Overview

Dupuytren disease is a progressive condition of the hand in which the connective tissue beneath the skin of the palm — called the palmar fascia — thickens and tightens over time. As this tissue contracts, it can pull one or more fingers toward the palm, making it difficult or impossible to fully straighten them. The ring finger and little finger are most commonly affected, though the condition can involve any finger.

Dupuytren disease tends to develop slowly over years, and in many cases early stages may cause a firm nodule or puckered skin in the palm. Over time, a cord of thickened tissue may form and gradually draw the finger inward in a bent position. The condition is generally not painful, though it can significantly limit hand function and quality of life.

Signs and Symptoms

Symptoms often develop gradually and may go unnoticed in the early stages. Common signs include:

• A firm, painless lump or nodule in the palm
• Puckering, dimpling or tethering of the skin on the palm
• A thick cord of tissue running from the palm toward one or more fingers
• Difficulty straightening one or more fingers, most often the ring or little finger
• Inability to lay the hand flat on a surface (known as the tabletop test)
• Gradual worsening of finger contracture (inflexible bending) over months or years

When to See a Doctor

You should make an appointment with your doctor if you notice a lump or thickening in your palm, if you have trouble straightening a finger, or if hand stiffness is affecting your ability to perform daily activities such as gripping objects, typing or shaking hands. Early evaluation can help you understand the stage of the condition and discuss treatment options before significant contracture develops.

Causes

The exact cause of Dupuytren disease is not fully understood, but it involves abnormal changes in the palmar fascia — the layer of fibrous tissue just beneath the skin of the palm. In people with Dupuytren disease, specialized cells called myofibroblasts become overactive and produce excess collagen, causing the tissue to thicken, tighten and eventually contract.

Genetics appears to play a central role. The condition is significantly more common in people with a family history of Dupuytren disease, and it is especially prevalent in those of Northern European ancestry. Certain medical conditions, including diabetes and epilepsy, also have been associated with a higher likelihood of developing Dupuytren disease, though the reason for these links is still being studied.

Diagnosis and Treatment

If you are experiencing symptoms of Dupuytren disease, a hand specialist at Norton Arm & Hand Institute can evaluate your hand and develop a treatment plan tailored to your needs. Learn more about Norton Arm & Hand Institute and our hand and upper extremity surgery program.

Tests

Dupuytren disease is typically diagnosed through a physical examination. Your doctor will assess the degree of contracture, examine the skin and tissue of your palm, and may ask you to perform the tabletop test (placing your hand flat on a surface). Additional tests may include:

• Physical examination: Your provider evaluates the range of motion in your fingers, checks for nodules or cords, and assesses how much the contracture affects hand function.
• Tabletop test: You place your hand palm-down on a flat surface. Inability to lay the hand completely flat is a classic sign of Dupuytren disease.
• Imaging: Ultrasound or MRI are rarely required for diagnosis but may occasionally be used to evaluate deeper tissue involvement or rule out other conditions.

Treatments

Treatment depends on the severity of your contracture, how quickly the condition is progressing and how much it affects your daily life. Not all cases require immediate treatment. Options include:

Medications

• Collagenase injection (Xiaflex): An injectable enzyme that breaks down the collagen cord causing the contracture. After injection, the provider manipulates the finger to rupture and straighten the cord. This is a minimally invasive option for some patients.
• Corticosteroid injection: This may help soften and reduce the size of painful nodules, particularly in early-stage disease, though effects are typically temporary.

Lifestyle Changes

• Activity modification: Avoiding prolonged gripping of vibrating tools or heavy equipment may help slow symptom progression in some patients.
• Hand therapy: A certified hand therapist can provide exercises and splinting to help maintain finger extension and hand function, particularly after a procedure or surgery.
• Splinting: Night splints may be used after a procedure or surgery to help maintain the corrected position of the finger during healing.

Surgical options

• Needle aponeurotomy: A minimally invasive procedure in which a needle is used to puncture and weaken the cord of thickened tissue so the finger can be straightened. It can be performed in an office setting with local anesthesia and generally allows for a faster recovery than open surgery.
• Fasciectomy: A surgical procedure in which the thickened tissue and cord are removed. This is typically recommended for more severe or recurrent contractures. Recovery involves hand therapy and may take several weeks to months.

Risk Factors

Several factors are associated with an increased risk of developing Dupuytren disease:

• Age: The condition becomes more common after age 40.
• Sex: Men are significantly more likely to develop Dupuytren disease and tend to have more severe contractures than women.
• Family history: Having a first-degree relative (parent or sibling) with the condition substantially increases your risk.
• Northern European ancestry: People of Scandinavian, Scottish, Irish or other Northern European descent have higher rates of the condition.
• Diabetes: People with diabetes have a modestly elevated risk of Dupuytren disease.
• Alcohol use:  Chronic alcohol use may be linked to an increased risk, though research findings vary.
• Tobacco use: Smoking has been associated with higher rates of Dupuytren disease, possibly due to effects on small blood vessels in the hand.

Complications

Dupuytren disease is not a life-threatening condition, but without treatment it can lead to meaningful complications, including:

• Progressive finger contracture that limits the ability to fully open or use the hand
• Difficulty with everyday tasks such as gripping, typing, wearing gloves or shaking hands
• Reduced hand strength and coordination
• Recurrence of contracture after treatment, which is relatively common and may require additional procedures
• In severe cases, permanent loss of full finger extension even after surgical treatment

Prevention

Because Dupuytren disease is driven largely by genetic factors, it cannot always be prevented. However, managing modifiable risk factors may help reduce your risk or slow progression:

• Avoid or limit tobacco and alcohol use.
• Manage blood sugar carefully if you have diabetes.
• Discuss any hand changes with your doctor early, when treatment options are most effective.

Managing Your Condition

If you have been diagnosed with Dupuytren disease, the following tips can help you stay informed and engaged in your care:

• Monitor your symptoms regularly using the tabletop test. If you can no longer lay your hand flat, it may be time to discuss treatment options with your provider.
• Communicate openly with your hand specialist about how the condition is affecting your work, hobbies and daily life. This helps guide the right treatment approach for you.
• Follow through with hand therapy before and after any procedure. Therapy plays a key role in achieving the best possible outcome.
• Wear any prescribed splints as directed, especially at night after a procedure or surgery, to help maintain finger extension during healing.
• Keep follow-up appointments even if your symptoms seem stable. Dupuytren disease can progress slowly and is best managed with regular monitoring.
• If the condition affects both hands or returns after treatment, speak with your care team about the best next steps.

Support

Living with Dupuytren disease is easier when you have the right support. Norton Arm & Hand Institute offers patient resources, care coordination and access to specialists who can help guide you through every step of your treatment journey.