Dupuytren's contracture is a painless thickening and contracture of tissue beneath the skin on the palm of the hand and fingers.

The cause is unknown, but minor injury and your genes may make you more likely to develop this condition.

One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.

A small, painless nodule develops in the connective tissue on the palm side of the hand and eventually develops into a cord-like band. In severe cases, it's difficult or even impossible to extend the fingers.

The condition becomes more common after the age of 40. Men are affected more often than women. Risk factors are alcoholism, epilepsy, pulmonary tuberculosis, diabetes, and liver disease.

• Difficulty extending the fingers -- the fourth and fifth fingers curl up and are unable to be easily straightened
• Painless nodule in the palm, developing into a cord-like band
• Thickening of the lines in the palms of the hands

A physical examination of the palm by touch (palpation) confirms the presence of thickened scar tissue (fibrosis) and contracture. Restriction of motion is common.

Exercises, warm water baths, or splints may be helpful.

Surgery may be performed to release the contracture, depending on the severity of the condition. Normal movement of the fingers is usually restored by surgery followed by physical therapy exercises for the hand.

The disorder progresses at an unpredictable rate. Surgical treatment can usually restore normal movement to the fingers. The disease can recur following surgery in some cases.

Worsening of the contracture may result in deformity and loss of function of the hand.

There is a risk of injury to blood vessels and nerves during surgery.

Call your health care provider if you have symptoms of this disorder.

Awareness of risk factors may allow early detection and treatment.

Calandruccio JH. Dupuytren contracture. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 72.

Mercier LR. The forearm, wrist, and hand. In: Mercier LR, ed. Practical Orthopedics. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 7.