The most common evidence of the disease is a “lump” or nodule in the palm near the flexion crease, most often located at the base of the ring or small finger. This lump or nodule may also occur at the base of the thumb. (Fig. 1)
Although the appearance of these nodules in the finger usually occurs within the course of the disease, these nodules may be evident as the very first symptom.
Another sign or symptom of Dupuytren’s contracture is known as a dermal pit. The pit may be single or multiple, and appears as a small, local, deep indentation of the skin. This may be the first finding, it may come later, or the pit may never appear at all.
The pit usually is located in the palm but also can be found in the fingers. This indentation occurs as the normal fibrous bands which hold the palmar skin in place shorten, drawing the attached skin deeper than the surrounding skin.
The cord is a longitudinal fibrous band, which extends from the palm into the finger(s). It most often appears with a nodule, but it can be separate. It may appear as a single or multiple band. The cord or band creates a flexion contracture at the finger joints as it crosses the joints; or, in other words, the cord pulls the finger into a bent position. Once the contracture has started, the process may proceed (either slowly or rapidly) to a severe deformity of one or several fingers. Even if only one or two fingers are involved, this condition may become so advanced that daily activities are embarrassingly awkward.
The ring and small fingers are the most frequently affected, the long finger is next, followed by the thumb. The index finger is seldom involved.