Dupuytren’s contracture is a deformity of the hand that develops slowly over years.  It is initially painful but most people seek help based on the functional disability that it causes.  Dupuytren’s contracture is caused by thickening of the layer of tissue under the skin of your palm.  The patient may notice nodules under the skin that are tender to touch.  These nodules eventually joint together to form thick bands of tissue, contract around the tendons of the fingers, and cause the fingers to bend toward the palm.  The fourth and fifth fingers of the hand are usually affected.  The disease usually develops in older men of Northern European descent.  The disease may be caused by trauma to the area.  It is also associated with diabetes and alcoholism.  X-rays or MRIs of the hand are useful to exclude other causes of pain and contracture such as fractures or tumors.  Treatment begins with conservative modalities such as physical therapy.  Needling of the fibrous chords has been done to break them up.  The chords can be injected with enzymes to break of the tissue followed by manual techniques to increase range of motion.  Surgery may be needed in severe cases to cut the chords in order to restore function.  About 20% of patients experience recurrence after treatment.