Dupuytren’s Contracture – Diagnosis and Treatment

Diagnosis

Doctors start by looking closely at both hands, checking for skin puckering or any unusual lumps on the palm. They gently press on the palm and fingers to find any hardened nodules or tough bands of fibrous tissue.

A simple test called the tabletop test helps with diagnosis:

Test Name	What Happens
Tabletop Test	Patient tries to lay palm flat; failure suggests contracture.

Doctors also check if any fingers, especially the ring or little finger, cannot straighten fully. They rarely order extra tests like ultrasound. This step-by-step check confirms Dupuytren’s contracture and guides the next steps.

Treatment

Needle Procedure

Doctors can use a needle-based technique to break apart the thick cords under the skin that cause the fingers to bend. The doctor inserts a fine needle through numbed skin, then carefully moves it to separate or snap the cord.

This approach takes place in a doctor’s office, and the doctor can treat more than one finger at a time. Since the procedure does not require large cuts, healing is quicker compared to surgery.

However, this method does not suit every finger position, as some cords are located near nerves or tendons that the needle could accidentally harm. The doctor can repeat the procedure if the contracture returns, although recurrences are common.

Medicine Injections

Doctors may use injections to help manage this condition. There are two main types:

Injection Type	Best For	Recovery Time	Office Visit Needed	Risk of Return
Steroid	Early nodules	Short	Often 1	Moderate
Collagenase Enzyme	Visible cords	Short	2 (injection + manipulation)	Moderate

• Steroid Injections: Doctors sometimes use these early in the process. When a lump forms, a steroid shot may help lessen swelling and discomfort. The steroid may also help soften or flatten the lump, making it less noticeable.
• Collagenase Enzyme Injections: For people with more noticeable cords, doctors inject an enzyme directly into the cord. This weakens and softens the tissue. After the enzyme acts, the doctor gently moves the finger to help break the cord and straighten the digit. The effects can last for years, though the problem can come back.

Surgical Removal

For people with more severe symptoms, surgeons can offer a surgical solution. Surgeons cut and remove the thickened tissue, which allows the fingers to straighten more fully.

This method provides stronger and longer-lasting relief than other treatments, but recovery takes longer.

In extreme cases, the surgeon might take out all affected tissue and sometimes even some of the overlying skin. If this happens, a skin graft helps the area heal.

Advantages:

• Best for severe contractures.
• Can offer the longest improvement.
• Suitable for multiple or severe finger issues.

Considerations:

• Needs more recovery time.
• May require physical therapy afterward.
• Risks include infection and nerve damage.
• Sometimes involves general or regional anesthesia.

Everyday Tips for Managing Dupuytren’s Contracture

People can protect their hands at home with a few simple habits:

• Use gloves with extra padding when handling heavy items.
• Add cushioning, like pipe insulation or soft tape, to tool handles to avoid gripping too hard.

These changes help keep hands more comfortable during daily activities, support range of motion, and may reduce the risk of further problems.

Getting Ready for Your Visit

Steps You Can Take

• Write down any family history of the condition.
• List treatments you have tried and note if they worked.
• Create a list of all medicines and supplements you are currently taking.

Bringing this information helps the healthcare provider understand your situation better.

Questions Your Doctor May Ask

Your healthcare provider, or a referred bone specialist, may ask questions such as:

• When did your symptoms start?
• Have your symptoms gotten worse?
• Do you feel pain in your hand?
• In what ways does this problem make daily life harder?

Thinking about your answers ahead of time might help.