Quick answer. Dupuytren’s contracture is a gradual thickening of the tissue under the skin of the palm that pulls one or more fingers into a bent position. It is benign and painless for most people, and treatment with needle, enzyme or surgery is offered when the bending interferes with hand function.
Dupuytren’s contracture is a slowly progressive condition in which the layer of tissue under the skin of the palm (the palmar fascia) thickens and tightens. Over months to years it can form firm cords and nodules that gradually pull one or more fingers – most often the ring and little fingers – into a permanently bent position towards the palm. It is usually painless and benign.
Many people in Singapore first notice a small firm lump in the palm and worry it is something serious. In most cases it is not, and Dupuytren’s contracture is a recognised, non-cancerous condition. This guide explains what causes it, how it is diagnosed, when treatment is needed, and the options available, from watchful waiting to needle, enzyme and surgical treatment. The aim is to reassure while helping you know when to seek help.
At a glance
| Approach | What it involves | Typically considered when |
|---|---|---|
| Watchful waiting | Monitoring without treatment | Mild changes, no functional problem |
| Needle release (needle aponeurotomy) | A needle is used to divide the tight cord | Suitable cords causing some contracture |
| Enzyme injection | An injection to soften and break the cord | Selected cords, where available |
| Surgery (fasciectomy) | Removing the thickened tissue | Significant contracture affecting function |
| Hand therapy & splinting | Stretching and support after treatment | To aid recovery and maintain results |
What is Dupuytren's contracture?
Dupuytren’s contracture is a condition affecting the palmar fascia, the sheet of connective tissue just beneath the skin of the palm. In Dupuytren’s, this tissue thickens and forms nodules and cords. As the cords tighten over time, they can pull the affected fingers – usually the ring and little fingers – into a bent position that cannot be fully straightened.
It is a benign (non-cancerous) condition and is usually painless, though some people feel tenderness early on. It tends to develop slowly over years and is more common with increasing age. Reassuringly, the firm lump people often notice in the palm is part of this recognised condition and is not a tumour. Treatment is focused on restoring hand function when bending of the fingers becomes a problem.
Symptoms & signs
Dupuytren’s contracture usually develops gradually. Typical features include:
- A firm lump or nodule in the palm, often near the base of the ring or little finger
- Thickened cords of tissue running from the palm towards the fingers
- Dimpling or puckering of the skin of the palm
- One or more fingers gradually bending towards the palm and becoming hard to straighten fully
- Difficulty laying the hand flat on a table (a useful self-check known as the tabletop test)
- Trouble with tasks such as shaking hands, putting a hand in a pocket or wearing gloves
It is usually painless, and the speed of progression varies a lot between people.
Causes & risk factors
The exact cause of Dupuytren’s contracture is not fully understood, but it is thought to involve a tendency to form excess connective tissue. Several factors are associated with a higher risk:
- Age – it becomes more common with increasing age
- Family history – it can run in families
- Sex – it is more common in men
- Certain health conditions, including diabetes
- Smoking and heavy alcohol use have been linked with it
It is not caused by manual work or a single injury, although hand use may make existing changes more noticeable. For many people no clear cause is found.
How it's diagnosed
Dupuytren’s contracture is almost always diagnosed clinically, from the appearance and feel of the hand, without the need for scans or blood tests. A doctor will typically:
- Ask about how long the changes have been present and whether they are progressing
- Examine the palm and fingers, feeling for nodules and cords
- Assess how far the affected fingers can straighten
- Use the tabletop test – asking you to lay your hand flat on a table to see whether the fingers stay raised
Imaging is rarely required. Because the diagnosis is usually clear on examination, the main purpose of the assessment is to judge how much hand function is affected and whether treatment is needed.
Treatment options
Not everyone with Dupuytren’s contracture needs treatment. If the changes are mild and the hand still works well, watchful waiting is often appropriate. Treatment is considered when the bending of the fingers interferes with daily activities. Options include:
- Watchful waiting – monitoring mild, non-troublesome disease over time
- Needle release (needle aponeurotomy) – using a needle to divide the tight cord, allowing the finger to straighten
- Enzyme injection – an injection that softens and helps break the cord, where available
- Surgery (fasciectomy) – removing the thickened tissue, usually for significant contractures
- Hand therapy and splinting – stretching and support after a procedure to maintain the gains
Dupuytren’s can recur after treatment, so your hand specialist will discuss the likely benefits and the chance of it returning for each option. Costs vary by procedure and hospital; ask your provider for an estimate, and note MediSave may apply to surgical treatment.
When to see a doctor & which specialist
Dupuytren’s contracture is benign and not an emergency, so there is no need to panic if you notice a firm lump in the palm. See a doctor if a finger is starting to bend and you cannot straighten it fully, if you cannot lay your hand flat on a table, or if the condition is making everyday tasks difficult. Earlier assessment gives more treatment choices.
While the condition itself is not dangerous, seek prompt review if you have sudden pain, redness, swelling or a rapidly growing or painful lump, as these are not typical of Dupuytren’s and should be checked to exclude another cause.
A hand specialist, usually an orthopaedic or hand surgeon, assesses and treats Dupuytren’s contracture. You can find one through our directory of the best orthopaedic surgeons in Singapore.
Related guides
- Best Orthopaedic Clinics in Singapore — our editorial shortlist
- orthopaedic clinics directory
- Adenomyosis
- Bronchoscopy
- Pleurisy
- Laminectomy
- De Quervain's
Sources
- NHS – Dupuytren's contracture
- Mayo Clinic – Dupuytren's contracture
- HealthHub Singapore – Bone & Joint Health
- SingHealth – Hand conditions
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