Understanding Dupuytren’s Disease: Symptoms, Diagnosis, and Treatment Options
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Dupuytren’s disease is a condition many people have never heard of—until it begins to interfere with everyday life. In a recent episode of Cancer Conversations, a Harold Leever Regional Cancer Center podcast, Dr. Joseph Ravalese, a radiation oncologist at the HLRCC, shared his expertise on what Dupuytren’s disease is, who it affects, and how it can be treated.
What Is Dupuytren’s Disease?
Throughout the body, tough fibrous connective tissue called fascia lies beneath the skin and helps protect underlying blood vessels, tendons, and nerves. In Dupuytren’s disease, the fascia—most commonly in the palm of the hand—undergoes a progressive thickening process. This leads to the formation of nodules and cords that can often be felt and sometimes seen along the finger tendons.
As the disease progresses, these cords may tighten, pulling the fingers into a bent position (flexion). While Dupuytren’s disease most often affects the hands, similar fibrotic conditions can occur in the feet (Ledderhose disease) and the penis (Peyronie’s disease).
Who Is at Risk?
Dupuytren’s disease affects an estimated 3%–5% of the U.S. population, but certain groups face a higher risk. These include individuals of Northern European descent—such as Nordic, German, or Irish ancestry—as well as people with diabetes, those who use alcohol or tobacco, and individuals taking certain medications. Repetitive or vibratory hand activities, such as prolonged use of tools like jackhammers, may also increase risk. In some families, Dupuytren’s disease appears across multiple generations. Overall, it is more common in men than in women.
Signs and Symptoms
Dupuytren’s disease often begins with painless thickening or nodules in the palm of the hand. Over time, the cords may tighten and restrict finger movement. It is usually at this stage that patients become most concerned, as bent fingers can interfere with daily activities—such as shaking hands, putting on gloves, performing push-ups, or placing the hand flat on a surface.
In addition, thickened cords and nodules can make gripping tools or weights uncomfortable. It is important to note that a related condition called trigger finger, which also affects hand tendons, does not respond to radiation therapy. Accurate diagnosis is therefore essential.
Diagnosis and Monitoring
In the United States, patients with early signs of Dupuytren’s disease are commonly referred to hand surgeons. With increased access to online information and social media, some patients now self-refer to specialists, including radiation oncologists.
Dr. Ravalese emphasizes the importance of evaluation by a hand surgeon, as Dupuytren’s disease can have a variable course—it may progress, stabilize, or remain unchanged for years. Once significant finger contractures develop, radiation therapy may no longer be effective, and more invasive treatments may be required. Ongoing monitoring helps ensure patients receive the most appropriate intervention at the right time.
Treatment Options
When Dupuytren’s disease is progressive, several treatment approaches may be considered:
- Collagenase injections, which use an enzyme to dissolve the affected fascia
- Needle fasciotomy, where a needle is used to break up the fibrous cords
- Limited or partial fasciectomy, which removes only the affected portion of fascia
- Total fasciectomy, a more extensive surgical option that may involve skin removal and grafting
These procedures are typically performed by hand surgeons and vary in invasiveness depending on disease severity.
The Role of Radiation Therapy
While less commonly used in the United States, radiation therapy has been widely adopted in parts of Europe—particularly Germany—as an early treatment for Dupuytren’s disease. When used in the early stages, radiation can help prevent progression, reduce deformity, and potentially delay or avoid surgery.
At the HLRCC, radiation therapy is offered to appropriately selected patients. The process begins with a consultation to determine whether radiation, surgery, or continued observation is the best option.
Radiation treatment is delivered Monday through Friday for one week, followed by a break of four to six weeks, and then a second week of treatment—a schedule known as a split course. Each session lasts 30 minutes or less. High-energy particles called electrons are used to target the affected tissue at a precise depth within the palm.
Patients do not feel different during or after treatment. They are not radioactive, do not lose hair, and do not experience nausea. Mild skin reactions—such as redness, dryness, or tanning in the treated area—may occur but are generally manageable.
A Multidisciplinary Approach
Dr. Ravalese encourages patients to consult both a hand surgeon and a radiation oncologist when considering treatment options. This multidisciplinary approach ensures patients are fully informed and able to make decisions that best align with their goals and stage of disease.
Although radiation therapy for Dupuytren’s disease has been less common in the U.S., increased access to information through online communities has empowered patients to explore all available options. In Dr. Ravalis’s experience, outcomes have been encouraging, with success rates of 80–90% and a recurrence risk of approximately 5%.
To listen to the full episode, visit the Dupuytren’s Contracture Conversation.