Dupuytren’s disease is primarily characterized by limited movement of the fingers. Those affected can no longer straighten their fingers, causing them to curl toward the palm. The condition is named after the French surgeon Baron Guillaume Dupuytren, who first described the phenomenon of curved fingers in 1832.
In Dupuytren’s disease, the connective tissue in the palms of the hands undergoes structural changes, and excess collagen forms. This results in thickened strands and nodules in both the palms and the fingers. These severely restrict finger mobility, ultimately leading to the development of what is known as Dupuytren’s contracture.
The exact cause of these changes in the hands is not yet fully understood. Since Dupuytren’s disease tends to run in families, researchers believe that genetic factors play a role in its development. It is believed that changes in specific gene regions disrupt cell function, thereby leading to these connective tissue remodeling processes. In people with a genetic predisposition, these remodeling processes appear to be triggered by injuries or other factors.
Furthermore, a connection has been observed between Dupuytren’s disease and other conditions. These include:
Common symptoms such as limited extension and diagnosis of Dupuytren’s contracture at any stage
Generally, the disease develops rather slowly. At first, patients often notice only soft, nodular changes or dimples in the palms of their hands. It is not until a later stage that the typical hard nodules and firm cords on the fingers and/or palms become apparent.
Finger stiffness increases as the disease progresses, but pain does not occur. People with Dupuytren’s disease may initially be unable to straighten one finger, and later, several fingers. Gradually, the fingers bend more and more inward toward the palm. The ring finger and little finger are most commonly affected by the contracture. In the majority of patients, Dupuytren’s disease occurs in both hands.
Typical presentation: Cord-like hardenings in the palm lead to increasing curvature of the fingers.
If fibromatosis of the palmar fascia is suspected, the doctor first examines the hands. If the fingers cannot be straightened and/or are bent toward the palm, this suggests Dupuytren’s disease. In addition, nodules and cord-like connective tissue changes can be felt in the palm. Thickening of the fingers (finger pad enlargement) is also usually noticeable.
However, limited finger mobility can also have other underlying causes. To rule out other possible underlying conditions, such as osteoarthritis of the finger joints, the doctor may order an X-ray.
In addition to the clinical examination, a detailed analysis of the idiopathic fibrosis of the palmar aponeurosis plays a central role in the etiology of Dupuytren’s disease, as the affected tissue exhibits characteristic changes on the palmar side and just dorsal to the tendon sheath. Epidemiological studies show that Dupuytren’s disease occurs 3 to 4 times more frequently in men and is often observed in conjunction with other fibromatoses, such as plantar fibromatosis or even Peyronie’s disease.
The exact cause remains unclear despite intensive research, which is why the diagnosis—within the context of Dupuytren’s etiology and treatment—always takes other systemic factors into account. It is particularly important to assess the spiral course of the finger nerves, as the tissue runs palmar and just dorsal to the neurovascular bundles and can impair their function in advanced stages.
In cases of Dupuytren’s disease, the physician therefore assesses whether the hand’s functionality is already impaired and whether surgery is necessary. The diagnostic process also helps determine whether a conservative treatment phase can halt the progression of the disease or whether surgical intervention is required. Modern guidelines for the management of Dupuytren’s disease emphasize that early intervention can slow or halt the progression of the disease. Even in more complex cases—such as when neurovascular bundles and the palmar side of the tendon sheath on the flexor side of the finger are located distally—differential diagnosis provides crucial information for further treatment.
Treatment of Dupuytren’s Disease—Conservative and Surgical Therapy
Treatment for Dupuytren’s disease primarily involves hand surgery, especially in more advanced stages of the disease. Various surgical procedures may be appropriate to restore finger mobility. For example, the thickened band of connective tissue can be cut through or excised. Depending on the severity of the condition, the connective tissue band in the hand may even be removed completely or partially. As a general rule, the more extensively the surgeon removes the affected tissue, the lower the risk of recurrence.
Healing is very slow in many patients. There is a risk of scar contracture, in which shrinking scar tissue once again restricts finger mobility. Physical therapy can effectively support rehabilitation after surgery, enabling patients to regain the desired mobility in their hand and fingers more quickly.
In surgical practice, the decision on treatment is often based on the total extent of extension deficits across all joints, with the joints of the most severely affected finger being particularly decisive.
Experts such as Robert Michael and Mike Ruettermann describe in the *Deutsches Ärzteblatt* that limited fasciotomy is an effective option in many cases—especially when mobility is significantly restricted but complete removal of the palmar fascia does not appear necessary.
This procedure aims to selectively release the pathologically altered tissue, improve hand function, and simultaneously reduce the risk of more extensive surgery. Careful postoperative follow-up remains essential, however, to stabilize the outcome and prevent a recurrence of movement restrictions as much as possible.
Non-surgical measures are also available for treating Dupuytren’s disease. For example, X-ray radiation as part of radiation therapy can slow the progression of the disease. Similarly, the hardened connective tissue strands in the fingers can be treated using a procedure known as needle fasciotomy. Non-surgical treatment options are particularly suitable for the early stages of the disease. However, since many patients do not seek medical attention until the contracture has progressed, hand surgery is often the only viable treatment option for Dupuytren’s disease. Surgery is strongly recommended, particularly when finger flexion exceeds 30 degrees.
Dupuytren’s disease is thus a condition that, particularly in its advanced stages, is associated with significant limitations in movement for patients. Early treatment can improve finger mobility and may prevent the need for surgery.
Dupuytren’s disease specialists are qualified, trained specialists in hand and plastic surgery. Before specializing, these physicians completed several years of basic surgical training at appropriate hospitals. This is followed by specialized training as plastic surgeons at hospitals specializing in plastic and hand surgery. Dupuytren’s disease specialists have both comprehensive surgical residency training and highly specialized advanced training based on the latest research at specialized clinics in Germany and abroad.
Following surgical treatment, the focus shifts to the postoperative management of Dupuytren’s disease to prevent complications and improve long-term mobility. However, the idiopathic fibrosis of the palmar aponeurosis remains a chronic condition that can continue to progress even after surgery. It is therefore crucial to accurately assess the stage of the disease before and after surgery, as both the prognosis and treatment options depend on this.
Many patients initially exhibit some loss of extension postoperatively, which is often reduced with consistent physical therapy. Nevertheless, new connective tissue cord formations may occur, which is a known risk of this condition.
It is particularly important to recognize and treat potential complications, such as scar contractures, at an early stage. Since the condition often affects both hands, long-term, individualized care is essential. For patients, this means that regular follow-up visits, functional training, and, if necessary, additional therapeutic measures remain necessary to maintain the best possible hand function.
Does fibrosis in Dupuytren’s disease always progress to significant hardening of the palm?
In Dupuytren’s disease, fibrosis usually leads to increasing hardening and thickening of the tissue in the palm. The rate at which these changes occur varies from person to person. In some patients, the course of the disease remains mild, while in others, significant cord formation develops. The key factor is whether the changes stabilize or progress toward a flexion contracture.
Why does the disease take an aggressive course in some patients?
Aggressive courses are often linked to a genetic predisposition. People who develop the disease at an early age or have a family history of the condition often develop cord-like formations more quickly. Additional factors, such as comorbidities, can also influence the rate of progression. Such courses of the disease require close monitoring and early treatment planning.
Is it true that men are affected more often than women?
Yes—statistically, men are affected significantly more often than women. In addition, the disease is often more pronounced in men. In many cases, the cord first becomes visible on the most severely affected finger before spreading to other fingers. Women usually develop the disease later and at a slower rate.
Which structures must be particularly protected during surgery?
During surgical procedures, the neurovascular bundles and the palmar tendon structures play a crucial role. Some of these structures run close to the pathologically altered tendons and must be carefully identified and protected. A precise surgical technique reduces the risk of sensory disturbances or circulatory problems.
Is postoperative follow-up care necessary, and what role does the Ruettermann technique play in this?
Structured postoperative follow-up care is important to ensure the mobility and function of the hand. This includes splinting, manual therapy, and targeted exercises. The Ruettermann technique describes a structured approach to follow-up care and recurrence prevention. It helps prevent the reformation of cord-like structures and maintain long-term hand function.
