Dupuytren's Contracture: Causes, Progression, and Management

What Is Dupuytren's Contracture?

Dupuytren's contracture (or Dupuytren's disease) is a progressive fibroproliferative condition of the palmar fascia, characterised by the formation of nodules and cords of abnormal collagen that progressively shorten the palmar fascia and draw the fingers — most commonly the ring and little fingers — into fixed flexion at the MCP and PIP joints. The condition is named after Baron Guillaume Dupuytren, the French surgeon who performed the first subcutaneous fasciotomy for the condition in 1831.

Dupuytren's disease is common in populations of Northern European descent (prevalence approximately 8–39% in males over 60 in Scandinavian populations), with a strong male predominance (male:female ratio approximately 5:1), familial clustering, and association with smoking, diabetes, alcohol use, and manual labour. It is also associated with the broader spectrum of fibromatoses including Peyronie's disease (penile fascia), Ledderhose disease (plantar fascia), and knuckle pads.

Clinical Progression and Assessment

The disease progresses through three phases: a proliferative phase with active nodule formation, often associated with tenderness; an involutional phase where the nodular tissue retracts and forms cords; and a residual phase of mature, contracted cord. The rate of progression varies enormously — some cases remain stable for decades, others progress to functionally significant contracture within years. The Hueston tabletop test — inability to place the palm flat on a table — provides a simple functional indicator of clinically significant contracture requiring consideration of intervention.

Manual therapy cannot reverse established Dupuytren's contracture — the pathological collagen is structurally distinct from normal fascial tissue, and stretching or massage will not resolve it. The clinical role of manual therapy is to address secondary myofascial restrictions in the intrinsic hand muscles and flexor tendons that develop around the contracture, and to provide post-procedural rehabilitation. Intervention options include collagenase clostridial histolyticum (CCH) injection (Xiaflex), needle fasciotomy, and open surgical fasciectomy. Each has different complication profiles and recurrence rates.