Dupuytren's Contracture

A slow thickening of the tissue under the skin of the palm that can pull the fingers into a bent position over time.

Palm of a hand showing a firm nodule and pit in the skin at the base of the ring finger, typical early signs of Dupuytren's — Early Dupuytren's often shows up as a firm nodule and a small pit in the skin of the palm.

What is Dupuytren's contracture?

Dupuytren's contracture is a condition in which the layer of tissue just under the skin of the palm (called the palmar fascia) slowly thickens and forms firm cords. Over years, those cords can shorten and pull one or more fingers into a bent position that you cannot fully straighten. The ring and small fingers are most often involved. It is generally not painful, but as it progresses it can make everyday tasks like putting on gloves, washing your face, or shaking hands difficult.

Palm showing a rope-like Dupuytren's cord running from the palm into the ring finger — Over time, nodules can join into a rope-like cord that pulls the finger into a bent position.

Common symptoms

A firm lump or pit in the palm, often at the base of the ring or small finger
A rope-like cord that runs from the palm into the finger
A finger that will not lay flat on a table (the "tabletop test")
Trouble putting your hand in a pocket or glove
Usually no pain, though the nodules can feel tender early on

Why does it happen?

Dupuytren's is largely genetic. It is more common in people of northern European ancestry, in men more than women, and in people over 50. Diabetes, smoking, and a family history increase the risk. It is not caused by work or hand use.

Treatment options

Non-surgical treatment

Observation. A small nodule with no contracture does not need treatment. We watch it and treat only if the finger starts to bend.
Needle aponeurotomy. A small needle is used in the office to perforate the cord in several places until it snaps, allowing the finger to straighten. Recovery is fast. The cord can come back over time.
Enzyme injection (collagenase). An injection into the cord weakens it, and the finger is straightened a day or two later. Not all patients are candidates.

Surgical treatment

Fasciectomy. The diseased tissue is carefully removed through an incision in the palm and finger. This gives the most complete correction and the lowest recurrence rate, at the cost of a longer recovery and hand therapy.

What to expect at your visit

Dr. Barrera will examine your hand, measure how much each joint is bent, and perform the tabletop test. Treatment is usually recommended when a knuckle cannot fully straighten (usually around 30 degrees of contracture) or when the finger joint is becoming stuck. You will review the options above and pick the one that fits your hand, your tolerance for recovery time, and your risk of recurrence.

Hand resting with the palm down on a tabletop, the tabletop test for Dupuytren's contracture — The tabletop test. If the hand cannot lay flat against a table, treatment is usually recommended.

When to call the office sooner

Call us if you notice the finger bending down quickly over weeks rather than years, if you develop skin breakdown in the palm crease, or if you have new pain, redness, or warmth after a recent injection or procedure.

Questions?

Call your office location for non-urgent questions:

NYU Langone Laurelton · 646-501-4950
NYU Orthopedic, Woodside · 929-429-3222
NYU Orthopedic, Richmond Hill · 718-206-6923
Jamaica Hospital Ambulatory Care Center (ACC) · 718-301-0720

See our office contact information for addresses and fax numbers.