surgery. A surgeon can advise you which treatment is most suitable for you, and when you should seek to have surgical treatment.
What can I expect from treatment?
Outcomes vary according to the severity of the contractures prior to intervention, and the underlying biology of your Dupuytren’s (ie whether it is aggressive and extensive, or not). Narrow cords tend to respond better than diffuse disease. Metacarpophalangeal joint contractures are more readily resolved than proximal interphalangeal joint contractures. Flexible hands stretch out more readily than stiffer hands. While needle fasciotomy is associated with earlier recurrence than open surgery, there is no cure for Dupuytren’s disease and the natural history is that the disease will progress across a lifetime, though the rate of progression varies widely and unpredictably between people.
What happens if it's left untreated?
Dupuytren’s is a progressive condition that doesn’t resolve on its own, though the rate of progression varies widely and unpredictably between people. Waiting doesn’t carry urgency for a mild lump, but that finger contracture, once established, is harder to fully correct the longer it’s present. This does not mean that there is benefit in seeking treatment when there is minimal or mild contracture without functional problems, but it does mean that it is preferable not to wait until you poke yourself in the eye with your finger each time you go to wash your face.