Dupuytren's Contracture in Vienna
A firm nodule can be felt in the palm, a cord runs under the skin to the ring or little finger, and the hand can no longer be laid flat on a table. This is Dupuytren's contracture, a disease of the connective tissue in the palm. I assess the cords and the bent position of the fingers and tell you whether a procedure makes sense now.
In short
In Dupuytren's contracture (Dupuytren's disease), the connective tissue under the skin of the palm thickens. Palpable nodules and firm cords develop and run towards the fingers; as they shorten, the ring and little fingers in particular can no longer be straightened. Tendons and tendon sheaths are not involved — this is the most common misconception. The disease progresses in episodes and often remains harmless for a long time. Treatment is given when the hand loses function; I then remove the altered tissue (fasciectomy). Recurrence remains possible.
What is Dupuytren's contracture?
Under the skin of the palm lies a firm sheet of connective tissue, the palmar fascia. It keeps the skin taut so that it does not slip when you grip. In Dupuytren's contracture this tissue changes: it deposits more collagen, thickens and contracts.
First a nodule can be felt, usually at the level of the base joints of the ring or little finger. A cord grows from the nodule towards the finger. As long as the cord remains slack, mobility changes little; as it shortens, it pulls the finger into a bent position that can no longer be straightened.
A striking feature is that the disease progresses in episodes: the findings stay the same for long periods, then the bent position progresses quickly. Why the disease develops has not been established. It runs in families and is more common in men; associations with diabetes and alcohol consumption have been described. Heavy manual work is not the cause.
Not a disease of the tendons
Almost everyone who comes to me with a cord in the palm suspects that a tendon is behind it. That is understandable, because the cord lies in line with the flexor tendon. In fact, the flexor tendon runs deeper and is healthy; the cord lies above it, in the sheet of connective tissue, and is attached to the skin.
The difference matters. Trigger finger shows itself through catching and pain when bending, while straightening remains free. In Dupuytren's contracture it is the other way round: bending works, straightening does not. The treatment is different, too.
Typical symptoms
- Firm nodule in the palm — bound to the skin and barely movable
- Cord towards the finger — visible as a ridge when the finger is straightened
- Dimples and puckering of the skin — often the first sign
- Increasing bent position — usually the ring and little fingers, later the middle finger
- Usually painless — unlike a disease of the tendon
- Everyday problems — the hand catches in a trouser pocket, and shaking hands becomes uncomfortable
The tabletop test as a self-check
Place your hand flat on a table top, palm down. If a finger stays up in the air, the test is positive. This simple check tells you more than the feeling that your hand is getting stiffer — and it marks the point from which I seriously discuss a procedure.
How I make the diagnosis
Dupuytren's contracture is diagnosed by looking and feeling. I assess nodules, cords and skin puckering and measure the extension deficit at the base joint and the middle joint separately, because the two behave differently. I check circulation and sensation in the fingers, because the nerves along the course of the cord are pulled out of place with it. Ultrasound helps to distinguish the cord from a ganglion. Further imaging is rarely needed.
Treatment: only once function is lost
A nodule alone is no reason for a procedure. As long as the hand can be laid flat on the table and everyday life works, I monitor the course and check it at intervals. That is not inactivity: an early operation does not halt the course of the disease.
I am open about the limits of conservative treatment. Stretching, kneading or a splint do not dissolve an established cord. Physiotherapy and hand therapy have their place after a procedure, when the scar and mobility need looking after — not as a substitute for it. Physiotherapy is available in the same building at the Orthozentrum Döbling.
Factors in favour of a procedure: the hand no longer lies flat on the table, the extension deficit increases, the little finger gets in the way when gripping, or the skin in the flexion crease can no longer be kept properly clean.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. I explain how this works on the page about private practice and reimbursement.
When an operation is necessary
The procedure is called a fasciectomy (removal of the altered connective tissue). Through an incision that follows the course of the cord, I remove the nodule and the cord. The flexor tendons are left untouched; the real task is to expose the bundles of nerves and blood vessels that the cord has pulled out of place without damaging them. The skin is closed in such a way that the scar does not restrict extension.
There are also techniques that divide the cord through the skin without removing any tissue. They are smaller procedures, but are not suitable for every cord; which route is right depends on the course, the previous history and the condition of the skin. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
After the procedure, the aftercare counts as much as the operation: early movement, scar care and, if needed, a night splint. Recurrence remains possible, at the same site or at another finger; you should know this before the decision is made. Related topics are carpal tunnel syndrome and thumb base osteoarthritis; I explain other possible causes under assessing hand pain. An overview is given under hand surgery in Vienna.
Whether and when to operate is not decided by the palpation findings alone. I make that choice together with you, once the findings are available and it is clear what your hand needs to do in everyday life.
Frequently asked
Common questions about Dupuytren's contracture
It usually begins with a firm nodule in the palm, often at the level of the base joint of the ring or little finger, together with dimples and puckering of the skin. Later a cord can be felt running to the finger, and the finger can no longer be fully straightened. Pain is often absent, which is why the disease goes unnoticed for a long time.
Place your hand flat on a table top, palm down. If all fingers and the heel of the hand touch the surface, the test is normal. If a finger stays up in the air, the test is positive. The tabletop test is simple, can be repeated at any time and is a useful guide to when a procedure should be discussed.
No, and that is the most common misunderstanding. What is affected is the sheet of connective tissue under the skin of the palm, the palmar fascia. The flexor tendons run deeper and are healthy. That is why the fingers can still bend even when straightening has long been restricted — with trigger finger it is the other way round.
No. A nodule without a bent finger does not need a procedure, and an early operation does not halt the course of the disease. I check it at intervals and discuss a procedure when the hand loses function: when it no longer lies flat on the table or the limited straightening gets in the way in everyday life.
No. An established cord cannot be dissolved by stretching, kneading or wearing a splint. Exercises and hand therapy have their place after a procedure, when the scar and extension are being looked after. They are not suitable as a substitute for removing the altered tissue; I would rather say this clearly than raise false expectations.
Through an incision that follows the cord, I remove the altered connective tissue. The flexor tendons are left untouched. Exposing the bundles of nerves and blood vessels that the cord pulls out of place requires care. At the end I check how far the finger can be straightened and close the skin so that the scar does not restrict extension.
Yes. The altered tissue can form again at the same site or appear at another finger; the procedure does not cure the disease. The aim is to regain the ability to straighten the finger. How high the risk is in an individual case depends on age, course and family history.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
Related
This might also concern you
Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.