Dupuytren’s Disease Symptoms & Treatment Options

Dupuytren's disease, also known as Dupuytren's contracture, is a condition where the tissue in the palm of your hand starts to thicken. This can lead to small, hard lumps forming on the palm and might cause your ring finger or pinky to curl inward toward your palm over time. This makes everyday activities involving your hand more difficult.

Dupuytren’s disease is most prevalent among individuals of Scandinavian or Northern European descent and often runs in families, indicating a strong hereditary link. While the condition is typically passed down through generations, the precise cause of Dupuytren’s remains unclear, and in many cases, it develops without any identifiable triggers. 

If you’ve experienced symptoms of Dupuytren’s disease, contact Houston Methodist Orthopedics & Sports Medicine to schedule your appointment with a certified hand specialist in our orthopedics department.

Understanding Dupuytren’s Disease

Dupuytren’s disease progresses through three stages (proliferative, involution and residual). These stages take on different forms, from initial nodules to the development of thick cords in the palm to severe contractures that can dramatically impair the mobility of your hand.

Early Signs and Progression

• Nodules appear in the palm: Usually, the first sign of the condition is the appearance of firm lumps in the palm, which are sometimes painful. These nodules form within the tissue of the hand.
• Thickened skin of the palm (i.e., cords or pitting): As the disease advances, your skin may appear puckered or dimpled.

Advanced Contractures

• Fingers drawn into the palm: As Dupuytren’s disease progresses, it can result in your fingers curling inward (contractures).
• Reduced hand function: These contractures can significantly hinder your ability to straighten your fingers, making everyday tasks very complicated.

Related Hand Conditions

• Garrod pads (knuckle pads): This condition presents as thickened skin over the knuckles and can develop independently or with Dupuytren’s. 
• Ledderhose disease (plantar fibromatosis): A similar condition, but it affects the feet. 
• Peyronie's disease: A related fibrotic condition that results in curvature and discomfort in the penis.

Our Treatment Options for Dupuytren’s Disease

At Houston Methodist, our treatment approach begins with the goal of reducing symptoms and restoring hand functionality. Depending on the severity of the disease and other risk factors, our physicians may recommend a variety of treatments:

• Enzyme injections (collagenase injections): These injections specifically target and break down the collagen in the affected fascia to help relieve contractures.
• Needle aponeurotomy: Also called needle fasciotomy, this is a minimally invasive technique that breaks up the cords pulling the fingers inward, improving range of motion. This technique uses a blade or needle bevel to cut one or more of the contractures. 
• Physical therapy: Physical therapy can help patients regain and maintain hand mobility while preventing worsened symptoms.
• Radiation therapy: Low-dose radiotherapy in the early stages may help to shrink or soften nodules and slow disease progression. This type of therapy is not commonly performed in the United States because it increases the risk of sarcoma, a rare cancer that develops in connective tissues, such as bones, muscles, fat, blood vessels and nerves.
• Splinting: Splints may be used to stretch the affected fingers and help patients regain hand functionality or to assist with wound healing after surgery. 
• Steroid injections: In cases where the lumps in your palm are painful, your physician may recommend corticosteroids. 
• Surgical removal of diseased tissue (fasciectomy): More severe cases may call for the removal of the diseased fascia to straighten the fingers or a skin graft, which can improve functioning and decrease symptoms. 

Signs and Symptoms of Dupuytren’s Disease

While it’s essential to consult with a hand specialist for an accurate diagnosis, some of the signs can include:

• Decreased range of motion or pain: Stiffness in the finger joints, inability to fully stretch your hands and a loss of dexterity may be signs of Dupuytren’s. 
• Difficulty laying the hand flat: Difficulty laying the hand flat, often referred to as failing the tabletop test, can be a strong indicator of advanced Dupuytren’s.
• Finger contractures: Fingers, particularly the ring and little fingers, may start curling inward. 
• Lumps in the palm: You may notice that firm bumps develop on the tissue of your palm early in the disease.
• Skin pitting: The skin on your palm may appear puckered or dimpled. 

There are other diagnoses (i.e., trigger finger) that can result in your finger being stuck in a bent position. n many cases, Dupuytren’s disease is usually a matter of family history, as it’s typically passed from generation to generation. However, the exact cause of Dupuytren’s is still unknown. 

How We Diagnose Your Dupuytren’s Disease

The orthopedic specialists at Houston Methodist treat every case individually and comprehensively. Our team uses the latest diagnostic techniques to pinpoint your hand issues and develop an effective treatment plan. The mainstay for diagnosis for Dupuytren’s is a physical exam, where your doctor will assess your hand for nodules, skin changes and finger mobility.

Helping Patients Manage Dupuytren’s Disease

The management of Dupuytren’s disease can vary depending on the severity of the disease, progression and many other factors. In many cases, effective treatment requires a combination of therapies that are specifically tailored to the stage of Dupuytren’s and your lifestyle. 

Depending on the circumstances, your physician may recommend collagenase injections, physical therapy, lifestyle changes and other treatments to help minimize discomfort and maintain overall hand function. 

Regain Your Hand Strength and Functionality After Dupuytren’s Disease

The hand specialists at Houston Methodist offer specialized care for Dupuytren’s disease. Our treatment plans are designed to restore as much functionality as possible, reduce pain and improve your quality of life. Contact us to schedule an appointment with an orthopedic specialist today.