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Health condition · Clinically reviewed

Dupuytren contracture, nodules, cords and the tabletop test that changes the plan.

A common, slowly progressive condition of the palm - and one where the timing of hand-surgery review matters more than any single treatment choice.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSSH, AAOS and peer-reviewed hand-surgery sources listed at the end.

  • 03

    Current for 2026

    Reflects current UK practice - needle aponeurotomy, fasciectomy pathways and the 2020 withdrawal of collagenase.

Key facts

Dupuytren at a glance.

The essentials, in plain English - what it is, who gets it, and how it is treated in the UK today.

  • What it is

    A progressive fibroproliferative disorder of the palmar aponeurosis - nodules and cords slowly bend the fingers.

  • Also known as

    Dupuytren's contracture, palmar fibromatosis or Viking disease - the same condition under different names.

  • Who it affects

    Common in Northern European ancestry. Prevalence up to 20 per cent in the over-65s. Men affected 3 to 7 times more than women.

  • Genetics

    Strong family history in about 70 per cent - autosomal dominant with variable penetrance, driven by WNT signalling and TGF-beta.

  • Fingers affected

    Ring finger most often (over half), then little, middle, thumb and index. Bilateral involvement is common.

  • Treatment ladder

    Observation for mild disease; needle aponeurotomy or fasciectomy when contracture limits daily function.

Why this guide matters

A staged plan, not a rush to surgery.

Dupuytren is common, slow and often manageable for years. The three points below shape everything else on this page.

  • Function decides timing

    Nodules alone are not a reason to operate. A positive tabletop test and loss of everyday function are the practical thresholds.

  • Two mainstream options

    Needle aponeurotomy is fast and minimally invasive. Fasciectomy is longer but has a lower recurrence rate - both are valid.

  • Hand therapy shapes the result

    The outcome after any procedure is set as much by post-op hand therapy and splinting as by the operation itself.

How the diagnosis is made

From first nodule to a clear plan.

The steps a UK GP or hand surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Hand and history

    A structured look at nodules, cords, pitting and puckering - alongside family history, diabetes and other fibromatoses.

  2. 02

    Assessing

    Hueston tabletop test

    Place the palm flat on a table. If the fingers cannot fully touch the surface the test is positive - a clear sign for referral.

  3. 03

    Assessing

    Goniometer measurement

    Total angle of contracture at the MCP, PIP and DIP joints - the number that guides treatment timing.

  4. 04

    Grading

    Tubiana grading

    Grades 0 to 4 based on total contracture angle - shared language between GP, hand surgeon and hand therapist.

  5. 05

    Grading

    Ultrasound (selective)

    Not routine. Reserved for atypical cases, pre-injection cord characterisation or planning revision surgery.

  6. 06

    Deciding

    Hand-surgery referral

    Any functional loss, tabletop-positive disease or rapid progression deserves a specialist hand-surgeon opinion.

  7. 07

    Deciding

    Shared decision

    Weigh needle aponeurotomy versus fasciectomy against recurrence risk, occupation and hand dominance - together.

Typical timeline: GP review to a settled hand-surgery plan in weeks, not months.

Symptoms

What Dupuytren actually looks like.

The classic sequence of nodules, cords and contracture, and the ectopic features that signal a more aggressive diathesis.

  • Palmar nodules

    Small firm painless lumps in the palm - often the first sign and sometimes mistaken for a callus.

  • Fibrous cords

    Longitudinal thickenings that develop from the nodules and gradually tether the finger down towards the palm.

  • Skin pitting and puckering

    Small dimples in the palm where the fascia pulls on the overlying skin - a classic feature.

  • Finger contracture

    Inability to fully straighten the ring or little finger - the reason most people finally seek help.

  • Positive tabletop test

    Palm cannot lie flat on a table - the practical threshold for offering intervention.

  • Bilateral involvement

    Both hands are commonly affected, though rarely to the same degree - the dominant hand is not necessarily worse.

  • Loss of daily function

    Trouble washing the face, driving, wearing gloves, putting the hand in a pocket or shaking hands.

  • Ectopic fibromatosis

    Garrod pads on the knuckles, Ledderhose disease of the sole or Peyronie disease - a more aggressive Dupuytren diathesis.

Treatment

How Dupuytren is treated in the UK.

Watchful waiting first, then needle aponeurotomy or fasciectomy when function is affected - shaped by disease severity, occupation and hand dominance.

  • Watchful waiting

    For nodules alone with no functional loss - stretching and splinting have not been shown to change the course of the disease.

  • Needle aponeurotomy

    Office procedure under local anaesthetic - a needle weakens the cord and it is snapped straight. Faster recovery, higher recurrence.

  • Regional fasciectomy

    The gold-standard operation. The diseased cord and fascia are removed through a zig-zag incision. Lower recurrence, longer recovery.

  • Dermofasciectomy with graft

    Cord and overlying skin removed and a full-thickness skin graft placed - reserved for recurrent or aggressive disease.

  • Segmental fasciectomy

    Small segments of cord removed through short incisions - a middle ground for selected patients and surgeons.

  • Open fasciotomy

    Cord divided but not removed - a shorter option for frail patients or those unfit for a full fasciectomy.

  • Hand therapy and splinting

    Specialist hand-therapy input after any procedure - the single biggest determinant of a good functional result.

  • Collagenase injection

    Xiapex was previously NICE-recommended but was withdrawn from the UK market in 2020 for commercial reasons - not currently available.

What this guide is based on

The sources behind every claim on this page.

UK and international specialist-society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or hand surgeon knows your hand and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Society for Surgery of the Hand (BSSH). Dupuytren's disease - patient and clinician resources.

  • American Academy of Orthopaedic Surgeons (AAOS). Clinical practice guideline on the treatment of Dupuytren's contracture.

  • NICE. Needle fasciotomy for Dupuytren's contracture (IPG43); collagenase update (2020 UK withdrawal).

  • Peer-reviewed hand-surgery literature on recurrence rates after needle aponeurotomy versus fasciectomy.

Red flags

When Dupuytren needs urgent review.

Most Dupuytren is a slow, planned pathway. These are the situations where earlier specialist input changes the outcome.

  • Rapidly progressive contracture

    A fast-moving contracture, especially in a younger patient, deserves early hand-surgery review before the joints stiffen.

  • Fixed PIP joint contracture

    Proximal interphalangeal contracture is harder to correct than MCP disease - refer early rather than watch it slide.

  • Aggressive Dupuytren diathesis

    Young onset, strong family history, bilateral disease and ectopic sites (Ledderhose, Peyronie, Garrod pads) predict recurrence.

  • Digital nerve injury after surgery

    Numbness in a finger after fasciectomy - especially revision surgery - needs urgent review by the operating team.

  • Complex regional pain syndrome

    Disproportionate pain, swelling or colour change after any hand procedure - see our CRPS guide and escalate quickly.

  • Skin loss or delayed healing

    Wound problems after fasciectomy are more common in smokers and diabetics - report early to the hand-therapy team.

  • Recurrence after previous surgery

    Recurrence rates of 10 to 50 per cent depending on procedure and diathesis - not a failure, but a signal for specialist review.

  • Diabetic Dupuytren

    Two to three times more common in diabetes and often milder - but glycaemic control still matters for wound healing.

  • Non-Dupuytren mimics

    Trigger finger, tendon adhesions or a locked joint can look similar. A hand surgeon can tell them apart quickly.

Living with it

A lifelong condition, with clear waypoints.

Four small habits make the biggest difference - a simple home test, honest tracking of function, disciplined hand therapy and a long-term view.

A quiet reminder

Function decides the plan, not the picture.

A hand that still works well may not need surgery, however dramatic it looks. What you can and cannot do is the real measure.

  1. 01 Test

    Try the tabletop test

    If your palm cannot lie flat on a table, book a review. It is the simplest sign that intervention is worth discussing.

  2. 02 Function

    Track what you cannot do

    Notice which everyday tasks are becoming harder - washing, driving, gloves, pockets. Function drives the timing of treatment.

  3. 03 Recovery

    Hand therapy is not optional

    After any procedure, a specialist hand therapist and a night splint make the biggest difference to the long-term result.

  4. 04 Recurrence

    Plan for the long game

    Dupuytren is a lifelong disease. A good result today does not rule out recurrence - stay in touch with your hand surgeon.

Frequently asked

Everything we get asked about Dupuytren.

Quick answers on the tabletop test, needle aponeurotomy, fasciectomy and long-term recurrence.

  • What is Dupuytren contracture?

    A progressive fibroproliferative disorder of the palmar aponeurosis - the layer of fascia under the skin of the palm. Nodules develop first, then fibrous cords, and over months or years these cords slowly bend the affected finger down into the palm.

  • Why is it called Viking disease?

    Dupuytren is far more common in people of Northern European ancestry - Scandinavian, British, French and Nordic. UK prevalence rises to around one in five in the over-65s. The genetics are complex, but WNT signalling pathway variants are involved.

  • When is treatment needed?

    Nodules alone do not need treatment. Intervention is offered when the contracture affects daily function - a positive Hueston tabletop test is the classic threshold, meaning the palm cannot lie flat on a table.

  • What is needle aponeurotomy?

    A minimally invasive office procedure done under local anaesthetic. A fine needle is passed through the cord in several places to weaken it, and the finger is then straightened - the cord snaps. Recovery is fast but recurrence is higher than after open surgery.

  • How does fasciectomy differ?

    Fasciectomy is a hand-surgery operation that removes the diseased cord and fascia through a zig-zag incision. Recovery takes weeks, requires hand therapy and a night splint, but the recurrence rate is lower - it remains the gold standard for significant contracture.

  • Is collagenase still available in the UK?

    No. Xiapex (collagenase clostridium histolyticum) was previously NICE-recommended, but it was withdrawn from the UK market in 2020 for commercial reasons. Needle aponeurotomy and fasciectomy are the current mainstays of treatment.

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