Dupuytren's Contracture

Overview

Disease where the fascia in the palm and fingers thickens and shortens
Results in flexion contractures to occur in the fingers
- Ring and pinky finger is most often affected
Cause is genetics

Anatomy

Key structured involved:
- Palmar fascia: Layer of connective tissue under the palm
  - This fascia thickens and tightens, forming "cords" or rope-like bands that pull the fingers into a flexed position
  - The cords are so prevalent they can be mistaken for tendons
- Joints involved are usually the MCP and PIP joints of the affected finger(s)

Image adapted from Gordon Groh, D. (n.d.). A Patient’s Guide to Dupuytren’s Disease. Dr. Gordon Groh Orthopaedic Clinic. Retrieved from https://www.drgordongroh.com/orthopaedic-injuries-treatment/hand-wrist/dupuytrens-disease/

Causes

Fibroblasts (the cells in the connective tissue that help with repair) become overactive due to a combination of genetics, cell signaling problems, and inflammation
The fibroblasts produce too much collagen which makes the connective tissue thick and stiff
Some fibroblasts become myofibroblasts (special cells that are a mix of fibroblasts and muscle cells), which can contract and make the connective tissue even more stiff
Over time, this thick connective tissue clumps together into small nodules, which then progress into form cords
More prevalent in men
More prevalent in Northern European ancestry - condition even has a nickname called " viking disease"

Symptoms

Painless nodules in the palm (usually at the distal palmar crease)
Thick cords in the palm
Flexion contractures at the MCP and PIP joints
Loss of finger extension
Tenderness

Prognosis/Timeline

Varying prognosis for each person
Corticosteroid injection
- Recurrence up to 50%
- Risk of a flexor tendon rupturing (due to the tendons being close to the palmar fascia in the palm)
Xiaflux injection and manipulation
- Xiaflux s an enzyme that breaks down collagen in the cords
- After a few days, the doctor will numb the hand and manually manipulate the fingers into extension to rupture the now weakened cords
- Is nearly as effective as surgery
Surgery can involve partial or total removal of affected palmar fascia tissue
- Recurrence up to 30% at 1-2 years post-op
Recurrence of the disease is unfortunately prevalent in many cases following conservative and surgical treatment
- Average of 20-50% recurrence rate at 5 years post any form of treatment

Treatment Ideas

Always ask your fieldwork educator or supervising therapist and review any followed protocols before implementing any of the following

Finger AROM targeting extension to combat the flexion contractures

Modified prayer stretch targeting finger extension

Tendon glides to help the flexor tendons glide more smoothly as they can become restricted from the thickened palmar fascia

Quiz Questions

1. What is Dupuytren’s contracture?

A. Inflammation of finger tendons

B. Thickening and shortening of fascia in the palm and fingers

C. Dislocation of the MCP joint

D. Rupture of the extensor tendon

2. Which fingers are most commonly affected in Dupuytren’s contracture?

A. Index and middle fingers

B. Thumb and index finger

C. Ring and pinky fingers

D. Middle and ring fingers

3. What tissue forms rope-like cords that pull the fingers into flexion?

A. Flexor tendons

B. Palmar fascia

C. Joint capsule

D. Extensor mechanism

4. What joints are typically affected by Dupuytren’s contracture?

A. DIP only

B. MCP and PIP

C. CMC and IP

D. Radiocarpal and MCP

5. What causes the connective tissue in Dupuytren’s to thicken and stiffen?

A. Loss of synovial fluid

B. Inactive fibroblasts

C. Overproduction of collagen by overactive fibroblasts

D. Ligament tears

6. How do cords in Dupuytren’s differ from tendons?

A. Cords are vascular, tendons are not

B. Cords are in the dorsal hand

C. Cords are thickened fascia and can be mistaken for tendons

D. Cords run vertically while tendons run horizontally

7. Over time, Dupuytren’s contracture results in:

A. Triggering and locking of the thumb

B. Flexion contractures and loss of extension

C. Joint dislocation

D. Wrist instability

Quiz Answers

References

Walthall, J., Anand, P., & Rehman, U. H. (2025). Dupuytren contracture. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK526074/

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