What Is Dupuytren's Contracture

Chances are you’ve never heard of Dupuytren’s contracture unless you’ve started to experience this hand deformity. Maybe you Googled “bent ring finger” or something similar. You could have Dupuytren’s contracture, also called Dupuytren’s disease or trigger finger, if any of your fingers — but particularly your ring or pinky fingers — are stuck in a bent or crooked position.

Dupuytren’s is a hand deformity that develops over a span of several years. It’s not dangerous, although it can be rather awkward and inconvenient. The finger bending is a result of collagen building up in the hand with no way to properly break it down. This excess collagen forms into hard bumps or chords that pull on the fingers, leaving them stuck in a bent position.

Although there is currently no cure for Dupuytren’s, there are several effective treatment options available. Here, we are answer the most commonly asked questions about the symptoms, diagnosis, and treatment of Dupuytren’s.

Q: What are the symptoms of Dupuytren’s?

A: Dupuytren’s occurs when there is buildup of abnormal tissue beneath the skin in the palm of the hand. It can cause pits, bumps, and thick chords that can force fingers to involuntarily bend. It often causes bent or stuck fingers, particularly the ring and pinky finger. Dupuytren’s can affect any finger, but often affects the ring and pinky fingers. It can strike more than one finger at a time and occur in both hands or just one.

Symptoms of Dupuytren’s include:

  • Stiff fingers, especially in the morning
  • Popping or clicking when you use your fingers
  • Pain, tenderness, or bumps in the palm at the base of your fingers
  • Fingers get stuck in a bent position

Q: What causes Dupuytren’s?

A: The cause of Dupuytren’s disease is unknown, although people who have a family history of Dupuytren’s, men of Northern European decent, people with diabetes, and people with a history of smoking/consuming alcohol are at a higher risk of developing the disease.

Q: Why is it called Dupuytren’s?

A: Guillaume Dupuytren (1777-1835) was the surgeon of French military leader Napoleon, and arguably the most famous French surgeon of the 19th century. In 1831, he performed surgery in Paris on what he later described as a hand suffering from a condition causing bent fingers. His name has been lent to the condition ever since.

Q: How is Dupuytren’s diagnosed? What kind of doctor should I see for Dupuytren’s?

A: The symptoms of Dupuytren’s are unique and quite visible. If you believe your symptoms match what experts describe as the symptoms of Dupuytren’s, see your doctor. Your primary care physician should be able to diagnosis Dupuytren’s just by looking at your hand, taking a medical history, and doing a physical exam. They will likely refer you to an orthopedic surgeon who is a hand specialist for treatment.

Q: Is Dupuytren’s treatable?

A: Dupuytren’s can be treated in many ways depending on the severity and impact on your quality of life. The three most common treatment options are:

Needle aponeurotomy: Needles are pushed into the bumps or chords to break up the collagen in your palm. After a series of needles, doctors typically manipulate and massage the hand to further the breakup. A hand splint that helps stretch out the fingers after treatment is also common.

CCH collagenase injection: Collagenase clostridium histolyticum (CCH) is an enzyme extracted from bacteria. Injections of these enzymes break down the collagen buildup in the hand that causes lumps and chords in Dupuytren’s. The enzymes are administered in a series of a few needle injections, depending upon the severity and fingers affected. This is currently the most common treatment form and a very effective, cost-efficient option.

Open fasciectomy surgery: For more advanced cases of Dupuytren’s, surgery may be required. In this procedure, incisions are made in the hand and pieces of the built-up chords or bumps are removed. Following surgery, you’ll need to wear a hand split and do physical therapy for several weeks. This is an effective treatment option, but the recovery period is longer.

Read more here about Dupuytren’s contracture treatment options.

Q: What happens if I don’t treat my Dupuytren’s?

A: The severity and progression of Dupuytren’s can vary from person to person. Some patients never progress beyond the hard bump phase and can manage their symptoms with conservative treatments like taking non-steroidal anti-inflammatory medications (ibuprofen, naproxen), wearing a splint, or doing hand and finger stretching exercises to help maintain mobility.

But a more likely scenario if you don’t treat Dupuytren’s is that over time your hand will develop hard chord-like formations that pull on your ring or pinky fingers, pulling them into a stuck position. If this goes untreated, it can make simple tasks involving your hand very difficult. It also makes getting treatment in the future harder and increases the chances of requiring surgery. It is important to catch Dupuytren’s early to increase your treatment options.

Q: How will having Dupuytren’s affect my quality of life and ability to do everyday tasks?

A: If your condition reaches the contracture phase (permanently bent finger), which many cases of Dupuytren’s do if untreated, it can have a significant negative impact on your quality of life. Advanced contracture pulls on your ring and pinky fingers until they are stuck in a closed bent position, which means you will have only the use of your index finger, middle finger, and thumb. Everyday tasks like driving, texting, cooking, exercising, shaking hands, and other basic tasks involving the hand become very difficult.

Q: I have bumps or chords in my hand but still have use of my fingers. What do I do?

A: A buildup of tissue does not necessarily mean your fingers will contract and get stuck. In some cases, a lump does not require treatment and does not guarantee the disease will continue. While inconvenient, most bumps on the hand caused by Dupuytren’s are not painful. The best course of action is to talk with your doctor to determine the severity of your condition and the right treatment option for you.

Q: Is there anything I can do to make living with Dupuytren’s easier or less painful?

A: Once you have Dupuytren’s, the only way to reduce its effects are through medical treatment. However, there are a few things you can do to reduce the pain and impact it has on your day-to-day life:

Protect your hands. If you have Dupuytren’s, doing exercises or tasks that put extra stress or force on your hands can be uncomfortable and cause further damage. Avoid activities that cause repeated gripping or straining of your fingers. Wearing padded gloves during chores or housework can help. Talk to a physical therapist about other ways to protect your hands during daily activities.

Do post-treatment PT. Doing physical therapy after receiving treatment for Dupuytren’s can help the healing and recovery process. You can learn exercises to improve mobility and daily function that you can continue to do on your own. These exercises directly target your hand and fingers to help alleviate the contracture.

Eliminate smoking tobacco/drinking alcohol. Studies link smoking tobacco and excess consumption of alcohol to an increased risk of developing Dupuytren’s.

Reduce inflammation through diet and supplements. Part of treating Dupuytren’s is reducing inflammation and swelling of the hand. Some experts believe that maintaining a healthy diet and taking anti-inflammatory supplements helps reduce inflammation and can expedite the healing process after surgery. However, this has not been proven.

This patient education resource was created independently with partial support from Endo Phamaceuticals’ philanthropic contribution group. Endo makes XIAFLEX® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture. Xiaflex is mentioned in the story along with other treatments.