Dupuytren's Contracture

Dupuytren’s affects the tissue under the skin of your palm or fingers called the fascia. The fascia becomes thicker and less flexible. Over months or years, it can make your fingers bend towards your palm. This bending is called a contracture. Dupuytren’s can sometimes be uncomfortable or painful. There is no cure yet for Dupuytren’s disease. Treatment can help to straighten your fingers and may improve the use of your hand, but it does not get rid of the disease.

The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors such as age, lifestyle factors and certain medical conditions (e.g. diabetes), that may increase your chance of developing the condition.

• Not being able to straighten your finger(s)
• Not being able to lay your hand flat on a table, palm down (called the tabletop test)
• One or more small, tender lumps (nodules) at the base of the fingers on the palm. Over time, the tenderness usually goes away
• The nodules may thicken and contract or tighten
• Pits or grooves appear in the skin caused by the bent (contracted) finger. These areas can become very sore and can lead to skin loss if they don’t heal properly
• You can't use your hand as you normally would

Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.

Further tests such as X-ray, MRI or ultrasound scan are rarely required, but may be performed if the Health Care Professional needs further information to finalise the diagnosis or if surgery is being considered.

There are a few things you can try to help you manage your Dupuytrens Contracture:

• Heat Therapy: Applying heat to the palms of the hand prior to massage or exercise can help to loosen the tissues
• Massage: Gently massage the thickened tissues of the palm
• Exercises: Gently straighten the fingers and feel the stretch in the palm of the hand

It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.

The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.

Soft tissue release in palm

Sit upright on a stable chair or wheelchair with your back supported. Ensure both feet are placed flat. Place a pillow on your lap and rest your affected arm onto it, palm facing up. Ensure your wrist is as straight as possible. Support the back of your hand with the fingers of your other hand. Using the flat of your thumb, firmly massage across the palm, stretching the width of the palm.

Finger extension stretch against a table

Place your hand on the table, palm down.
Gently straighten your fingers as flat as you can against the table.
Hold the stretch for a moment and then relax.

You should see a Health Care Professional if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have any tingling or loss of sensation in your hand or wrist 
• Notice changes to your grip strength and are frequently dropping things
• Have severe pain after trauma, such as a fall, collision, or impact to the wrist or hand
• Notice your fingers becomes acutely red hot and swollen without any prior explanation of activity/overuse

If you do not have any of the above, you may be able to effectively self manage your condition

Decision support tools, also called patient decision aids, support shared decision making by making treatment, care and support options explicit. They provide evidence-based information about the associated benefits/harms and help patients to consider what matters most to them in relation to the possible outcomes, including doing nothing.

These decision support tools are designed to support shared decision making between people and a clinician. People may find they are useful before, during or between consultations depending on their care pathway.