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Health condition · Clinically reviewed

Dupuytren's contracture, the tabletop test, needle release and fasciectomy.

A slow, familial fibrosis of the palm that quietly bends the ring and little fingers. Treatable, staged and worth acting on before the palm can no longer lie flat.

Jump to treatment

Two closely related guides on this site: Dupuytren contracture and Dupuytren's disease - the same clinical entity described from slightly different angles.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered hand surgeon before publication.

  • 02

    Sourced from guidance

    Checked against BSSH, BAPRAS and NICE guidance you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including needle aponeurotomy, regional fasciectomy and hand-therapy pathways.

Key facts

Dupuytren's at a glance.

The essentials, in plain English - what it is, where it strikes, and the yardsticks UK hand surgeons use to decide when to act.

  • What it is

    A progressive fibroproliferative disorder of the palmar aponeurosis. Cords and nodules pull the fingers into a fixed flexion posture.

  • Other names

    Also called Dupuytren disease, palmar fibromatosis or Viking disease due to its Northern European heritage predominance.

  • Who gets it

    More common in men over 50 of Northern European descent. Family history, diabetes and heavy alcohol use raise risk.

  • Where it affects

    Most often the ring and little finger rays. The thumb and index finger are usually spared.

  • Key clinical test

    Hueston tabletop test - if the palm cannot lie flat on a table, intervention is usually warranted.

  • Recurrence

    Real and common. Reported recurrence sits between 10 and 50 per cent depending on the technique used and how it is measured.

Why this guide matters

A staged plan, not a wait-and-see forever.

Dupuytren's is slow, familial and rarely painful - which is exactly why it drifts on for years. Three ideas shape everything that follows.

  • Observation is fine, until it isn’t

    Nodules with a flat palm can be safely watched. A positive tabletop test or any PIP joint contracture changes the calculus.

  • Match the technique to the joint

    Isolated MCP cords respond well to needle aponeurotomy. PIP joint disease usually needs an open regional fasciectomy.

  • Hand therapy is not optional

    Whichever procedure you have, the long-term outcome depends on structured post-operative splinting, scar work and range-of-motion training.

How the diagnosis is made

From a palm 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

    Family and medical history

    Northern European heritage, family history, diabetes, epilepsy medication and alcohol use all raise your baseline risk.

  2. 02

    Assessing

    Inspection of palm and fingers

    The clinician looks for nodules, skin pits and pre-tendinous cords along the ring and little finger rays.

  3. 03

    Assessing

    Hueston tabletop test

    You place your palm flat on a table. If it will not sit flush, the disease is contracting the joints and treatment is usually indicated.

  4. 04

    Confirming

    Goniometer measurement

    Metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures are measured in degrees to plan and track treatment.

  5. 05

    Confirming

    Look for ectopic disease

    Knuckle pads (Garrod nodes), plantar fibromatosis (Ledderhose) and Peyronie disease can all coexist and signal a more aggressive phenotype.

  6. 06

    Preparing

    Shared decision on timing

    A palm that will not lie flat, a PIP contracture of any degree, or a rapidly progressing MCP contracture usually warrants intervention.

  7. 07

    Preparing

    Procedure choice with the surgeon

    Needle aponeurotomy for isolated MCP cords in older patients, regional fasciectomy for PIP disease or diffuse cords, dermofasciectomy for aggressive recurrence.

Typical timeline: a first hand-surgery visit to a settled treatment plan in one or two appointments.

Symptoms

What Dupuytren's actually looks like.

A quiet nodule in the palm, a cord that tightens over months and years, and - eventually - a finger that will not straighten. Here is the sequence.

  • Palmar nodule

    The earliest sign - a firm, painless lump in the palm, most often in line with the ring finger.

  • Skin pitting and dimples

    Small puckered dimples in the palm appear as the aponeurosis tethers the skin.

  • Pre-tendinous cord

    A firm cord that runs from the palm into the finger. This is what pulls the finger into flexion over time.

  • MCP joint contracture

    The knuckle sits in a fixed bend. Usually the most responsive joint to any treatment.

  • PIP joint contracture

    The middle finger joint sits bent. Harder to correct and much more likely to recur - a firm indication to treat early.

  • Hueston tabletop positive

    You cannot flatten your palm on a table. The classic clinical threshold for offering intervention.

  • Ectopic disease

    Knuckle pads over the PIP joints, plantar nodules or penile plaques - all point to a more aggressive Dupuytren diathesis.

  • Red flag - rapid progression

    Worsening contracture over weeks to months, in a young patient with strong family history, needs a hand-surgery opinion sooner rather than later.

Treatment

How Dupuytren's is treated in the UK.

Observation while the palm still lies flat, needle release or regional fasciectomy once it doesn't - and dermofasciectomy for aggressive recurrence.

  • Observation

    Nodules without contracture and a palm that lies flat can be safely watched. Photograph the hand and re-measure at intervals.

  • Hand-therapy input

    A specialist hand therapist teaches stretching, night splinting after intervention and scar management. Essential to any surgical plan.

  • Steroid injection into nodule

    Occasionally softens an early, painful nodule. Does not reverse an established cord or contracture.

  • Needle aponeurotomy

    A needle divides the cord through the skin under local anaesthetic. Quick recovery. Best for isolated MCP cords in older patients. Higher recurrence.

  • Collagenase injection

    Xiapex enzymatic cord lysis. No longer marketed in the UK from 2020, but you may see it referenced in older guidance.

  • Regional (limited) fasciectomy

    Open removal of the diseased cord through a zig-zag incision. The UK workhorse operation for PIP contracture and diffuse disease. Lower recurrence than needle release.

  • Dermofasciectomy with skin graft

    Diseased cord plus overlying skin removed and replaced with a full-thickness skin graft. Reserved for aggressive or recurrent disease.

  • Salvage options

    Joint fusion or, in rare severe cases, ray amputation for a stuck, macerated little finger that no longer helps the hand.

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 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 disease evidence and management standards.

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

  • NICE. Needle fasciotomy for Dupuytren contracture (IPG43) and related interventional procedure guidance.

  • Royal College of Surgeons of England. Commissioning guide: painful osteoarthritis of the trapeziometacarpal joint and Dupuytren disease.

Red flags

When Dupuytren's needs prompt attention.

Most Dupuytren's is watchable. These are the situations where waiting quietly loses ground - and where a hand-surgery opinion is worth arranging.

  • Fixed PIP contracture

    A stuck middle finger joint is the hardest deformity to correct and the most likely to recur. Refer early rather than watch it worsen.

  • Rapid progression

    Contracture that worsens over weeks in a younger patient suggests an aggressive Dupuytren diathesis - a hand-surgery opinion is warranted.

  • Skin maceration in the palm

    Deeply flexed fingers can trap moisture and skin flora in the palm - a hygiene and infection risk that pushes towards intervention.

  • Loss of function

    Cannot put a hand in a pocket, wash a face, or shake hands. Functional loss is a stronger indication than any number on a goniometer.

  • Sensory change in the finger

    True numbness is unusual in Dupuytren disease. Consider coexisting carpal tunnel syndrome or a compressive digital neuropathy.

  • Recurrence after prior surgery

    Return of a cord in a previously operated ray is common and often signals more aggressive disease - dermofasciectomy may be needed.

  • Diabetes with poor control

    Raises risk and can slow post-operative healing. Optimise glycaemic control before any elective procedure.

  • Suspicion of a different diagnosis

    Aggressive fibromatosis, desmoid tumour or tendon-sheath fibroma can masquerade as Dupuytren - specialist review and imaging are needed.

  • Acute red, hot, painful palm

    Not Dupuytren. Think palmar-space infection or flexor sheath sepsis and seek same-day surgical review.

Living with it

A slow disease, managed patiently and well.

Four habits that keep a Dupuytren's hand working: track progress, keep moving, invest in hand therapy after treatment, and plan for recurrence.

A quiet reminder

The palm is the yardstick.

When your palm no longer lies flat, or a PIP joint has started to bend, the conversation with a hand surgeon should happen sooner rather than later.

  1. 01 Track

    Photograph and measure

    A monthly phone photo and a tabletop test at home gives you and your surgeon an honest record of progression.

  2. 02 Move

    Keep the hand working

    General hand use does not accelerate Dupuytren. Keep gripping, stretching and using the hand normally.

  3. 03 Recover

    Commit to hand therapy after treatment

    Post-operative splinting, scar massage and range-of-motion work is where the result is won or lost. Book it before the procedure.

  4. 04 Expect

    Plan for recurrence

    Ten to fifty per cent of cords come back. It is not failure - it is the natural history of the disease. Early re-review protects your long-term function.

Frequently asked

Everything we get asked about Dupuytren's.

Quick answers on the tabletop test, needle release, fasciectomy, hand therapy and recurrence.

  • What is Dupuytren’s contracture?

    Dupuytren’s contracture is a progressive fibroproliferative disorder of the palmar aponeurosis - the fibrous sheet that lies under the skin of the palm. Nodules and cords form, tether the skin and gradually pull the ring and little fingers into a fixed bent position. It is the same disease as Dupuytren disease and palmar fibromatosis - three names for one clinical entity.

  • Why is it called Viking disease?

    Dupuytren’s contracture is markedly more common in people of Northern European descent, which is where the nickname Viking disease comes from. It is not exclusive to that group - people of every heritage can develop it - but the strong familial and geographical clustering is well described.

  • How is Dupuytren’s contracture diagnosed?

    It is a clinical diagnosis. Your GP or hand surgeon inspects the palm for nodules, pits and cords, asks you to place your palm flat on a table (the Hueston tabletop test) and measures any joint contracture with a goniometer. Imaging is not routinely needed. If the diagnosis is uncertain, or an aggressive lesion is suspected, MRI or biopsy is used to exclude other palmar fibromatoses.

  • What is the difference between needle aponeurotomy and fasciectomy?

    Needle aponeurotomy uses a hypodermic needle to divide the cord through the skin under local anaesthetic. It is quick and lets you use the hand almost immediately, but recurrence rates are higher. Regional fasciectomy is an open operation through a zig-zag incision that removes the diseased cord entirely. Recovery is longer and requires structured hand therapy, but recurrence is lower and it is the preferred approach for PIP joint contracture or diffuse disease.

  • Do I need hand therapy after treatment?

    Yes. Hand therapy is not optional. Whether you have needle release or open fasciectomy, a specialist hand therapist teaches you scar massage, stretching, night splinting and graded loading. The functional result of the surgery is heavily dependent on the therapy that follows it.

  • Will Dupuytren’s come back after surgery?

    Recurrence is common. Depending on how it is defined and measured, between ten and fifty per cent of patients see a cord return in a previously treated ray over five to ten years. This is not a failure of the operation - it is the natural biology of the disease. A more aggressive diathesis (young age, strong family history, ectopic disease) predicts higher recurrence.

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