Dupuytren's contracture is a fairly common condition that occurs when the connective tissue or fascia under the skin begins to thicken and shorten. As the tissue tightens, it may pull the fingers down towards the palm of the hand. In some individuals, the condition may progress until the involved fingers become disabled.
The first sign is a thickening or nodule in the palm of the hand that most frequently develops near the base of the ring or little finger. The nodule, which can resemble a callus, may be tender to the touch. Gradually, other nodules may develop and extend a contracture across the first joint into the finger. The overlying skin begins to pucker, and rough cords of tissue extend into the finger. As the process continues, these cords tighten and pull the finger in toward the palm. The ring finger is usually affected first, followed by the little, long and index fingers. The problem is not pain, but the restriction of motion and the deformity it causes.
A physical examination of the palm by touch called palpation confirms the presence of the contracture or shortening of the tissue. A good guideline for determining when to consider surgery is the "table top test." Try to place the palm of your hand completely flat on a hard surface. If you can't, the contracture has progressed to a point where surgical intervention may be helpful.
The only treatment for this condition is surgery, which is usually reserved for individuals who have developed deformity as a result of the progressive condition. Several different surgical techniques can be used to remove the thickened fascia and correct the contracture. The aim of the surgery is to release the contracture and improve hand function by removing the diseased tissue.
Reviewed by health care specialists at UCSF Medical Center.