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Dupuytren contracture

Last updated: October 16, 2020

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Dupuytren contracture is a common fibroproliferative disorder affecting the palmar fascia mainly of the 4th and 5th fingers, particularly in males. The etiology is uncertain. Trauma (manual labor, pneumatic tools) or ischemic injury (cigarette smoking, diabetes) are thought to stimulate fibroblast proliferation and collagen deposition in the palmar fascia of genetically susceptible individuals. Skin puckering proximal to the flexor crease of the affected finger is the earliest sign. As the disease progresses, nodules and cords develop in the palmar fascia, causing flexion contractures to develop at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Patients with Dupuytren contracture may also have fibroproliferative disorders at other sites (e.g., plantar fibromatosis and Peyronie disease). Diagnosis is usually clinical but ultrasound can demonstrate the nodules and cords of the palmar fascia. Treatment depends on the severity of the disease. Observation, passive finger extension exercises, and/or splints are useful in early disease. Patients with moderately severe contractures can be treated with intralesional injections of corticosteroid or collagenase. Severe contractures are best treated with surgery (fasciectomy, fasciotomy). Prognosis is variable, with the disease remaining indolent for many years or progressing rapidly. Regression is seen in approx. 10% of patients, and recurrence rates are high (approx. 60%) regardless of treatment.

Epidemiological data refers to the US, unless otherwise specified.

The exact etiology is unknown, but several factors appear to play a role in the development of the disease. [4]

Differential diagnosis of Dupuytren contracture

Condition Etiology Clinical features [11]

Palmar fasciitis

Claw hand deformity
  • Extension of the MCP with PIP and DIP flexion
  • 4th and 5th fingers affected
  • Numbness of the ulnar aspect of the palm

Stenosing tenosynovitis

(trigger finger)

  • Painful locking of a finger in flexed position; releases suddenly with a snap/pop on extension
  • A tender nodule is often palpable at the base of the metacarpophalangeal joint
  • Mostly affects thumbs and ring fingers

The differential diagnoses listed here are not exhaustive.

  • Conservative therapy: Indicated in patients with early disease (skin puckering; nodules) and no functional disability. [4]
  • Intralesional injections: Indicated in patients with rapidly progressing disease or painful nodules [4]
  • Surgery: Indicated in patients with functional disability due to contractures [9]
  • Prognosis
    • Variable prognosis [4][9]
    • Recurrence rates are high, even after surgery (∼ 60%) [9]
  1. W A Townley, R Baker, N Sheppard, A O Grobbelaar. Dupuytren's contracture unfolded. BMJ. 2006; 332 (7538): p.397-400. doi: 10.1136/bmj.332.7538.397 . | Open in Read by QxMD
  2. Riesmeijer SA, Werker PMN, Nolte IM. Ethnic differences in prevalence of Dupuytren disease can partly be explained by known genetic risk variants. European Journal of Human Genetics. 2019; 27 (12): p.1876-1884. doi: 10.1038/s41431-019-0483-5 . | Open in Read by QxMD
  3. Dana Britt DiBenedetti, Dat Nguyen, Laurie Zografos, Ryan Ziemiecki, Xiaolei Zhou. Prevalence, Incidence, and Treatments of Dupuytren's Disease in the United States: Results from a Population-Based Study. Hand. 2010; 6 (2): p.149-158. doi: 10.1007/s11552-010-9306-4 . | Open in Read by QxMD
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  5. Shih B, Bayat A. Scientific understanding and clinical management of Dupuytren disease.. Nature reviews. Rheumatology. 2010; 6 (12): p.715-26. doi: 10.1038/nrrheum.2010.180 . | Open in Read by QxMD
  6. Attali P, Ink O, Pelletier G et al. Dupuytren's contracture, alcohol consumption, and chronic liver disease. Arch Intern Med. 1987; 147 (6): p.1065-7.
  7. Mayerl C, Del Frari B, Parson W, et al. Characterisation of the inflammatory response in Dupuytren’s disease. Journal of Plastic Surgery and Hand Surgery. 2016; 50 (3): p.171-179. doi: 10.3109/2000656x.2016.1140054 . | Open in Read by QxMD
  8. K Baird. T-cell-mediated response in Dupuytren's disease. The Lancet. 1993; 341 (8861): p.1622-1623. doi: 10.1016/0140-6736(93)90760-e . | Open in Read by QxMD
  9. Townley WA, Baker R, Sheppard N, Grobbelaar AO. Dupuytren's contracture unfolded. BMJ. 2006; 332 (7538): p.397–400.
  10. Akdag O, Yildiran G, Karamese M, Tosun Z. Dupuytren-Like Contracture of the Foot: Ledderhose Disease. The Surgery Journal. 2016; 02 (03): p.e102-e104. doi: 10.1055/s-0036-1593355 . | Open in Read by QxMD
  11. Yazici Y. Malignancy and rheumatic disorders. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/malignancy-and-rheumatic-disorders?source=see_link§ionName=Palmar%20fibromatosis&anchor=H12#H12.Last updated: July 10, 2015. Accessed: December 18, 2016.
  12. Denschlag D. Palmar fasciitis and polyarthritis as a paraneoplastic syndrome associated with tubal carcinoma: a case report. Ann Rheum Dis. 2004; 63 (9): p.1177-1178. doi: 10.1136/ard.2003.015693 . | Open in Read by QxMD
  13. Shaw RB Jr, Chong AK, Zhang A, Hentz VR, Chang J. Dupuytren's disease: history, diagnosis, and treatment.. Plast Reconstr Surg. 2007; 120 (3): p.44e-54e. doi: 10.1097/01.prs.0000278455.63546.03 . | Open in Read by QxMD
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  15. Upreti V, Vasdev V, Dhull P, Patnaik SK.. Prayer sign in diabetes mellitus. Indian Journal of Endocrinology and Metabolism. 2013; 17(4): (4): p.769-770.
  16. Cherqaoui R, Mckenzie S, Nunlee-Bland G. Diabetic cheiroarthropathy: a case report and review of the literature. Case Reports in Endocrinology. 2013 . doi: 10.1155/2013/257028 . | Open in Read by QxMD
  17. De Keyser F. Ganglion cysts of the wrist and hand. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/ganglion-cysts-of-the-wrist-and-hand.Last updated: August 24, 2015. Accessed: December 18, 2016.
  18. camptodactyly. http://www.orthobullets.com/hand/6074/camptodactyly. . Accessed: December 18, 2016.
  19. Magro G, Lanterni E, Micali G, Paravizzini G, Travali S, Lanzafame S. Myofibroblasts of Palmar Fibromatosis co-express transforming growth factor-alpha and epidermal growth factor receptor. The Journal of Pathology. 1997; 181 (2): p.213–217.
  20. Brant WO, Bella AJ, Lue TF. Peyronie's disease: Diagnosis and medical management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/peyronies-disease-diagnosis-and-medical-management#H9.Last updated: May 26, 2016. Accessed: December 18, 2016.
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  22. Hougeir FG. Plantar Fibromatosis. In: Elston DM, Plantar Fibromatosis. New York, NY: WebMD. http://emedicine.medscape.com/article/1061903-overview#showall. Updated: June 3, 2016. Accessed: December 18, 2016.