Have you noticed a firm but painless lump in your palm or a finger that won’t fully straighten out? It may be a symptom of Dupuytren’s contracture. This hand condition is more common in people with type 2 diabetes, but it often goes unnoticed until symptoms appear. While this condition is not as well known as other diabetes-related complications, it’s worth learning about — especially because early treatment can help.

As this condition progresses, simple everyday activities like holding a cup or writing may become more difficult. Despite a link to diabetes, many people aren’t familiar with the early signs. Below, we’ll explain what Dupuytren’s contracture is, how it’s linked to diabetes, and what treatment options exist.

What Is Dupuytren’s Contracture?

Dupuytren’s contracture is a medical condition that happens when one or more of your fingers begin to bend inward toward the palm of the hand. This condition can limit your range of motion, usually in your little and ring fingers. These fingers are pulled inward over time by connective tissue under the skin that forms into a knotlike shape. The condition worsens with time, leaving your most affected fingers in a curled position.

Dupuytren’s contracture usually begins with small and painless nodules (bumps) you can feel in the palm of your hand. At first, these nodules may not cause any trouble, but eventually, they can grow larger and thicker.

As these nodules grow, the fingers furthest from your thumb move into a bent position without you even trying. As your fingers move into this flexed position, it becomes nearly impossible to fully open them.

Dupuytren’s contracture often affects both hands, but in some cases it may affect only the right or, less frequently, only the left hand. It can affect different aspects of daily living. One DiabetesTeam member wrote: “It interfered with picking up objects.”

Some people with Dupuytren’s contracture also have problems with other daily tasks, like preparing food or gripping a pen or pencil to write.

Causes and Risk Factors

Researchers don’t know the cause of Dupuytren’s contracture just yet, but they do know this condition runs in some families. According to the American Society for Surgery of the Hand, the condition is most common among:

• Men
• Individuals over 40
• Those with a family history of Dupuytren’s contracture
• People of Northern European descent

Other risk factors include smoking and alcohol use, a medical history of type 2 diabetes, and use of anti-seizure medication for epilepsy.

How Is It Connected to Type 2 Diabetes?

One of the risk factors of Dupuytren’s contracture is type 2 diabetes. Researchers believe Dupuytren’s contracture tends to occur more often in people with type 2 diabetes than in those with type 1, especially when their blood glucse (sugar) levels need better control. People living with diabetes are three times more likely to develop Dupuytren’s contracture than the general population.

When someone has type 2 diabetes, their body can produce more harmful chemicals. These can collect in the hands and make the tissues there stiff. If you have high blood sugar for a long time, this can make the problem worse.

The buildup of these harmful substances can also cause damage to your small blood vessels. This can lead to diabetes-related complications like kidney disease, nerve disorders and changes in soft tissues. Soft tissues include muscles, tendons, and ligaments.

Uncontrolled blood sugar levels can lead to a buildup of collagen. Collagen is a type of protein that makes up the cords of tissue found in Dupuytren’s contracture. Collagen gives tissue its shape and strength. When collagen builds up, tissues can grow thicker and tighter, which weakens these tissues over time. These tissues may also become less flexible.

Your hand is full of soft tissues, like tendons and ligaments, which help the fingers bend and straighten for different activities. Some fingers may be pulled inward when collagen builds up in these areas.

What Are the Signs To Watch For?

People with Dupuytren’s contracture might not notice symptoms right away. In fact, symptoms can take months or even years to show up. However, long before your fingers start bending, changes are happening beneath the skin of your hand. Doctors call these early changes Dupuytren’s disease.

In the early stages of Dupuytren’s disease, you might notice small, painless bumps appearing on your palm, usually near the bottom of your ring or little fingers. Over time, these bumps grow into thick, ropelike cords of tissue beneath your skin.

When these cords tighten enough to pull your fingers inward toward your palm, Dupuytren’s disease progresses into Dupuytren’s contracture. At this stage, your fingers become very difficult to straighten. Even though it might not hurt, everyday tasks — like holding objects or putting on gloves — can become harder.

Other symptoms of Dupuytren’s disease that are less common include:

• Swelling or tenderness of the hand
• Pain or burning sensation of the hand
• Itching

The severity of symptoms can vary. It’s important to talk with your healthcare provider about any symptoms you may have. You should also discuss symptoms that may have gone away. They can work with you to determine if you have Dupuytren’s disease and provide a treatment plan that helps with the symptoms.

What Are the Treatment Options?

There is no cure for Dupuytren’s contracture, but some people with the condition do not have noticeable symptoms. Moderate to severe cases are usually managed with either surgical or nonsurgical treatments. Nonsurgical methods include:

• Physical therapy — Your healthcare provider may first suggest physical therapy to manage symptoms. Some people may have symptom relief with hand stretches.
• Collagenase injections — An enzyme or protein called collagenase is injected into your hand to loosen and break down cords of tissue. This procedure is done in a healthcare provider’s office in two visits.
• Needle aponeurotomy — A special needle is passed through the cords of tissue to loosen and break them down.

Some people who use collagenase injections or needle aponeurotomy may need to repeat these procedures over time. One potential complication following collagenase injections is skin tearing.

Hand surgery may be the next step when symptoms and hand function don’t improve. Surgical procedures include:

• Fasciotomy — The hand surgeon will make an incision in the palm of the hand to locate and break down the thick cords of tissue.
• Subtotal palmar fasciectomy — The hand surgeon will make an incision along the creases in the hand to locate and remove cord tissue.

People living with diabetes may have an increased risk of complications with wound healing. These complications could include scarring, infections, and wound reopening after the procedure. It’s important to watch for symptoms of complications and report them immediately.

Treatment of Dupuytren’s disease will look different for everyone. Some people who have symptoms may find relief with blood sugar control and no other treatment options. One DiabetesTeam member wrote: “Dupuytren’s disease went away once I got better control of my blood glucose levels.”

Early treatment can help with symptoms and may prevent fingers from permanently bending.

Dupuytren’s contracture has a 20 percent to 50 percent chance of returning within five years.

Talk With Your Doctor

Dupuytren’s contracture is more common in people with type 2 diabetes, but help is available. Check your hands regularly for bumps or nodules, especially around the palms of your hands. Talk with your healthcare provider immediately if you notice symptoms of Dupuytren’s disease or contracture, even if the symptoms have disappeared. Catching symptoms early may give you more choices for treatment and better results. Staying on top of your blood sugar levels may also provide relief and lower your risk of developing Dupuytren’s contracture.

Find Your Team

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Have you noticed small, painless bumps or nodules on your hand? Have your fingers started curling inward without effort? Share your experience in the comments below, or start a conversation by posting on your Activities page.