Last Updated on September 25, 2025
Dupuytren’s contracture happens when cords under the skin of the palm thicken and tighten, pulling one or more fingers toward the palm. It’s most common in people of Northern European ancestry and those with diabetes. Less-invasive treatments like needle aponeurotomy and collagenase injections can quickly restore function, while surgery remains an option for severe or recurrent disease. Early evaluation and steady glucose management help people choose safer treatments and improve recovery.
What is Dupuytren’s contracture?
According to the Mayo Clinic, Dupuytren’s contracture is a progressive hand condition where tough collagen cords form beneath the skin of the palm and fingers. Over time, these cords tighten, pulling one or more fingers into a bent position. This can make everyday tasks—like typing, shaking hands, or placing your hand flat—difficult.
Who is at higher risk and why?
Research shows several clear risk factors:
- Genetics & age: A StatPearls clinical review notes that family history, Northern European ancestry, and being over 40 significantly raise risk.
- Diabetes: A systematic review in Plastic and Reconstructive Surgery found that people with type 1 or type 2 diabetes are far more likely to develop Dupuytren’s contracture—affecting 15–20% of patients, compared with 3–12% in the general population.
- Other associations: The StatPearls review also links smoking, heavy alcohol use, epilepsy medications, HIV therapies, and certain endocrine conditions (like hypothyroidism) to higher risk.
Interestingly, current evidence suggests repetitive hand use or manual labor is not a proven cause, despite long-held beliefs.
Why is Dupuytren’s contracture linked to diabetes?
Connective tissue changes
The journal Diabetes Care explains that long-term high blood sugar promotes formation of advanced glycation end products (AGEs), which stiffen collagen and drive fibrosis in hand tissues.
Microvascular effects
The same Diabetes Care review highlights how diabetes-related microvascular damage reduces blood flow in the hands, further fueling disease progression.
Does glucose management help?
The American Diabetes Association (ADA) emphasizes that reasonable blood sugar control may reduce connective tissue complications and improve post-treatment healing, although it does not cure Dupuytren’s.
What are the best treatment options?
Hand surgeons often use the “tabletop test” (placing your hand flat on a surface) to decide when intervention is needed, according to the American Society for Surgery of the Hand (ASSH). Options include:
| Treatment | How it works | Recovery | Evidence |
|---|---|---|---|
| Needle aponeurotomy | A fine needle divides cords through small punctures. | Quick recovery; splinting or therapy is often needed. | A systematic review in Hand reported 50–58% recurrence within 3–5 years. |
| Collagenase injection (Xiaflex) | An enzyme dissolves the cord, and the finger is straightened the next day. | A fast return to activities is expected; bruising and swelling are common. | A landmark NEJM clinical trial showed significant correction in contracture, and a 2023 PRS study found lower 3-year recurrence than needle aponeurotomy. |
| Surgery (fasciectomy) | Open removal of diseased tissue. | Longest recovery; requires therapy. | A 5-year randomized trial in J Hand Surg confirmed surgery’s durability but noted recurrence remains possible. |
Which option is safest if you have diabetes?
Because wound healing can be slower in people with diabetes, experts at the ASSH recommend starting with minimally invasive approaches when appropriate. The ADA also advises keeping glucose in range around procedures to support healing. Still, recurrence is expected across all options (PRS 2023), so splinting and therapy are key to maintaining motion.
When should you see a hand specialist?
- If you cannot lay your hand flat on a table.
- If finger bending interferes with work, hobbies, or daily self-care.
- If you notice rapid progression or multiple fingers becoming involved.
Key takeaways
- Dupuytren’s contracture is significantly more common in people with diabetes.
- Less-invasive treatments, such as needle aponeurotomy and collagenase, are effective but often recur.
- Surgery remains a valuable option for advanced or recurrent disease, although recovery is typically longer.
- Stable glucose levels, individualized treatment, and hand therapy all improve outcomes.