Dupuytren’s contracture is caused by an abnormal buildup of collagen in the palm, where cells in the connective tissue transform into aggressive, scar-like cells that form thickened nodules and cords beneath the skin. Over time, these cords tighten and pull one or more fingers toward the palm. No single cause explains every case. Instead, the condition results from a combination of genetic predisposition, metabolic triggers, and environmental exposures that together push the palm’s connective tissue into overdrive.
What Happens Inside the Palm
The palm contains a sheet of tough connective tissue called the palmar fascia, which normally helps you grip objects. In Dupuytren’s, normal cells in this tissue transform into a specialized cell type called a myofibroblast, a hybrid between a regular connective tissue cell and a muscle cell. These myofibroblasts contract like tiny muscles while simultaneously producing large amounts of collagen, the structural protein that gives tissue its strength.
Healthy palmar fascia is made mostly of type I collagen. In Dupuytren’s, the tissue becomes loaded with type III collagen, a type not normally found in the palm at all. This abnormal collagen is what forms the firm nodules you can feel under the skin and the cord-like bands that eventually pull fingers inward. The myofibroblasts responsible for this may originate from several different cell types, including immature connective tissue cells, cells lining small blood vessels, and circulating immune cells. Researchers still don’t fully understand what triggers the initial transformation, but once it begins, it tends to be self-reinforcing.
Genetics Play the Largest Role
Dupuytren’s contracture has a strong hereditary component. It is 3 to 10 times more common in people of European descent than in other populations, and it runs in families with enough consistency that researchers have long recognized a genetic predisposition. The largest genome-wide association study to date, analyzing over 11,000 cases and 47,000 controls, identified 56 locations in the genome linked to the condition, 34 of which were previously unknown.
Several of the implicated genes point to specific biological signaling pathways. Two that stand out are the Hedgehog and Notch pathways, both of which help regulate how cells grow, specialize, and produce structural proteins. A gene called WNT7B, part of yet another growth-signaling pathway, is highly active in Dupuytren’s tissue. Another gene, MMP14, carries a variant that causes a specific defect in the body’s ability to break down collagen in affected tissue. In other words, the genetic picture suggests that Dupuytren’s involves both too much collagen production and too little collagen removal.
The same genetic study found a significant overlap between Dupuytren’s and frozen shoulder, suggesting these two conditions may share underlying biological mechanisms.
Age and Sex
Dupuytren’s is primarily a condition of older adults. In men, it most often appears after age 50. Women tend to develop it later and generally experience a milder form. Men are affected considerably more often overall, though the gap narrows in older age groups. The reason for this sex difference isn’t fully understood, but hormonal influences on connective tissue metabolism are one likely factor.
Alcohol Consumption
Drinking alcohol is one of the more clearly established modifiable risk factors. A large Mendelian randomization study, a method that uses genetic data to test whether a risk factor truly causes a disease rather than just appearing alongside it, found that alcohol consumption nearly triples the odds of developing Dupuytren’s (an odds ratio of about 2.95). This effect was independent of smoking, meaning alcohol itself drives the increased risk rather than the lifestyle patterns that sometimes accompany it.
The biological link likely involves alcohol’s effects on liver function and tissue repair. Chronic alcohol use promotes fibrosis, the same type of excessive collagen deposition that characterizes Dupuytren’s, in multiple organs throughout the body.
Smoking May Not Be a Direct Cause
For years, smoking was listed alongside alcohol as a risk factor for Dupuytren’s. More recent genetic evidence challenges this. The same Mendelian randomization study that confirmed alcohol’s causal role found no causal association between cigarettes per day, age of smoking initiation, or smoking cessation and Dupuytren’s disease. Earlier studies that linked smoking to the condition may have been picking up on the fact that heavy smokers are also more likely to drink heavily.
Diabetes
People with diabetes develop Dupuytren’s at notably higher rates. The prevalence in diabetic patients ranges from 16% to 42%, compared with about 13% in the general population. Chronically elevated blood sugar promotes changes in connective tissue proteins that make them stiffer and more resistant to normal turnover. This likely creates a tissue environment where the abnormal collagen buildup of Dupuytren’s gains a foothold more easily. Dupuytren’s in diabetic patients often affects more fingers but tends to progress more slowly and cause less severe contracture than in non-diabetic patients.
Vibration and Manual Labor
Occupational exposure to hand-transmitted vibration is a recognized risk factor. A review by the UK’s Industrial Injuries Advisory Council concluded that sufficient exposure to hand-held vibrating tools can more than double the risk of Dupuytren’s. The qualifying threshold they identified was using vibrating power tools for at least two hours per day, three or more days per week, over a cumulative period of ten years or more.
The relationship with manual labor more broadly is harder to pin down. Some studies have found links between heavy manual work and Dupuytren’s even in jobs that don’t involve vibrating tools, but the definition of “manual work” varies so widely across studies that it’s difficult to draw firm conclusions. The vibration connection is on stronger footing: repetitive micro-trauma to the palm’s connective tissue may trigger the same kind of abnormal healing response seen after acute injuries.
Hand Injury and Trauma
There is growing evidence that a single traumatic injury to the hand can trigger Dupuytren’s, even in younger people without other predisposing factors. One proposed mechanism is that trauma causes the release of nerve growth factors that promote the migration and multiplication of the connective tissue cells that eventually become disease-causing myofibroblasts. Case reports have documented Dupuytren’s developing in the wake of fractures, crush injuries, and even minor hand trauma. The association remains debated in the medical literature, partly because it’s difficult to prove that an injury caused the condition rather than simply preceded it, but clinical criteria now exist to help identify trauma-related cases.
Anti-Seizure Medications
Long-term use of certain anti-seizure medications, particularly phenobarbital and phenytoin, has been linked to Dupuytren’s. The incidence increases with the duration of treatment. This connection was first recognized in epilepsy patients, where prolonged use of these drugs over many years correlated with higher rates of the condition. The mechanism isn’t fully clear, but these medications may alter connective tissue metabolism in ways that promote fibrosis.
Connection to Other Fibrotic Conditions
Dupuytren’s doesn’t always occur in isolation. It belongs to a family of conditions characterized by excessive connective tissue growth. In a study of 730 men with Dupuytren’s, about 22% also had Ledderhose disease (the same type of tissue thickening on the sole of the foot) and roughly 9% had Peyronie’s disease (fibrotic tissue in the penis). These overlaps suggest that some people carry a body-wide tendency toward abnormal fibrosis rather than a problem limited to the palm. When Dupuytren’s appears alongside these other conditions, or when it develops at a younger age, affects both hands, or progresses rapidly, clinicians sometimes refer to this as “Dupuytren’s diathesis,” a constitutional predisposition toward aggressive disease.
If you have Dupuytren’s and notice firm lumps on the soles of your feet or other fibrotic changes elsewhere in the body, these are likely related rather than coincidental.