Dupuytren contracture

Also called: Palmar fibromatosis; bent finger

See someone before self-treating

Fingers pulled progressively into the palm by thickening cords in the fascia. It is a fibrotic disease of connective tissue, not a muscle or tendon problem - and stretching and exercise do not reverse it.

How common: 5-10% of adults over 60 in northern European populations

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What it is

Dupuytren's disease is progressive fibrosis of the palmar fascia, the sheet of connective tissue under the skin of the palm. Nodules form, then cords, and the cords contract and pull the fingers - usually the ring and little fingers - into permanent flexion.

It is important to be straightforward: this is a fibrotic disease of the fascia itself. It is not caused by tight muscles or short tendons, and no amount of stretching, massage or exercise reverses established contracture. The useful things are recognising it, monitoring it, and knowing when treatment is indicated.

What it feels like

A firm lump or nodule in the palm, usually at the base of the ring or little finger
Thickened cords running from the palm into the finger
The finger gradually becoming unable to straighten fully
Difficulty putting the hand flat on a table, which is the standard test
Usually painless, though early nodules can be tender

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Fibrosis of the palmar fascia: Fibroblasts in the palmar fascia proliferate and lay down excessive collagen, forming nodules and then contracting cords. It is a disease of the connective tissue itself.
Genetics: Strongly inherited, with a marked prevalence in people of Northern European descent - it is sometimes called Viking disease for that reason. Family history is one of the strongest predictors.
Sex and age: Considerably more common in men, and prevalence rises steeply after fifty. Onset before forty is associated with more aggressive disease.
Diabetes: Substantially more common in people with diabetes, though the pattern tends to be milder and involves the middle fingers more often.
Alcohol: Associated with a higher prevalence, independently of liver disease.
Smoking: Associated with both prevalence and severity, probably through effects on small blood vessels.
Epilepsy and some anticonvulsants: A long-recognised association, though the mechanism is not established.
Associated fibrotic conditions: Knuckle pads, plantar fibromatosis in the foot and Peyronie's disease all cluster with it, which supports it being a systemic tendency to fibrosis rather than a local hand problem.
Not manual work: Long assumed to be caused by heavy hand use, and the evidence for occupational causation is weak. Vibration exposure has some association; ordinary manual work does not.
Treating it as tightness: Not a cause, but the reason people spend years stretching. Established cords do not stretch out, and time spent trying is time before treatment.

Who tends to get it

Men over fifty, particularly of Northern European descent
Anyone with a family history, which is the strongest single factor
People with diabetes
Smokers and regular drinkers
Anyone with knuckle pads, plantar fibromatosis or Peyronie's disease

What makes it worse, and what settles it

Makes it worse

Waiting until the contracture is severe, since results are better with earlier treatment
Expecting stretching or massage to reverse it, which it does not
Smoking and heavy alcohol use, both associated with progression
Aggressive stretching of nodules, which can irritate them without changing anything
Assuming any lump in the palm is Dupuytren's, since other conditions occur there

Settles it

Getting it properly diagnosed and monitored, since timing of treatment matters
The tabletop test at home - if the hand cannot be laid flat, that is the point to seek assessment
Needle fasciotomy, collagenase injection or surgery, depending on the pattern and severity
Hand therapy and splinting after treatment, which is where exercise genuinely contributes
Stopping smoking and moderating alcohol

What actually helps

The short version: Progressive fibrosis of the palmar fascia pulling fingers into flexion. It is a fibrotic disease, not a muscle or tendon problem

Strength work: Not effective

Stretching: Not effective - stretching does not slow or reverse it

Massage: Not effective

Also worth doing: Needle fasciotomy, collagenase injection, or surgery when the hand no longer lies flat on a table

What the evidence says: LISTED DELIBERATELY AS A NEGATIVE ENTRY: a recommendation engine should know what NOT to offer. Stretching a Dupuytren cord wastes the user's time and delays effective treatment.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

No ready-made routine for this one yet

249 of the 267 problems here have a routine already built, and this is not one of them — usually because the work that helps is covered by a general routine rather than needing its own. What actually helps above names the muscles and the work involved, which is enough to put it together yourself.

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Get it checked if…

Refer when the finger cannot be straightened on a tabletop test

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Dupuytren's is progressive in most people but the rate varies enormously - some people have a nodule for decades that never contracts. Treatment is indicated when the finger cannot be straightened enough to lay the hand flat on a table, and needle release, injection and surgery are all effective with different recurrence rates. Recurrence is common whichever treatment is used, particularly in younger patients with a strong family history. Exercise has a genuine role after treatment and none before it.

Prevalence basis: Hand surgery epidemiology

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

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