What is Viking disease? Dupuytren's contracture explained
- Jun 2
- 6 min read
You may have heard Dupuytren's contracture referred to as Viking disease and wondered what on earth the Vikings have to do with your fingers. The nickname reflects a genuine pattern in who gets the condition and where it is most common. This article explains what Dupuytren's contracture is, why it has this unusual name, and what can be done about it.
What is Dupuytren's contracture?
Dupuytren's contracture is a condition in which the connective tissue beneath the skin of the palm gradually thickens and tightens. This tissue, called the palmar fascia, normally lies flat beneath the skin and plays a role in stabilising the hand. In Dupuytren's contracture, it begins to change, forming firm nodules and, over time, thick cords that run up towards the fingers.
As these cords tighten, they pull the affected fingers into a bent position. The ring finger and little finger are most commonly affected, though the middle finger or other fingers can be involved. The bending is permanent: the finger cannot be straightened, even if you push it with your other hand. In advanced cases the finger may be bent at 90 degrees or more.
The condition is not painful for most people, though the early nodules can be tender. The main impact is functional: difficulty gripping objects, shaking hands, wearing gloves, putting a hand in a pocket, or laying the hand flat on a surface.
Why is it called Viking disease?
The name Viking disease reflects the condition's strong association with people of Northern European descent, particularly those from Scandinavia, the British Isles, Iceland, the Netherlands and Northern France. These are the regions from which the Vikings originated and through which they spread during their expansion across Europe.
Dupuytren's contracture is considerably more common in people with ancestry from these areas than in the general global population. It is rare in people of African, East Asian or South Asian descent. The theory is that the condition has a genetic origin that spread with the movements of Northern European peoples across Europe and, later, to North America and Australia.
In Iceland, which has a particularly homogeneous population with strong Norse ancestry, Dupuytren's contracture affects a high proportion of the older population. Studies in Scandinavia show similarly high rates. In countries like the UK, where Norse and Anglo-Saxon ancestry is common, the condition is estimated to affect around one to two million people.
Who was Dupuytren?
The condition is named after Baron Guillaume Dupuytren, a French surgeon who practised in Paris in the early nineteenth century. In 1831 he gave a famous clinical demonstration in which he described the anatomy of the condition and performed the first surgical treatment for it, a procedure to release the contracted tissue and allow the fingers to straighten.
His name became attached to the condition even though earlier descriptions exist in the medical literature. The operation he described forms the basis of modern surgical treatment, which has of course advanced considerably since then.
Who gets Dupuytren's contracture?
Several factors increase the likelihood of developing Dupuytren's contracture:
Ancestry
As described above, people of Northern European descent are most commonly affected. If your family has roots in Scandinavia, Ireland, Scotland, England or Northern France, your risk is higher.
Family history
Dupuytren's contracture runs strongly in families. If a parent or sibling has the condition, your risk of developing it is significantly increased. The inheritance pattern is complex, but the genetic component is well established.
Age
The condition becomes more common with age. It most often first appears after the age of 50, though it can occur in younger people. Older men are at the highest risk.
Sex
Men are affected more often than women and tend to develop more severe disease. Women who develop Dupuytren's contracture often do so later in life and with less rapid progression.
Diabetes
People with diabetes are more likely to develop Dupuytren's contracture, and the condition tends to affect more fingers when it occurs in the context of diabetes.
Epilepsy and certain medications
Certain anti-epileptic medications have historically been associated with a higher rate of Dupuytren's contracture, though the reasons are not fully understood.
Alcohol
Heavy alcohol consumption has been linked to increased rates of Dupuytren's contracture in some studies, possibly through its effects on liver function and collagen metabolism.
Manual work
The role of manual labour and vibration exposure remains debated in the medical literature. There is some evidence that repetitive vibration exposure increases risk, and the condition is more common in certain occupations. However, it also occurs frequently in people who have never done manual work.
How is it diagnosed?
Dupuytren's contracture is diagnosed clinically. A surgeon or doctor examines the hand, looking for the characteristic nodules and cords in the palm and assessing the degree of finger bending. A useful diagnostic tool is the tabletop test: if you cannot place your hand flat on a table because your finger is bent, Dupuytren's contracture is likely to be significant enough to warrant discussion about treatment.
Imaging such as ultrasound is not usually required for diagnosis but may occasionally be used to assess the relationship between the cord and nearby structures such as the digital nerves.
What can be done about it?
Treatment for Dupuytren's contracture depends on how advanced the condition is and how much it is affecting function.
Monitoring
For early disease with no significant finger bending, regular monitoring is appropriate. Not all cases progress quickly, and some remain stable for years.
Non-surgical treatment
For selected patients with early to moderate disease, needle fasciotomy (dividing the cord using a needle under local anaesthetic) or collagenase injection (an enzyme that weakens the cord, followed by manipulation to break it) may be suitable. These options have quicker recovery times but higher recurrence rates than surgery.
Surgery
Fasciectomy, the surgical removal of the thickened cords and abnormal tissue from the palm, is the most effective treatment for significant Dupuytren's contracture. It provides the most durable correction and is the treatment of choice for moderate to severe disease. The procedure is performed under local or regional anaesthetic and most patients go home the same day.
Is there a cure?
There is no cure for Dupuytren's contracture in the sense that the underlying predisposition cannot be eliminated. The condition can recur after treatment, and patients with a strong family history, younger age at onset or rapidly progressive disease are more likely to experience recurrence.
However, treatment can successfully straighten the fingers and restore function for many years, and repeat treatment is possible if recurrence occurs.
Research into the genetic and cellular mechanisms behind Dupuytren's contracture is ongoing, and a better understanding of these mechanisms may eventually lead to treatments that address the root cause rather than just the effects.
FAQ
Is Viking disease the same as Dupuytren's contracture?
Yes. Viking disease and Dupuytren's contracture are the same condition, referred to by different names. The term Viking disease reflects the condition's prevalence in people of Northern European descent, from the regions associated with Viking ancestry. The clinical name honours Baron Guillaume Dupuytren, the French surgeon who first described its surgical treatment in 1831. It is different from - and often confused with - Trigger Finger.
Can Dupuytren's contracture affect the feet?
Yes. A related condition called Ledderhose disease (plantar fibromatosis) can cause nodules to form in the sole of the foot. Similarly, Peyronie's disease involves a similar process in penile tissue. These conditions are related to Dupuytren's and can occur in the same patient, suggesting a shared underlying fibrotic process.
Does Dupuytren's contracture only affect older people?
Dupuytren's contracture most commonly appears after the age of 50 and becomes increasingly prevalent with age. However, it can develop in younger adults, particularly those with a strong family history or significant risk factors. When it appears at a younger age, it often progresses more aggressively.
Can Dupuytren's contracture be prevented?
There is no established way to prevent Dupuytren's contracture, as it is primarily genetic in origin. Reducing modifiable risk factors such as excessive alcohol consumption and managing conditions like diabetes appropriately may help reduce risk, but cannot guarantee prevention.
How common is Dupuytren's contracture in the UK?
Dupuytren's contracture is relatively common in the UK, given the strong Northern European heritage of much of the population. Estimates suggest it affects between one and two million people in the UK. It is significantly more common in men and becomes increasingly prevalent from middle age onwards.
Mr Rikki Mistry is a Consultant Plastic Surgeon specialising in Dupuytren's contracture surgery at clinics in East Grinstead, Chatham and Tunbridge Wells. To arrange a private consultation, call 0330 1331 464 or visit rikkimistry.com/contact.