Why Won’t My Finger Straighten? Understanding Dupuytren’s Contracture
Have you noticed a firm lump in the palm of your hand? Does one of your fingers seem to be slowly curling toward your palm—or becoming harder to straighten? It may be more than simple hand stiffness. Dupuytren’s contracture is a hand condition that can gradually cause one or more fingers to bend toward the palm. While it is usually not painful, it can eventually interfere with everyday activities such as shaking hands, putting on gloves, reaching into a pocket, typing, gripping objects, or placing your hand flat on a table.
The good news? Not everyone with Dupuytren’s contracture needs treatment, and when the condition begins interfering with hand function, several treatment options may help.
What Is Dupuytren’s Contracture?
Dupuytren’s contracture, also called Dupuytren’s disease, affects the connective tissue, called fascia, beneath the skin of the palm. Normally, this tissue helps support the hand. With Dupuytren’s disease, the fascia begins to thicken and tighten. Small lumps, or nodules, may develop in the palm and can eventually form thick, cord-like bands beneath the skin. As these cords tighten, they can pull the fingers toward the palm, making it difficult—or sometimes impossible—to completely straighten them.
Dupuytren’s contracture most commonly affects the ring and pinky fingers, although other fingers can also be involved. It may occur in one or both hands.
What Causes Dupuytren’s Contracture?
The exact cause of Dupuytren’s contracture is not fully understood. However, genetics appear to play an important role, and the condition can run in families. Certain factors are associated with a higher likelihood of developing Dupuytren’s disease, including:
- Being over age 50
- Being male
- Having a family history of Dupuytren’s contracture
- Northern European or Scandinavian ancestry
- Diabetes
- Tobacco use
- Heavy alcohol use
Dupuytren’s contracture is not simply caused by using your hands too much, and everyday activities such as typing, gripping, or exercising are not considered direct causes.
What Are the Symptoms?
Dupuytren’s disease usually develops slowly, sometimes progressing over several years. One of the earliest signs may be a small, firm lump or thickened area in the palm. Over time, additional changes may occur, including puckering or dimpling of the skin, thick bands or cords beneath the palm, increasing finger stiffness, and one or more fingers beginning to curl inward.
A simple way to check your hand function is the tabletop test. Place your hand flat on a table with your palm facing downward. If you cannot get your palm and fingers to lie flat against the surface, particularly because a finger remains bent, consider discussing the change with a healthcare provider or hand and upper extremity specialist.
How Is Dupuytren’s Contracture Treated?
Treatment depends on how far the condition has progressed and how much it affects your daily life. If you have a small nodule but can still fully use and straighten your fingers, your provider may recommend monitoring the condition rather than treating it immediately. When a contracture begins limiting hand function, treatment may be considered. Options can include procedures that release or break apart the tightened cord, depending on the individual case.
For more advanced Dupuytren’s contracture, hand surgery may be recommended. A procedure called a fasciectomy removes affected tissue to help improve the finger’s ability to straighten. The best treatment depends on several factors, including which fingers are involved, the severity of the contracture, your overall health, and whether Dupuytren’s disease has returned after previous treatment.
What Is Recovery Like?
Recovery varies depending on the type of treatment. After a minimally invasive procedure, some people can return to light activities relatively quickly. Recovery following Dupuytren’s contracture surgery may take longer as swelling decreases and the incision heals. Your care team may recommend a splint and hand or occupational therapy to help restore motion and hand function. Therapy can be especially important after treatment to address stiffness, swelling, range of motion, and safe use of the hand. It is also important to know that treatment can improve the contracture, but Dupuytren’s disease can return or progress over time.
Can Exercises Help Dupuytren’s Contracture?
Exercises cannot remove or “break up” the abnormal tissue responsible for Dupuytren’s contracture. However, gentle hand exercises may help maintain mobility and can be an important part of rehabilitation after treatment when recommended by your healthcare provider or hand therapist. One simple mobility exercise is gentle finger extension:
Place your hand palm-down on a flat surface. Without forcing the fingers, gently work toward straightening them against the surface. Hold briefly, relax, and repeat as comfortable. Avoid aggressively forcing a contracted finger straight. If your finger is becoming increasingly bent or your hand function is changing, a hand specialist or certified hand therapist can recommend exercises appropriate for your condition.
When Should You See a Hand Specialist?
Dupuytren’s contracture often progresses gradually, which can make early changes easy to overlook. Consider seeking an evaluation if you notice a new lump or cord in your palm, increasing difficulty straightening a finger, or a bent finger that is beginning to interfere with daily activities.
You do not have to wait until your finger is severely contracted to ask about it.
If a finger that once straightened normally is beginning to curl toward your palm, an orthopedic or hand specialist can determine whether Dupuytren’s contracture may be the cause and discuss the appropriate next steps.
Don’t let a tightening hand tighten its grip on your daily life. If you are experiencing finger stiffness, a bent finger, or other changes in your hand function, the orthopedic team at Waterbury Hospital can help evaluate your symptoms and discuss treatment options to keep your hands moving!
