Dupuytren's contracture (Dupuytren's disease)

Anatomy: What is affected?

The palmar aponeurosis (palmar fascia) lies in the palm of the hand. This strong connective tissue lies superficially over the flexor tendons and serves as a “tension sail” for the palm. In Dupuytren's disease, there is an increased deposition of collagen and scar-like shrinkage (fibromatosis).

• Lumps (nodules): palpable, often firm thickenings in the palm of the hand, sometimes painful to touch at the beginning.
• Strands (cords): longitudinal hardenings that continue to the fingers and force flexion.
• The joints and tendons are not initially damaged, but are functionally forced into a flexed position by the cords.

What is Dupuytren's contracture?

Dupuytren's disease is a fibroproliferative disease of the palmar fascia with genetic imprint. It predominantly affects men over the age of 50, but can affect both genders. Often there is a bilateral, differently pronounced event. The disease progresses in phases: active phases with nodule growth and resting phases with stable findings.

• Benign (benign), non-infectious, non-rheumatic.
• Not “caused” by overuse, but physical activity can make symptoms more visible.
• Related fibromatoses: Ledderhose (sole of the foot), knuckle pads (extensor side of the fingers), Peyronie's (penis).

Causes and risk factors

A single cause is not known. It is a multifactorial event with a genetic focus. Certain factors are associated with a higher risk without being solely responsible.

• Genetics and Northern European ancestry (familial aggregation).
• Age and male gender.
• Smoking and higher alcohol consumption (associated).
• Diabetes mellitus, metabolic syndrome.
• Certain medications (e.g., previous antiepileptic drugs) are discussed.
• Microtrauma/manual labor: more of an amplifier than a cause, the data is inconsistent.

Typical symptoms

• Small, rough lumps in the palm of the hand, often in the line of the ring or little finger rays.
• Longitudinal strands that become more prominent when grasped.
• Progressive flexion contracture: fingers can no longer be fully extended (tabletop test failed).
• Rarely painful at first; Pressure sensitivity possible. Over time, functional limitations in everyday life (e.g. putting on gloves, washing hands, grasping objects).

Diagnostics in practice

The diagnosis is made clinically. Inspection, palpation and measurement of the extension deficit in the affected joints (MCP/base joint, PIP/middle joint, less commonly DIP/end joint) are crucial. Imaging is usually not necessary.

• Clinical tests: Tabletop test (place hand flat on the table), measuring the angle of flexion contracture.
• Documentation of functional level (grasping, hand hygiene, professional requirements).
• Ultrasound only if the findings or differential diagnoses are unclear (e.g. ganglion).
• Differential diagnoses: Finger arthrosis with capsule shrinkage, trigger finger (tendovaginitis stenosas), scar contracture after injury.

Stages and course

The severity is often classified according to tubiana (sum of flexion contracture on MCP, PIP and DIP per finger):

The process is individual. Some findings remain stable for years, others progress quickly. Early intervention only makes sense if function or everyday life are significantly impaired or rapid progression is observed.

Conservative treatment: initially as little as necessary

Not every finding requires immediate intervention. Conservative treatment is particularly important for nodules with little or no contracture. The aim is to maintain hand function and individual monitoring.

• Explanation and follow-up: regular measurement of the extension deficit and photo documentation.
• Hand therapy/ergo: instructions for use that is gentle on the joints, scar and tissue care techniques, fine motor skills training; Purely passive “stretching out” does not loosen cords and can be irritating.
• Splints: Night positioning splints can improve subjective sensation in individual cases; the evidence for inhibition of progression is limited and inconsistent.
• Injections: Corticosteroid injections into painful, active nodes can dull pain; they do not loosen established cords. Benefits and risks (skin atrophy, depigmentation) are weighed individually.
• Shockwave/radiation therapy: Discussed in individual cases; the evidence is heterogeneous. We do not make a routine recommendation without a clear indication.

Minimally invasive: percutaneous needle fasciotomy (PNF)

If there is a contracture requiring treatment (e.g. tabletop test negative, functional limitation) and the cord is easily accessible, a percutaneous needle fasciotomy (PNF, “needle aponeurotomy”) can be considered. The cord is cut at specific points under local anesthesia.

• Advantages: small procedure, usually outpatient, quick recovery.
• Limits: not for all cord courses (e.g. near the skin, nerve course), less correction at the PIP joint.
• Risks: skin tear, bleeding, injury to sensitive nerves or vessels, infection, complex regional pain syndrome (rare).
• Recurrences: more common in the long term than after open surgery; further minimally invasive corrections are possible.

Enzymatic fasciotomy (collagenase injection) was used intermittently in Europe. The preparation is currently not regularly available in Germany; Application is only considered - if at all - in individual cases after careful risk-benefit assessment.

Surgical procedures: justified indication

If the contracture is severe, the function is significantly impaired or minimally invasive procedures are not suitable, surgical removal of diseased parts of the fascia (partial fasciectomy) may make sense. In selected cases with extensive skin involvement, a dermofascictomy with skin replacement may be considered.

• Goal: To restore stretching ability and function as best as possible - a complete “cure” of the underlying disease is not possible.
• Technique: Removal of pathologically altered palmar fascia via targeted incisions; protection of nerves/vessels; If necessary, Z-plasties or skin transplants.
• Anesthesia: regional or general anesthesia; In specialized centers sometimes also wide awake technique without bloodless.
• Risks: impaired wound healing, infection, nerve/vascular injury, stiffness, scarring problems, CRPS; Long-term recurrences are possible.
• Results: On average, better and longer-lasting improvement in extension than after PNF, but requires consistent follow-up treatment.

Follow-up treatment and rehabilitation

Follow-up treatment is crucial for the functional result - regardless of whether the operation was minimally invasive or open.

• Early mobilization: guided movement exercises from the first days to avoid stiffness.
• Splint concept: individually tailored positioning/stretching splints, usually at night, for several weeks; regular adjustments as the progress progresses.
• Scar care: massage, silicone pads, if necessary scar care creams; Sun protection.
• Hand therapy: coordination, strength building, gripping patterns relevant to everyday life.
• Time requirement: everyday use often after 1-3 weeks (PNF) or 3-6 weeks (open surgery); Full resilience can take longer – varies from person to person.

Everyday tips and prevention

There is no safe prevention. However, they can support hand function and avoid irritation.

• Regular, painless movements of the fingers (without force).
• Ergonomic aids at work/at home: thicker handle diameters, non-slip surfaces.
• Skin care of the palm; Protection against cold/wet for sensitive skin.
• Quitting smoking and balancing your metabolism in diabetes promote general tissue health.
• See a doctor early if the ability to stretch deteriorates.

When should you introduce yourself?

• You can no longer place your hand flat on the table (tabletop test negative).
• Increasing dysfunction in everyday life (hand hygiene, gripping, gloves).
• Rapidly growing knot or new strand formation.
• Pain, numbness, tingling or blood circulation problems (rare) – please clarify as soon as possible.
• Skin tear/small wound over a stretched cord.

Our approach in Hamburg-Winterhude

We take the time to take a careful anamnesis, clinically measure the contracture and determine the procedure together. The focus is on conservative measures and a reliable basis for decision-making for or against interventions.

• Individual advice on the course, everyday life and therapy paths.
• Conservative therapy and hand therapy planning, including splint concepts.
• Minimally invasive options (e.g. percutaneous needle fasciotomy) with suitable anatomy - after information about the benefits and risks.
• Operation planning in cooperation with hand surgical partners, if necessary.
• Follow-up care with standardized follow-up checks.

Location: Dorotheenstraße 48, 22301 Hamburg. Appointments can be made conveniently online or by email (see below).

Common mistakes briefly explained

• “It’s arthritis.” – No, the palmar fascia is primarily affected, not the joint.
• “You can stretch the cords away.” – Stretching improves the elasticity of the soft tissues, but does not loosen the cord.
• “After one treatment, it will never come back.” – Recurrences are possible; The aim is to achieve the most sustainable functional improvement possible.
• “Dupuytren does hard work.” – Work can increase symptoms, but is not the sole cause.

Risks, limits and education

Every measure has possible side effects. We discuss individually which options suit your hand, your everyday life and your expectations.

• Conservative therapy: low risks, but also limited influence on the disease.
• PNF: higher recurrence rate, small skin tears possible; Advantage of quick recovery.
• Open surgery: higher tissue and scar strain, but often more lasting improvement in stretching.
• underlying disease remains; Recurrences or new growths are possible.

Related and distinct diseases

If there is pain and stiffness, other causes must also be considered. These pages provide additional information:

• Finger osteoarthritis (DIP, PIP, MCP): Wear and tear of the finger joints with pain and restricted movement.
• Rhizarthrosis: Osteoarthritis of the thumb saddle joint with pressure pain and weakness in grip.
• Radiocarpal and midcarpal arthrosis: Wrist wear with pain on exertion.
• Unstable wrist kinematics: Ligament lesions as a cause of insecurity in the wrist.
• Kienböck's disease: circulatory disorder of the lunate with wrist pain.