Early Signs of Dupuytren’s Disease: What to Look for Before a Finger Bends
Dupuytren’s disease, also called Dupuytren’s contracture, is a thickening of tissue under the skin of the palm, and its early signs are a firm lump and puckered or dimpled skin in the palm. Most lumps are painless, according to Mayo Clinic, so pain is not a reliable signal to wait for.
About 5% of people in the United States have Dupuytren’s contracture, and as a finger bends, everyday tasks like putting on gloves, shaking hands or reaching into pockets can get difficult. It can also be hard to grasp large objects, and in some people it becomes difficult or impossible to prepare food, write or play an instrument. A bend in the middle joint of the finger is harder to treat and less likely to recover fully than a bend at the knuckle.
Dupuytren’s contracture tends to run in families and is the most common inherited disorder of connective tissue, yet some people who inherit the gene changes never develop it. Men are much more likely to develop it than women, and in men it most often appears after age 50. In women, it tends to appear later and be less severe, and it can start at any time of life. People with diabetes or seizure disorders are also more likely to have it.
Key takeaways about Dupuytren’s contracture
- The early signs of Dupuytren’s contracture are a firm lump in the palm, puckered skin and a finger that will not fully straighten, and most lumps are painless, though some people notice tenderness, burning or itching
- To check for Dupuytren’s contracture at home, lay your hand flat on a table and feel your palm for a lump or puckered skin, and see a healthcare professional if the hand will not lie flat or you find either
- A lump in the palm can be Dupuytren’s contracture, a ganglion cyst, a trigger finger nodule or a callus, so a hand specialist examines the hand to tell them apart
- The exact cause of Dupuytren’s contracture is unknown, but genetics appear to play the biggest role, and no single trigger has been pinned down
- Dupuytren’s contracture usually does not go away on its own, though for some people the lumps stay the only sign
- Dupuytren’s contracture is not cancer or life threatening, but it becomes harder to treat as it progresses, so a hand specialist should see it early
What are the early signs of Dupuytren’s disease?
The early signs of Dupuytren’s disease start in the palm, usually with a small, hard lump you can see and feel under the skin. The skin over the lump may look puckered or dimpled, and the lump is usually painless.
| Sign | What you may notice |
|---|---|
| Lump | A firm lump in the palm that is usually painless. |
| Puckered skin | The skin over the lump may look puckered or dimpled. |
| Hard cord | Over months or years, a cord can form and pull the finger toward the palm, and the cord can look like a tendon even though the tendons are not involved. |
| Bent finger | The finger will not fully straighten, and the ring finger is most often involved, followed by the little finger. |
Doctors use “Dupuytren’s disease” for the whole condition and save “contracture” for the later stage when a finger can no longer fully straighten. That means a lump or a cord can be there for months or years before any finger bends, and for some people the lumps stay the only sign.
Tenderness, burning and itching
About one in four people with Dupuytren’s contracture feel uncomfortable inflammation, tenderness, burning or itching in the affected hand, and some also feel pressure or tension, especially when trying to straighten a finger. The lump may feel tender at first, and the tenderness usually fades.
Mayo Clinic, MedlinePlus and OrthoInfo do not say whether burning or itching comes before the lump, how long it lasts, or how far ahead of a bent finger it tends to show up. If you notice these sensations in your palm, mention them to a healthcare professional along with any lump or skin change.
How can you check for early Dupuytren’s disease at home?
Lay your hand flat on a table, palm down, and see whether every finger rests against the surface, because trouble doing this is a reason to see a healthcare professional.
- Rest your forearm on a table with your palm facing down.
- Press your palm and fingers flat against the surface.
- Look for any finger that lifts, curls or leaves a gap.
- Run the fingertips of your other hand over your palm and feel for a firm lump or puckered, dimpled skin, especially near the base of the ring and little fingers.
- Repeat on the other hand, since about 80% of people with Dupuytren’s eventually develop it in both hands.
Passing the flat-hand check does not rule out early Dupuytren’s disease, because it only catches a finger that already bends. If your fingers lie flat but you can feel a firm lump in your palm or notice puckered skin near the base of a finger, that is also worth showing a hand specialist, even without any bend yet.
If your hand will not lie flat or everyday tasks are getting harder, OCR’s hand and upper extremity specialists can examine your hand and measure how far your fingers move.
How is a Dupuytren’s lump different from other lumps in the palm?
A Dupuytren’s lump is usually painless and can be followed by a cord and a bent finger, while a trigger finger nodule is tender, a ganglion cyst usually shrinks with rest and a callus is rarely painful. A hand specialist examines the hand to tell them apart.
| Possible lump | What sources describe |
|---|---|
| Dupuytren’s nodule | A firm lump under the skin of the palm that is usually painless and can be followed by a cord and a finger that will not fully straighten. |
| Ganglion cyst | The most common lump in the hand, which can form at the base of a finger, and with rest the lump usually becomes smaller. |
| Trigger finger nodule | A tender lump at the base of the finger on the palm side, often with pain or catching when the finger bends or straightens and stiffness that is worse in the morning. |
| Callus | A thick, rough, hardened area of skin from friction or pressure that rarely hurts and, for most people, goes away once the friction stops. |
When should you see a hand specialist about early Dupuytren’s disease?
See a hand specialist when a lump in your palm does not go away, a finger starts to bend, your hand will not lie flat on a table or everyday tasks get harder, since these are all reasons to see a healthcare professional.
Dr. Timothy Pater, a board-certified hand and upper extremity surgeon who has been with OCR since 2005, has written that mild contractures are usually harmless and that many people live their entire lives with a mild form that does not progress. He has also written about how hard it can be to know when to act.
“When contractures progress and create functional difficulty, action should be taken. It can be difficult for patients to determine when it is time to intervene, and a consultation with a Hand Specialist can provide reassurance and education.”
Dr. Timothy Pater, from his Dupuytren’s disease article
If your fingers still move fully and you have only a lump or puckered skin, Dupuytren’s contracture is not an emergency, because it is not life or limb threatening and usually progresses slowly. A hand specialist should still see it sooner rather than later, and neither OrthoInfo nor Dr. Pater’s article names an exact deadline.
Functional difficulty with Dupuytren’s contracture means trouble putting on gloves, shaking hands, reaching into pockets or laying your hand flat on a table. An early visit puts a baseline measurement on record, and whether Dupuytren’s contracture needs treatment depends on how much it affects what your hand can do.
To see a hand specialist about a lump or a bent finger, find the OCR specialist and location nearest you.
What did early Dupuytren’s disease feel like for one OCR patient?
For OCR patient Rich Woodburn, early Dupuytren’s disease was a nuisance in his right hand, not a painful problem. He loves working on his cars, and Dupuytren’s made that harder.
“It wasn’t particularly painful. It was just a nuisance. It was hard to shake people’s hands,” Rich said.
When Rich was living on the west coast seven years ago, he decided to have surgery on his right hand to correct the contracture.
“The surgery fixed the Dupuytren’s … kind of. But, unfortunately, the surgery was very invasive and painful. I was in a wrap for almost a month, and then I went to therapy for 3-4 months. The result was my finger was straight, but I couldn’t make a fist very well.”
Rich Woodburn, OCR patient
Rich was frustrated with the surgery and how long the recovery took, so when Dupuytren’s began in his left hand, he decided to ignore it because it did not hurt. When he saw his primary care doctor, she suggested he see Dr. Timothy Pater, an OCR hand surgeon, for a routine check-up, and Dr. Pater treated him.
By the end of that week, Rich was working with wrenches on his car again, something he had not been able to do in years. He called Dr. Pater “very straightforward and candid.” Check out Rich’s story to learn about his full experience with Dupuytren’s and seeking help from Dr. Pater at OCR.
What happens at a hand specialist visit for early Dupuytren’s disease?
A hand specialist starts with your health history and symptoms, and may ask whether relatives have Dupuytren’s, since it can run in families. The exam usually includes recording where nodules and cords sit in your palm, measuring how far your fingers and thumb move, and testing feeling in them. Some doctors also take photos to document your hand. Those measurements can be compared at later visits to see whether the condition is changing.
What comes out of the visit depends on how much Dupuytren’s affects your hand. In many cases, Dupuytren’s progresses slowly and may remain mild enough that no treatment is needed, so the plan can be to measure again at later visits. If it does progress, the doctor may first recommend nonsurgical treatment to help slow the disease, and if the contracture interferes with hand function, surgical treatment may be recommended. OrthoInfo and Dr. Pater’s article do not give a set follow-up schedule, so ask your specialist how often to be measured.
If you would like your hands measured and checked, find the OCR location closest to you.
What is the root cause of Dupuytren’s contracture, and what triggers it?
Doctors do not know the exact cause of Dupuytren’s contracture, but genetics appear to play the biggest role. Changes in genes are thought to affect the risk, and in the palm, connective tissue cells grow abnormally and make extra collagen, which thickens and tightens the tissue.
OCR hand surgeon Dr. Timothy Pater writes that Dupuytren’s has “a very strong genetic inheritance” and “is rarely seen in individuals who do not have genetic heritage from Northern Europe.”
Associated risk factors
Doctors have not pinned down a single trigger. Smoking, heavy alcohol use, liver disease, diabetes, high cholesterol, thyroid problems, some seizure medicines and a past hand injury may raise the risk of developing it, but they are statistical links and not proven causes, and the cause of Dupuytren’s contracture is still unknown.
Why is Dupuytren’s contracture called the Viking disease?
Dupuytren’s contracture is also called Viking disease, and it is 3 to 10 times more common in people of European descent than in people of non-European descent. A 1999 review reported that prevalence approaches 30% in people over age 60 in Norway. OCR hand surgeon Dr. Timothy Pater most often sees it in patients whose families came from England, Ireland, Scotland, Scandinavia, Northern France and Northern Germany.
What aggravates Dupuytren’s contracture?
The research on what makes Dupuytren’s contracture worse is mixed, and OCR hand surgeon Dr. Timothy Pater writes that the disease “does not appear to have any real relationship to injury, activity level or other factors.” Smoking, heavy alcohol use and diabetes are linked to a higher risk of developing it, but Mayo Clinic, MedlinePlus and OrthoInfo do not say whether they make existing Dupuytren’s progress faster. Those sources also do not show that changing these factors slows Dupuytren’s once it has started, though smoking, heavy alcohol use and diabetes are worth managing for other health reasons.
| Factor | What the research says |
|---|---|
| Heavy hand use | No convincing evidence suggests that overuse causes Dupuytren’s contracture. |
| Hand injury or surgery | Some people report Dupuytren’s contracture appearing or worsening afterward, but good evidence is lacking. |
| Vibrating tools | Studies cited by Mayo Clinic link vibrating tool use to a higher risk of Dupuytren’s contracture. |
Can Dupuytren’s contracture go away on its own?
Dupuytren’s contracture usually does not go away on its own, and in most cases it gradually gets worse. For some people, the lumps stay the only sign and occasionally fade without treatment. A small, painless lump is still worth showing a hand specialist, since measurements taken over time show whether the lump is changing.
What happens if Dupuytren’s contracture is left untreated?
Dupuytren’s contracture that keeps progressing can make it harder to straighten a finger fully, and it becomes harder to treat as it progresses. Dupuytren’s contracture is not cancer and not life or limb threatening, so the main thing at stake is how well your hand works. A hand specialist should see Dupuytren’s contracture sooner rather than later. Do not try to force a bent finger straight, because stretching a bent finger with force is not helpful and could injure the finger or hand.
If everyday tasks are getting harder for you, browse OCR’s physicians by specialty and location to find a hand specialist near you.
Where can you see a hand specialist for Dupuytren’s disease in Colorado?
You can see a hand specialist for Dupuytren’s disease at Orthopaedic & Spine Center of the Rockies (OCR), an orthopaedic and spine practice with six Colorado locations in Fort Collins, Loveland, Greeley, Longmont, Westminster and Lafayette. The hand and upper extremity team includes Dr. Satoru Chamberlain, Dr. Christine Johnson, Dr. Riikka Koso, Dr. Timothy Pater, Dr. Bret Peterson, Dr. Chris Stockburger and Dr. Cara Thorne.
If everyday tasks are getting harder, or you have a lump in your palm or a finger that will not lie flat, request an appointment with an OCR hand and upper extremity specialist to have your Dupuytren’s disease evaluated.