Dupuytren's Contracture Progression: What It Looks Like
Dupuytren contracture can appear as painless lumps or nodules under the skin of your hand, but progression over time can cause your fingers to curl in toward your palm.
Dupuytren contracture is a medical condition affecting the palmar fascia of your hand. Fascia is a thin layer of connective tissue found throughout the body. It provides support and protection for your muscles, bones, nerves, and vessels.
In your hand, the palmar fascia is the main layer of fascia in your palm, located just under your skin. It spreads out in an upside-down triangle from the base of your fingers to your wrist.
Dupuytren contracture causes an atypical thickening in the palmar fascia and leads to the formation of rigid, fibrous cords. These thickened areas restrict the natural movement and function of the fascia and can pull your fingers into a bent position.
Not every person diagnosed with Dupuytren contracture will develop a finger curl. The condition follows a path of progression, but it doesn't always lead to severely bent fingers. For some people, Dupuytren contracture might never progress beyond the lump or nodule phase.
The progression of Dupuytren contracture
Several grading and staging systems have been used to track the progression of Dupuytren contracture since the early 1950s, but there's still no universally accepted standard for classification. Doctors typically use three clinical stages to describe a diagnosis, but they may also refer to a staging system first developed in 1968 known as the Tubiana classification.
Who is at risk for Dupuytren contracture?
Around 80% of Dupuytren contracture is attributed to genetics, with many genes contributing in small ways to the overall risk.
People of Northern European descent have a higher risk for Dupuytren contracture, and the condition has also been associated with:
smoking
diabetes
alcohol
aging
low body mass index (BMI)
How is Dupuytren contracture treated?
Doctors treat Dupuytren contracture based on its severity. In its earliest stage, it might not require treatment if it isn't causing any pain or affecting the function of your hand.
As Dupuytren contracture progresses, doctors consider:
Needle aponeurotomy: A minimally invasive procedure that uses a needle to break apart thickened areas of fascia.
Collagenase injections: The injections of an enzyme that dissolves collagen in Dupuytren cords.
Fasciectomy: The surgical removal of affected parts of the fascia.
Dupuytren contracture can't be cured, but treatments can help restore and maintain your hand's function.
The takeaway
Dupuytren contracture occurs when the fascia in your hand starts to thicken and constrict. In its early stages, it can appear as lumps under the skin, puckering, or hard nodules. Over time, Dupuytren contracture can progress to a point where it curls your fingers in toward your palm.
Not everyone will need treatment for this condition if it doesn't cause pain or affect hand function. When treatment is necessary, nonsurgical and surgical options are available.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
USA Today
22 minutes ago
- USA Today
How to clean your dog's, cat's teeth without a toothbrush: Video
Cats and dogs need dental care, too! While they don't need routine visits to the dentist like their human companions do, it is still just as important to keep their teeth clean as it is to keep yours clean. Like humans, pets can have bad breath and face the risk of plaque buildup, gum disease and tartar, which can cause oral health issues and could result in the loss of teeth, or the costly professional removal of teeth. However, since they lack opposable thumbs and the ability to use a toothbrush, they need some help from you. Watch this video for 4 easy ways to keep your pet's teeth clean. How often should you brush your dog's teeth You should aim to brush your dog's and cat's teeth at least 2-3 times per week, according to PetMD. Need a break? Play the USA TODAY Daily Crossword Puzzle. Many veterinarians perform a routine check of your pet's mouth during a routine visit, where they will see any oral issues developing in your pet's mouth. How to brush a dog's, cat's teeth The best way to familiarize your pet with having their teeth cleaned is to start getting them used to it as soon as you can. The younger they are when you start, the easier it is to do as they get older. First, you need the right tools: a pet-safe toothbrush and toothpaste. For puppies and kittens, start by getting them used to having a toothbrush in their mouth and the lifting of their lips. You can easily incorporate this into their regular grooming routine, so they are familiar with being brushed, having their nails trimmed and having their teeth checked and cleaned. Not all pets are comfortable with having their teeth brushed, so it may require some time, effort and patience to get your pet comfortable with it, especially if the animal is older. Fortunately, using a toothbrush isn't the only way to clean your pet's teeth. Keep reading for some toothbrush-free alternatives. Shop top-rated related products: Easy ways to clean your dog's teeth Our lives are busy, so frequent brushing of our pets' teeth isn't always feasible. Consider some of these alternatives that still allow you to clean their teeth, but might be a more manageable way to go about it. Let a professional handle it. Some pets don't do well with oral care, so ask your vet for a recommendation on where to get your pet's teeth professionally cleaned. However, depending on the pet and the dental care or work that's needed, it may require them to go under anesthesia and can be costly. Some pets don't do well with oral care, so ask your vet for a recommendation on where to get your pet's teeth professionally cleaned. However, depending on the pet and the dental care or work that's needed, it may require them to go under anesthesia and can be costly. Finger toothbrush. These fit on your finger and are an alternative to a traditional toothbrush. These are good for smaller dogs. However, keep in mind your pet's temperament and consider any potential risks of putting your finger in their mouth. These fit on your finger and are an alternative to a traditional toothbrush. These are good for smaller dogs. However, keep in mind your pet's temperament and consider any potential risks of putting your finger in their mouth. Plaque wipes. Use these to wipe their teeth and gums to help fight against plaque buildup. Wipes can be a good alternative if your pet isn't a fan of the toothbrush or considers it a toy, not a cleaning tool. Use these to wipe their teeth and gums to help fight against plaque buildup. Wipes can be a good alternative if your pet isn't a fan of the toothbrush or considers it a toy, not a cleaning tool. Powders or chews. These alternatives don't require as much work or risk of directly brushing your pet's teeth. These alternatives don't require as much work or risk of directly brushing your pet's teeth. Toys. Make teeth cleaning fun and let a toy do all the gritty work. Some rope toys can double as a flosser, while some harder toys can work on fighting plaque and other gunk on teeth. Just look at the label to see if the toy also doubles as a teeth cleaner. Also, check that the toy is appropriate for the size and age of your pet.
Associated Press
37 minutes ago
- Associated Press
Inside the legal fight over the telehealth clinics that help women defy abortion bans
Every month, thousands of women thwart abortion bans in their home states by turning to telehealth clinics willing to prescribe pregnancy-ending drugs online and ship them anywhere in the country. Whether this is legal, though, is a matter of debate. Two legal cases involving a New York doctor could wind up testing the shield laws some states have passed to protect telehealth providers who ship abortion pills nationwide. Dr. Margaret Carpenter faces a felony charge in Louisiana for supplying abortion medication through the mail to a pregnant teen in that state. The patient's mother also faces criminal charges. A Texas judge fined the same physician $100,000 after the state accused her of prescribing abortion medication for a woman near Dallas. So far, the prosecution hasn't progressed thanks to New York's shield law, which has protected Carpenter from extradition to Louisiana. But other telehealth centers operating in states with similar legal protections for abortion providers are watching closely. 'We have great legal counsel who have advised us that what we are doing is legal,' said Dr. Angel Foster, co-founder of The Massachusetts Medication Abortion Access Project, which is among a handful of telehealth providers that facilitate abortions from afar in states with bans. As more states consider enacting shield laws or expanding existing ones, whether one state can shield providers from liability for breaking another state's laws around abortion is still an unsettled area of law. Erik Baptist, senior counsel for the Alliance Defending Freedom, which opposes abortion, said shield laws violate a constitutional requirement that states respect the laws and legal judgments of other states. 'What these shield law states are doing are undermining the prerogative of these pro-life states to implement and enforce pro-life laws,' said Baptist, director of the group's Center for Life. 'And so I think the Supreme Court ultimately will want to take this.' 'That is inherently a challenge with shield laws and telehealth,' said Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School. 'At a certain point, for the purposes of abortion bans, the courts will need to decide: Do we treat a telehealth abortion as happening within the state of the provider or within the state of the patient?' Abortion pills sent to your home Decades ago, the FDA approved the use of two prescription medicines — mifepristone and misoprostol — to terminate pregnancies. But it wasn't until 2023 that telehealth abortions across states became more popular, after the U.S. Supreme Court overturned Roe v. Wade in 2022. The Society of Family Planning, which supports abortion rights, said that between April and June 2024 there were an average of 7,700 telehealth abortions performed each month in states that either ban abortion totally or after six weeks of pregnancy. The prescribing process at telehealth clinics varies by provider, but usually takes place entirely online, with the patient answering a series of health-related questions and consent forms. At some telehealth clinics, medical providers don't come face-to-face with patients, even via videoconferencing, and patients don't necessarily know the prescriber's name unless requested. For instance, when Foster's clinic, also known as The MAP, puts pills in the mail, only the name of the practice appears on the label, as allowed under the Massachusetts shield law. If patients have follow-up questions, they can talk or text the doctor working that day, but may not know that doctor's name either. Pills can arrive in a less than a week. 'This has been the safety net, post-Dobbs, of allowing people who don't have the ability to travel out of state to get abortion care,' said Greer Donley, a University of Pittsburgh law professor and abortion law expert. When dealing with medications not related to abortion, doctors are often able to write prescriptions for patients in other states. However, in most states, if the patient is located within its borders, the doctor must have a license issued by that state, according to Mei Wa Kwong, executive director of the The Center for Connected Health Policy. States with shield laws Twenty three states and Washington, D.C., currently have shield laws protecting abortion providers. Of those, eight have specific provisions protecting them from criminal prosecution or civil lawsuits even if the patient is in another state, according to the nonprofit research organization KFF. They include California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington. Louisiana's request to extradite Carpenter hit a roadblock when New York Gov. Kathy Hochul rejected it, citing the state's shield law. (A county clerk also cited the shield law as he refused to file the civil judgment from Texas.) 'These are not doctors providing health care. They are drug dealers,' Republican Louisiana Attorney General Liz Murrill told state lawmakers as she promoted a bill that would expand who can sue and be sued in abortion medication cases. 'They are violating our laws. They are sending illegal medications for purposes of procuring abortions that are illegal in our state.' Clinics say they will keep prescribing Julie Kay, the executive director of the Abortion Coalition for Telemedicine, the nationwide organization co-founded by Carpenter, said providers won't be 'bullied and intimidated' into ceasing operations. Other telehealth abortion providers said they also won't be deterred by legal threats. 'I have been working in this field for 25 years and this is part of the work,' said Dr. Rebecca Gomperts, founder and director of Aid Access, an abortion pill supplier. 'It's something that we all anticipated would happen,' she said of the legal challenges. A doctor who is part of A Safe Choice, a network of California-based physicians that prescribes abortion pills to women in all 50 states, told The Associated Press he believes he is protected by the state's shield law, but is also taking precautions. 'I'm not going to be traveling outside of California for a very long time,' said the doctor, who spoke with The Associated Press on condition of anonymity because he wanted to protect his identity for safety reasons. ___ Associated Press writer Sara Cline in Baton Rouge, Louisiana, contributed to this report.
Medscape
41 minutes ago
- Medscape
Speeding Up Vericiguat Target Dose in HFrEF Shown Safe
Ditching the standard two-step pathway to the target 10-mg dose of vericiguat in patients with heart failure with reduced ejection fraction (HFrEF) and instead employing a one-step protocol can be done safely and overcome the clinical inertia many of these patients encounter, the lead investigator of a prospective clinical trial of the one-step approach said. The 2022 American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines recommend starting patients with HFrEF on a 2.5-mg dose of vericiguat, a soluble guanylate cyclase activator, then stepping up to a 5-mg dose enroute to reaching a target of 10 mg. VELOCITY Study Results Stephen Greene, MD However, the VELOCITY study found nine of 10 patients safely tolerated starting on the 5-mg dose and skipping the recommended 2.5-mg step, Stephen Greene, MD, an advanced heart failure specialist at Duke Cardiology Clinic in Durham, North Carolina, reported at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2025. The study was simultaneously published in the European Journal of Heart Failure . 'We know from real-world evidence studies that, in US practice, there are many patients who are initiated on 5-mg vericiguat already, but now we have, actually, clinical data to suggest that this 5-mg initiation dose does appear to be safe among our patients that haven't had recent hypotension,' Greene told Medscape Medical News. The VELOCITY results make the case for updating the clinical guidelines for vericiguat, he added. The rationale for the study was to determine if starting patients closer to the target dose would give them a better chance of getting to and staying on the 10-mg target dose, according to Greene. 'Simplifying this process is one of the best ways to improve implementation for all our guideline-directed medical therapies,' Greene said. VELOCITY was a single-arm, two-week-long prospective trial that enrolled 106 patients with heart failure with an ejection fraction < 45% who were well-treated with background guideline-directed medical therapies. The primary endpoint was tolerability of 5-mg vericiguat dose after 2 weeks. Overall, 93.4% of patients tolerated the dose, including 90.6% in the group with worsening heart failure and 96.2% whose condition remained stable. Fourteen patients (13.2%) had an adverse event associated with treatment. One, a case of facial angioedema, was severe but the rest were considered mild. Four patients (3.8%) discontinued treatment because of an adverse event. VELOCITY also compared outcomes of those starting on the 5-mg dose with outcomes in the VICTORIA trial, which started patients on the 2.5-mg dose. In VICTORIA, 97.2% of patients tolerated the 2.5-mg starting dose over 2 weeks. Among patients with worsening heart failure, again 97.2% of VICTORIA patients tolerated the 2.5-mg treatment well, compared with 90.6% taking the 5-mg starting dose in VELOCITY. Greene also noted that patients in VELOCITY had 'the exact same mean reduction' in systolic blood pressure as those in VICTORIA: Both up to 3.2 mm HG on average. In VICTORIA, the placebo group also experienced a reduction in systolic blood pressure, he said, and the difference between the treatment and placebo groups was 1-to-2 mm HG. Had VELOCITY been a placebo study, the 3.2 mm HG reduction observed with the 5 mg dose 'likely would've been even further attenuated,' Greene said. 'This goes with what we already know about vericiguat, in that it seems to have minimal to no effect on systolic blood pressure.' Starting patients with HFrEF on 5 mg of vericiguat can help overcome 'clinical inertia' and increase the likelihood they will get to the 10-mg target dose, Greene said. 'Many of our patients with HFrEF never achieve target doses of guideline-directed medical therapies, and despite clinic visit after clinic visit, medication changes are, unfortunately, relatively rare,' Greene said. 'We see minimal medication titration, even when our patients have robust blood pressure, even when they have normal kidney function, even when we're talking about our inexpensive generic medications, we don't see many medication changes.' Time for Change, or 'Unique Strategy'? Ankeet S. Bhatt, MD, MBA, ScM Calling for a rewrite of clinical guidelines for using vericiguat in patients with HFrEF based on the VELOCITY results might be premature, Ankeet S. Bhatt, MD, MBA, ScM, a cardiologist and intensivist at Kaiser Permanente San Francisco Medical Center, told Medscape Medical News. 'VELOCITY really tests a unique strategy, reducing one of the steps in the titration of vericiguat, which may, if the clinical efficacy is confirmed in dedicated trials, bolster the confidence around early implementation at a higher dose of this therapy, without the need for an intra-dose titration,' Bhatt said. Validating the VELOCITY findings in a clinical trial 'might improve both acceptance from clinicians and the clinical implications about implementation of the therapy,' he added. Pairing the randomized clinical trial evidence with larger-scale real-world evidence would provide stronger evidence, he said. 'It's possible that there might be late effects or add-on effects that might either promote tolerability or might have safety concerns that we couldn't see in the context of this trial,' Bhatt said. 'So this is an important area that sets the stage, and when it's confirmed in real-world evidence, then I think we can make a compelling case that this might be an important addition to the guidance we already have.' This study was funded by Bayer and Merck Sharp & Dohme. Greene reported financial relationships with Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corcept, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Idorsia, Lexicon, Lilly, Merck, Novartis, Novo Nordisk, Otsuka, Pfizer, Roche Diagnostics, Sanofi, scPharmaceuticals, Sumitomo, and Tricog Health. Bhatt reported consulting for Merck.
