I never had nodules in my hand. I did have "dimpling" which looked like a small callus with a hole in the middle. The "hole" seemed to be tied to the cord.

Hi Javier and callie,

DD without nodules is a really good question. The general accepted theory of disease development (pathogenesis) has been described by Vernon Luck 50 years ago http://www.dupuytren-online.de/downloads/luck.pdf . He considers the proliferative, nodular stage as the inititial stage, followed by the involutional stage (creating the dimples), and finally by contracture. That seems to be the typical behaviour. But Dupuytren's is not fully understood, obviously there are pre stages before the nodule where you don't see anything but the disease has already started nevertheless. It might also be that cords develop without a nodule. Another possibility would be that nodules are there but so small or embedded in the connective tissue that you don't feel them. Room for research.

Cords are believed to be a result of frequent pulling on the nodule that glues skin and connective tissue together. This is supported by the fact that cords develop along the pulling forces and degrade when the finger is stiffened, e.g. by an accident. So one would expect that prior to cord formation there is something causing that a pulling effect. Whether this is necessarily a distinct nodule is unclear.

Wolfgang