Bent Fingers (Dupuytren’s Contracture)

Dupuytren’s contracture is a hand condition that affects the connective tissue just beneath the skin of the palm and fingers. It develops when the palmar fascia, a thick layer of tissue in the palm, gradually thickens and tightens. Over time, this can form nodules and cord-like bands that pull one or more fingers into a bent position, limiting your hand functions.

As the condition progresses, simple movements can become challenging. Tasks like shaking hands, placing your hand flat on a surface, or gripping everyday objects may feel limited or uncomfortable.

At Kimball Health Services, our plastic and reconstructive surgeon, Dr. Todd A. Zuhlke, specializes in minimally invasive treatment for Dupuytren’s contracture, including collagenase injections such as Xiaflex®. This targeted therapy helps release the affected finger and improve movement.

What is Dupuytren’s Contracture?

The palmar fascia is a layer of connective tissue that supports and stabilizes the skin on the palm side of your hand. This tissue helps keep the skin firm and anchored, allowing for a strong, controlled grip.

In Dupuytren’s contracture, the palmar fascia gradually thickens. Over time, it can form small lumps and cord-like bands beneath the skin. These cords may shorten and pull the fingers inward toward the palm, most commonly affecting the ring and little fingers.

How Dupuytren’s Contracture Progresses

Early Stage: You may first notice a small lump or nodule in the palm. It can feel firm to the touch and may be tender or painless. Some people also describe mild itching, tightness, or a burning sensation. At this stage, hand movement is usually not affected, so it’s easy to overlook.
Progressive Stage: The nodules begin to thicken and develop into firm cords beneath the skin. You might start to feel tightness in your palm or notice a visible line extending toward the fingers. The hand may feel less flexible, and certain movements, such as fully opening your hand, may become restricted.
Advanced Stage: The cords tighten and restrict movement, pulling one or more fingers into a bent position. You may find it difficult or impossible to fully straighten your fingers. Everyday tasks like placing your hand flat on a surface, putting your hand in your pocket, or gripping larger objects can become increasingly challenging.

Causes of Dupuytren’s Contracture

While the exact cause of Dupuytren’s contracture isn’t known, certain factors may increase your risk:

Family history or genetic predisposition
Age (more common after 50)
Male gender
Diabetes or certain medical conditions
Smoking or alcohol use

Symptoms of Dupuytren’s Contracture

Dupuytren’s contracture often progresses slowly. You may notice:

A small lump or nodule in the palm
Thickened or tight skin in the hand
A visible cord forming under the skin
Fingers (often the ring or pinky) bending inward
Difficulty straightening the affected fingers

If you’re unable to lay your hand flat on a table, it may be time to consider evaluation by your provider.

Diagnosis of Dupuytren’s Contracture

Dupuytren’s contracture is typically diagnosed with a simple physical exam. In most cases, no imaging or additional testing is needed.

Dr. Zuhlke will examine your hands, comparing both sides for changes. This includes looking for puckering or dimpling of the skin and feeling for firm nodules or cord-like bands beneath the surface.

A common part of the evaluation is the “tabletop test.” You’ll be asked to place your hand flat on a surface. If you’re unable to fully flatten your palm or fingers, it may indicate progression of the condition.

Treatment of Dupuytren’s Contracture

Dupuytren’s contracture often progresses slowly, and for some people, it may not cause significant functional limitations for years. Treatment is typically recommended when finger movement becomes restricted or begins to interfere with daily activities.

At Kimball Health Services, care is focused on improving hand function while avoiding surgery whenever possible. Dr. Zuhlke specializes in non-surgical treatment options designed to address the condition at its source.

Xiaflex® Injection Therapy

Dr. Zuhlke uses Xiaflex® (collagenase clostridium histolyticum), an FDA-approved prescription injection designed to manage Dupuytren’s contracture.

The medication works by breaking down excess collagen in the tightened tissue, helping release the tension that pulls the finger inward. As the cord softens, the finger can begin to move more freely.

Xiaflex® is performed in the office, and the procedure is quick and focused. After the injection, it’s normal to experience mild swelling, bruising, or soreness around the treatment area.

We schedule a follow-up appointment to check your progression. During this visit, Dr. Zuhlke examines the treated hand and may perform a manipulation to help break the softened cord and further straighten the finger. Many patients experience meaningful improvement in hand function without the need for surgical intervention.

Treating Dupuytren’s Contracture in Kimball, NE

If you’ve noticed changes in your hand, early evaluation can help prevent progression and improve outcomes.

At Kimball Health Services, Dr. Zuhlke brings specialized expertise in non-surgical treatment options for hand conditions like Dupuytren’s contracture. Your care plan is tailored to your symptoms, lifestyle, and goals, with a focus on preserving function and minimizing disruption to your daily life.

For appointments, call ahead or fill out our online form. We're here for you whenever you need us.