Dupuytren's contracture claims: when work is to blame

Dupuytren's contracture develops slowly, and many people put it down to age or family history. That may be right: NHS guidance says the exact cause is unknown and that it has been linked to a family history of the condition, smoking, drinking lots of alcohol, and diabetes or epilepsy. But if you spent years using powered tools that vibrate, such as sanders, grinders or chainsaws, work may have played a part. This guide explains the condition, the evidence linking it to vibration, what employers must do, how a claim is proved when there are other risk factors, the state benefit and the time limits across the UK. We are an independent information service, not a law firm.

What Dupuytren's contracture is

NHS guidance describes Dupuytren's contracture as one or more fingers bending in towards your palm so that you cannot straighten them. It starts with lumps or ridges on the palm, mainly affects the ring and little fingers, is common in both hands at the same time and tends to get slowly worse over many months or years. It is not usually painful, but it can affect how you use your hand.

Severity varies a great deal. The Industrial Injuries Advisory Council (IIAC), an independent statutory body that advises the government on the industrial injuries scheme, says the majority of cases cause little or no functional loss. It describes the table top test as a rough guide to severity: whether you can place your hand flat against a hard surface such as a table.

Treatments described by the NHS include surgery to remove the affected tissue (fasciectomy), a needle inserted along the palm and finger to loosen and straighten it (needle fasciotomy), and surgery with a skin graft (dermofasciectomy). The NHS says your finger may not be completely straight after treatment and the contracture could come back after a few years. The IIAC also notes that surgery is effective but frequently followed by recurrence. If you claim, the medical evidence should cover future treatment and the chance of recurrence.

The link with vibrating tools

In 2014 the IIAC reviewed the research on work with hand-held vibratory tools and Dupuytren's disease. It found that the condition has various established non-occupational causes, that links with the use of hand-held powered vibratory tools had long been suspected and that evidence on this has grown. Taken together, it said, the evidence indicates that the risk of the disease can be more than doubled, provided that exposure to vibration is long enough.

The IIAC recommended adding the condition to the list of prescribed diseases, and Dupuytren's contracture of the hand is now prescribed disease A15 for Industrial Injuries Disablement Benefit. It covers work with hand-held powered tools whose internal parts vibrate so as to transmit that vibration to the hand, where use of the tools adds up to at least 10 years and, within that time, amounts to at least 2 hours a day on 3 or more days a week. A fixed flexion deformity of a finger joint is also required.

Those thresholds decide entitlement to the benefit, not whether a civil claim succeeds, but they show the kind of exposure the IIAC linked to the disease. HSE guidance names two other permanent conditions that regular exposure to hand-arm vibration can cause: hand-arm vibration syndrome and carpal tunnel syndrome. If you have symptoms of those as well, see our guides to vibration white finger and carpal tunnel claims.

What your employer should have done

The Control of Vibration at Work Regulations 2005 set out what employers must do about hand-arm vibration:

• Assess the risk. An employer whose work is liable to expose employees to risk from vibration must make a suitable and sufficient assessment of that risk (regulation 5).
• Work to the exposure values. For hand-arm vibration the daily exposure action value is 2.5 m/s² A(8) and the daily exposure limit value is 5 m/s² A(8) (regulation 4).
• Eliminate or reduce the risk. The risk must be eliminated at source or, where that is not reasonably practicable, reduced to as low a level as is reasonably practicable (regulation 6).
• Provide health surveillance. Where the assessment shows a risk to health, or exposure is likely to reach an action value, employees must be placed under suitable health surveillance, and a health record kept for each of them (regulation 7).
• Inform and train. Employees at risk must be given suitable and sufficient information, instruction and training (regulation 8).

One legal detail: since 1 October 2013, section 47 of the Health and Safety at Work etc. Act 1974 has provided that breach of a duty in health and safety regulations is not actionable except to the extent that regulations provide. If your exposure spans that date, ask your solicitor how it affects the way the claim is put.

Proving work caused it

Because the condition also has non-work causes, a claim needs evidence that your work played a part in causing it. That normally means evidence of what you were exposed to, and an opinion from an independent medical expert who has examined you and weighed your other risk factors, such as family history, smoking, alcohol or diabetes.

Useful exposure evidence includes:

• the names and types of tools you used, and roughly how many hours a day and days a week;
• the years you did that work, and for which employers;
• whether you were given information, training, limits on tool time or health checks; and
• statements from colleagues who did the same work.

Your solicitor can also ask for any vibration risk assessment and the health record the Regulations require for each employee under health surveillance.

How a claim is made

In England and Wales, claims for work-related illness follow the Pre-Action Protocol for Disease and Illness Claims. Under it:

• the letter of claim should contain a clear summary of the facts, details of the illness and the main allegations of fault;
• an employment history should be provided, with a work history from HM Revenue and Customs;
• copies of any relevant search result from the Employers' Liability Tracing Office should be attached;
• the defendant should acknowledge within 21 days and give a reasoned answer within 90 days of the acknowledgement.

HMRC can give you a record of your employment history for a compensation claim: the current and past 5 years online, and earlier years with a paper application. Employers carrying on business in Great Britain must insure against liability for injury and disease their employees suffer at work. If a former employer has closed or become insolvent, your rights against it can transfer to its insurer: see our guide to claims when an employer is insolvent.

Industrial Injuries Disablement Benefit (A15)

Industrial Injuries Disablement Benefit is a state benefit, separate from a compensation claim. GOV.UK says you may be able to get it if you have Dupuytren's contracture caused by your work. The condition must have started while you were employed for 10 years or more in jobs that involved using hand-held powered tools with internal parts that vibrate, for 2 hours or more a day on 3 or more days a week for all of that period, and you must have developed a fixed flexion deformity (a permanent bend) in one or more finger joints.

• If only the joint between your finger and your palm is affected, the permanent bend must be more than 45 degrees.
• If any of the joints along the finger are affected, they can be permanently bent to any degree.
• If the bend developed after you left the job, you also need to show that the finger and palm joint had started to bend, or that changes to your palm such as thickening of the skin or palmar nodules had started, while you were in that job.

You cannot claim the benefit if you were self-employed. If you later receive compensation, the Compensation Recovery Unit may recover certain social security benefits from it; see our guide to compensation and benefits.

Time limits

Dupuytren's contracture develops gradually, so the key date is usually your date of knowledge, not the date you started the work. In England and Wales, section 11 of the Limitation Act 1980 allows three years from the date of knowledge if that is later than the date the cause of action accrued. Under section 14 that is when you first knew that the injury was significant, that it was attributable to the act or omission said to be negligent, and who the defendant is. You can be treated as knowing facts you could have found out with medical or other expert advice it was reasonable to seek.

In Scotland the period is 3 years, running from when you became aware, or could reasonably have become aware, of the relevant facts (section 17 of the Prescription and Limitation (Scotland) Act 1973). Northern Ireland uses three years from accrual or the date of knowledge (article 7 of the Limitation (Northern Ireland) Order 1989). Courts in all three jurisdictions can allow a late claim if it is equitable, but that is discretionary.

Use the checker as a first guide only. If you are unsure when your date of knowledge was, take advice now rather than later.

Frequently asked questions

Related guides: vibration white finger (HAVS) claims, carpal tunnel claims, hand injury claims, industrial disease claims, RSI claims and time limits.

Official sources used for this guide: NHS: Dupuytren's contracture; IIAC: Dupuytren's contracture due to hand-transmitted vibration (2014); GOV.UK: IIDB for Dupuytren's contracture; Prescribed diseases, Schedule 1 (A15); Control of Vibration at Work Regulations 2005, reg. 5; Limitation Act 1980, s.14. This guide is general information about the law in the UK, not legal advice; the law can change, so check your own position with a regulated solicitor.