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Health condition · Clinically reviewed

Dupuytren’s contracture, the palmar fibrous cord — needle fasciotomy, collagenase and modern fasciectomy.

A benign but progressive fibrous cord in the palm that pulls fingers (usually ring and little) into flexion. Treatment is stratified by contracture severity and function — from watchful waiting to needle fasciotomy, collagenase injection or open fasciectomy.

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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

    Every claim is checked against BSSH, NICE and specialist society sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK hand-surgery practice on needle fasciotomy, collagenase and modern fasciectomy.

Key facts

Dupuytren’s contracture at a glance.

The essentials, in plain English — what Dupuytren’s is, when to treat it, and how needle fasciotomy, collagenase and open fasciectomy actually compare.

  • Definition

    Dupuytren’s contracture is a fibromatosis affecting the palmar fascia — benign nodules and cords that gradually pull the fingers into flexion.

  • Who gets it

    Higher prevalence in people of Northern European descent — sometimes called Viking disease — with a strong familial pattern.

  • Course

    Often bilateral and gradual over years — nodules first, then cords, then fixed contracture of the fingers, usually ring and little.

  • Table-top test

    The Hueston table-top test — inability to lay the palm flat on a table — is a good functional trigger for treatment discussion.

  • Needle fasciotomy

    Percutaneous needle fasciotomy (PNF) is quick and low-morbidity, done under local — but has a higher recurrence rate than open surgery.

  • Open fasciectomy

    Limited fasciectomy has lower recurrence but a longer recovery and higher complication rate — a trade-off worth discussing openly.

Why this guide matters

Function first, procedure second.

Dupuytren’s treatment isn’t one-size-fits-all — the right choice depends on your contracture, your function and how you weigh recurrence against recovery.

  • Nodules aren’t an emergency

    Isolated palmar nodules without contracture are usually watched — a cord that pulls the finger down is when the conversation changes.

  • Needle vs open — a real trade-off

    Needle fasciotomy is fast and gentle but has higher recurrence. Open fasciectomy is more definitive but longer to recover from.

  • Hand therapy matters after

    Splinting and hand-therapy exercises are as important to the outcome as the procedure itself — don’t skip them.

How the diagnosis is made

From palmar nodule to a clear plan.

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

  1. 01

    Recognising

    Symptoms and family history

    Gradual palmar thickening and finger contracture, often bilateral — a family history of Dupuytren’s is a strong pointer.

  2. 02

    Recognising

    Palpate nodules and cords

    Firm palmar nodules and longitudinal cords, most commonly along the ring and little finger rays.

  3. 03

    Recognising

    Hueston table-top test

    Ask the patient to lay the palm flat on a table — inability to do so is a well-recognised trigger for treatment.

  4. 04

    Confirming

    Measure contracture angles

    Goniometer measurement of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) contracture — the numbers guide the plan.

  5. 05

    Confirming

    Rule out other palmar mass

    Consider ganglion, epithelioid sarcoma, giant cell tumour of tendon sheath or other soft-tissue mass if the presentation is atypical.

  6. 06

    Managing

    Hand surgery consultation

    Referral to a hand surgeon once a functional contracture is present — MCP ≥30° or any PIP contracture with function loss.

  7. 07

    Managing

    Discuss expectations honestly

    Every treatment has a recurrence rate — an honest conversation about needle fasciotomy vs collagenase vs open surgery is essential.

Typical timeline: 4–8 weeks from GP referral to hand-surgery consultation.

Symptoms

What Dupuytren’s actually looks and feels like.

A slow story that unfolds over years — nodules, then cords, then contracture, most often in the ring and little finger of both hands.

  • Palmar nodules

    Firm, sometimes tender nodules in the palm — usually the earliest sign of Dupuytren’s.

  • Palmar cord

    A longitudinal fibrous cord running from the palm into the finger — the mechanical cause of contracture.

  • Skin pitting

    Small pits and puckering of the palmar skin overlying the developing fascial disease.

  • Finger contracture

    A progressive inability to fully extend one or more fingers, most commonly the ring and little finger.

  • PIP joint contracture

    Contracture at the proximal interphalangeal (PIP) joint is harder to correct fully than pure MCP contracture.

  • Ring / little finger

    The ring and little finger rays are most commonly affected — thumb involvement is less usual.

  • Family history

    A strong family history of Dupuytren’s is common — the condition clusters in families of Northern European descent.

  • Red flag

    Rapidly progressive contracture in a young patient (Dupuytren’s diathesis) — needs early hand surgery review.

Treatment

How Dupuytren’s is treated in the UK.

A stratified approach — watchful waiting for early nodules, needle fasciotomy or collagenase for suitable cords, and open fasciectomy or dermofasciectomy for severe or recurrent disease.

  • Watchful waiting

    Asymptomatic nodules without contracture do not need treatment — many people live with them for years without functional issues.

  • Stretching and splinting

    Limited evidence for stretching or splinting alone to prevent progression — sometimes used adjunctively but not curative.

  • Percutaneous needle fasciotomy (PNF)

    A needle divides the cord under local anaesthetic — quick, low-morbidity, back to work fast, but higher recurrence than open surgery.

  • Collagenase (Xiapex) injection

    Collagenase clostridium histolyticum digests the cord, followed by manipulation — availability varies in the UK; check current supply.

  • Limited fasciectomy (open surgery)

    The traditional operation — the diseased cord is excised through a palmar incision. Lower recurrence, longer recovery.

  • Dermofasciectomy + skin graft

    For recurrent or severe disease — the overlying skin is also removed and grafted to reduce further recurrence.

  • Radiotherapy for early disease

    Low-dose radiotherapy in the early proliferative phase, offered in specialist centres — evidence is evolving.

  • Hand therapy after treatment

    Splinting, scar management and range-of-motion work with a specialist hand therapist — essential for the best functional outcome.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and 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 history and can tell you which parts apply to you. If in doubt, get seen.

  • British Society for Surgery of the Hand (BSSH). Patient information and clinical standards on Dupuytren’s disease.

  • Dupuytren’s Society UK. Patient-facing guidance and support.

  • NICE Interventional Procedures Guidance. Dermofasciectomy for Dupuytren’s disease.

  • British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).

Red flags

When Dupuytren’s needs a specialist quickly.

Most Dupuytren’s progresses slowly. These are the situations where hand-surgery input should not be delayed.

  • Rapid progression in a young patient

    Dupuytren’s diathesis — early, aggressive, bilateral disease with a strong family history — needs prompt hand surgery review.

  • PIP contracture >30° with function loss

    PIP contracture is harder to correct fully — don’t leave it too long before referral for treatment.

  • Post-op complications

    New nerve injury, complex regional pain syndrome (CRPS), wound infection or flare after surgery — contact your surgical team.

  • Recurrence after prior surgery

    Recurrent disease after previous fasciectomy can be more complex — plan with a specialist hand surgeon rather than repeating the same operation.

  • Bilateral aggressive Dupuytren’s

    Aggressive bilateral disease with knuckle pads or ectopic sites is the classic diathesis pattern — expect higher recurrence.

  • Coexistent Ledderhose or Peyronie’s

    Ledderhose (plantar) or Peyronie’s (penile) fibromatosis alongside Dupuytren’s reflects the wider fibromatosis cluster — flag to the surgical team.

  • Vasculopathy of the finger

    Cold, dusky or ischaemic finger in the context of a Dupuytren’s cord — needs urgent vascular assessment before any procedure.

  • Skin necrosis post-collagenase

    Skin tears or necrosis following collagenase injection and manipulation — needs prompt hand surgery review.

  • Wound healing in diabetics

    Diabetes and vasculopathy increase wound-healing risk after open surgery — factor this into the choice of intervention.

Living with it

A slow condition, with real options at every stage.

Four things that make the biggest difference — watching without panic, using function as the trigger, taking hand therapy seriously and expecting some recurrence.

A quiet reminder

Trade-offs, honestly discussed, beat quick fixes.

Every technique has a recurrence rate — the right one for you depends on your disease, your function and what you can accept.

  1. 01 Monitor

    Watch, don’t rush

    Asymptomatic nodules don’t need treatment — the trigger is functional loss, not the presence of a cord.

  2. 02 Function

    Use the table-top test

    If you can’t lay your palm flat on a table, it’s time for a hand-surgery conversation about your options.

  3. 03 Recovery

    Take hand therapy seriously

    Splinting and hand-therapy exercises after any procedure make a real difference to long-term function.

  4. 04 Reviews

    Expect some recurrence

    All treatments have a recurrence rate — regular review with your hand surgeon catches new cords early.

Frequently asked

Everything we get asked about Dupuytren’s.

Quick answers on when to treat, needle fasciotomy vs open surgery, collagenase availability and recurrence.

  • What actually is Dupuytren’s contracture?

    It is a benign fibromatosis affecting the palmar fascia — the connective-tissue layer of the palm. Nodules and cords develop gradually and can pull the fingers into a fixed flexion contracture, most commonly the ring and little finger.

  • When should I have treatment?

    The usual trigger is functional loss — most commonly measured with the Hueston table-top test (can you lay the palm flat on a table?) or MCP contracture of about 30° or any PIP contracture with function loss.

  • Needle fasciotomy or open surgery?

    Percutaneous needle fasciotomy is quick, low-morbidity and done under local anaesthetic, but has a higher recurrence rate. Open limited fasciectomy has a lower recurrence rate but a longer recovery. The right choice depends on your disease, function and preferences.

  • Is collagenase (Xiapex) still available?

    Collagenase clostridium histolyticum has had variable availability in the UK — supply changes over time. Your hand surgeon will be able to tell you what is currently on offer locally.

  • Will it come back after treatment?

    Recurrence is expected with every treatment for Dupuytren’s — the rate varies with the technique used and the individual’s diathesis. Regular follow-up with a hand surgeon helps catch new cords early.

  • What is the red flag I should not ignore?

    Rapidly progressive contracture in a young person with a strong family history (Dupuytren’s diathesis), a cold or ischaemic finger with a cord, or skin necrosis after a procedure — these need prompt hand-surgery review.

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