Dupuytren’s contracture is a progressive hand condition in which the connective tissue (fascia) in the palm thickens and tightens over time. This tightening gradually pulls the fingers, most commonly the ring and little fingers, into a bent position. As the condition progresses, the affected fingers become increasingly difficult to straighten, which can significantly impact daily activities such as washing, writing, gripping objects, typing, and shaking hands.

While Dupuytren’s contracture is not usually painful, it can interfere with hand function, dexterity, and grip. Treatment aims to improve hand position and function, with options ranging from observation and non-operative interventions to surgery depending on severity.

Understanding the Condition: Anatomy and Physiology

The palmar fascia is a thin sheet of connective tissue located just beneath the skin on the palm of the hand. In Dupuytren’s contracture, this tissue becomes thickened, forming nodules and cord-like bands. These cords shorten and pull the fingers toward the palm, resulting in loss of extension.

Although the exact cause is not fully understood, Dupuytren’s is believed to involve a combination of genetic, biochemical, and mechanical changes in collagen metabolism within the fascia.

Causes and Risk Factors

Dupuytren’s contracture develops gradually and is thought to be influenced by genetic and environmental factors. It is more common in individuals of Northern European ancestry and may run in families.

Factors associated with increased risk include:

• Genetics: Strong hereditary link
• Age: More common after age 50
• Sex: Men are affected more frequently and more severely
• Medical conditions: Diabetes, epilepsy, and certain metabolic disorders
• Lifestyle factors: Higher prevalence in smokers and individuals with regular alcohol intake

It is not typically caused by injury, though trauma may trigger earlier presentation in predisposed individuals.

Signs and Symptoms

Symptoms often develop slowly over months or years.

Early signs may include:

• Thickened skin or firm nodules in the palm
• Indentation or puckering of the skin

As the condition progresses:

• Rope-like cords form under the skin
• The affected finger(s) gradually bend towards the palm
• Patients lose the ability to fully straighten the fingers

Importantly, the condition rarely causes pain, which is why some individuals delay seeking treatment until function becomes noticeably impaired.

Assessment and Diagnosis

Diagnosis is made through a detailed clinical examination. During assessment, a consultant will evaluate:

• Location and size of nodules or cords
• Degree of finger contracture
• Grip and pinch strength
• Functional impact on daily activities

Objective measurements may include the Tabletop Test – if the hand cannot lay flat on a surface, this suggests significant contracture.

X-rays are not usually required, but ultrasound may occasionally be used to assess soft tissue structures.

Treatment Options

Treatment depends on the severity of deformity, progression speed, and the impact on hand function. Early cases that are stable and minimally symptomatic may be monitored without intervention.

Non-Surgical Management

Non-operative therapies do not reverse the condition but may be appropriate for mild or early cases, or while monitoring progression.

Management may include:

• Hand therapy for joint mobility and soft tissue management
• Splinting in selected cases to maintain extension
• Steroid injections to reduce painful nodules in early inflammatory phases

Surgical Management

When contracture affects hand function, surgery is the most effective way to restore mobility. London Bridge Orthopaedics offers a range of surgical approaches tailored to disease severity, hand anatomy, and patient needs.

Surgical Options Include:

Needle Aponeurotomy

A minimally invasive technique where a needle loosens and divides the tight cords. This allows the finger to straighten without a large incision. Recovery is quicker, but recurrence may be more likely.

Collagenase Injection (Enzyme Fasciotomy)

A specialised enzyme (collagenase) is injected into the cord to weaken it. The finger is then manipulated to break the cord. This method is less invasive and suitable for selected patients.

Open Fasciectomy

A more traditional procedure where diseased fascia is removed through an incision. This approach is often used in moderate to severe cases and provides longer-lasting results.

Dermofasciectomy

Used for advanced or recurrent disease, this procedure removes both affected fascia and overlying skin, which is replaced with a skin graft. It offers the lowest recurrence risk but requires a longer recovery.

The Role of Hand Therapy

Hand therapy is a key component of successful treatment—both before and after surgery. At London Bridge Orthopaedics, our consultants work collaboratively with experienced hand therapists to optimise outcomes.

Hand therapy may include:

• Stretching and mobilisation exercises
• Scar management and soft tissue massage
• Strengthening programmes
• Custom splints to maintain corrected finger position

Research and clinical experience show that coordinated surgical and rehabilitative care significantly improves mobility, grip strength, and long-term function.

Prognosis and Recovery

Recovery varies depending on the type of treatment. Minimally invasive approaches have shorter recovery times, while open procedures may take several weeks to months.

Dupuytren’s contracture can recur, particularly in younger patients or those with aggressive disease. However, modern surgical techniques combined with structured hand therapy significantly reduce recurrence rates and help maintain function.

Frequently Asked Questions

Will Dupuytren’s contracture go away on its own?
No, it is a progressive condition. Early stages may remain stable, but once contracture develops, it usually worsens without treatment.

When should I seek specialist advice?
If you notice difficulty straightening your fingers, or cannot place your hand flat on a table, specialist assessment is recommended.

Is surgery always required?
Not necessarily. Mild or early cases may be monitored or managed with non-operative approaches. Surgery is considered when function is affected.

How long is recovery after surgical treatment?
Recovery may range from a few weeks after minimally invasive procedures to three months or more after more extensive surgery. Hand therapy plays an essential role in rehabilitation.

Can Dupuytren’s return after treatment?
Yes, recurrence is possible, especially in more aggressive or genetic cases. However, appropriate surgical technique and post-operative therapy help reduce this risk.

References

Bainbridge, C., Davis, T.R.C. and Elliott, D. (2020) ‘Surgical treatment of Dupuytren’s contracture: current practice patterns’, Journal of Hand Surgery (European Volume), 45(6), pp. 612–620.

National Institute for Health and Care Excellence (NICE) (2023) Dupuytren’s contracture treatment guidelines. Available at: https://www.nice.org.uk (Accessed 2 December 2025).

Zhao, J., Verjee, L.S., Nanchahal, J. and Davidson, P. (2019) ‘Dupuytren’s disease and therapeutic strategies’, Journal of Hand Therapy, 32(3), pp. 337–346.