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Health condition · Clinically reviewed

Dupuytren's disease, from a single palmar nodule to fixed contracture and ectopic sites.

Not just the bent finger. Dupuytren's is a whole spectrum - nodules and cords in the palm, Ledderhose in the sole, Peyronie in the penis and Garrod pads on the knuckles. Understanding the spectrum shapes the treatment.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

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

  • 02

    Sourced from guidance

    Checked against BSSH, BAPRAS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including needle aponeurotomy, limited fasciectomy and management of ectopic disease.

Key facts

Dupuytren's disease at a glance.

The essentials, in plain English - what it is, the spectrum, and how it's treated in the UK today.

  • What it is

    A benign but progressive fibroproliferative disorder of the palmar fascia and, in some, other fibrous sites in the body.

  • Disease spectrum

    Ranges from a single palmar nodule to fixed digital contracture, with ectopic disease in the sole, penis or knuckle pads.

  • Who it affects

    Northern European ancestry, family history, men over 50 - alcohol, smoking and diabetes are recognised associations.

  • Key signs

    Palmar nodules, thickened cords, tabletop test positive, and the classic ring and little finger flexion contracture.

  • Ectopic sites

    Ledderhose disease in the sole, Peyronie disease in the penis and Garrod knuckle pads on the finger joints.

  • Treatment ladder

    Watchful waiting for nodules, needle aponeurotomy or limited fasciectomy for functional contracture.

Why this guide matters

The whole disease, not just the bent finger.

Dupuytren's is often described only as a finger contracture. In practice it's a spectrum - and knowing where you sit on it shapes when to treat and how. See also Dupuytren contracture and the alternate spelling Dupuytren's contracture.

  • A spectrum, not a single problem

    Dupuytren nodules can exist for years without a cord or contracture. Ectopic sites (sole, penis, knuckle pads) belong to the same disease.

  • Treatment follows function

    Painless nodules do not need treatment. A positive tabletop test or loss of hand function is the usual trigger.

  • Diathesis predicts recurrence

    Early onset, family history, bilateral hands and ectopic disease predict aggressive diathesis and higher recurrence after treatment.

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

    History and family pattern

    Age of onset, rate of progression, hand dominance and any relatives with Dupuytren or Ledderhose - a strong family history means Dupuytren diathesis.

  2. 02

    Assessing

    Hand examination

    Palpation of nodules and cords, mapping of skin puckering and dimpling, joint-by-joint measurement of MCP and PIP contracture.

  3. 03

    Assessing

    Tabletop (Hueston) test

    If the palm and fingers cannot lie flat on a table, functional contracture has crossed the threshold where treatment is usually discussed.

  4. 04

    Confirming

    Look for ectopic disease

    Examine the soles for Ledderhose nodules, the knuckle pads for Garrod nodes and ask sensitively about Peyronie disease.

  5. 05

    Confirming

    Exclude mimics

    Stenosing tenosynovitis, epithelioid sarcoma, camptodactyly and post-traumatic scarring can look similar - the pattern and history usually clarify.

  6. 06

    Preparing

    Imaging only if atypical

    Most cases are diagnosed clinically. Ultrasound or MRI is reserved for atypical masses, ectopic sites or pre-operative planning.

  7. 07

    Preparing

    Hand surgery referral

    A functional contracture, rapid progression or aggressive diathesis is a signal for referral to a hand or plastic surgeon.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What Dupuytren's actually looks like.

The classic mix of palmar nodules and cords, contracture, plus the ectopic sites that mark aggressive disease.

  • Palmar nodules

    Firm, tethered lumps in the palm - often the first sign and, on their own, do not need treatment.

  • Fibrous cords

    Rope-like thickenings running from the palm into the fingers - the structure that drives contracture.

  • Skin puckering and dimpling

    Skin drawn down into the fascia, most obvious when the hand is held out flat.

  • Ring and little finger contracture

    The classic pattern - MCP and PIP joints held flexed and slowly losing extension.

  • Ledderhose (plantar) nodules

    Firm, sometimes tender nodules in the arch of the foot - the plantar sister disease.

  • Peyronie disease

    Fibrous plaques of the penile tunica albuginea causing curvature - the genital ectopic form.

  • Garrod knuckle pads

    Thickened pads over the dorsum of the PIP joints - a marker of aggressive diathesis.

  • Red flag - rapid, painful growth

    Fast-growing, painful or ulcerating masses are not typical of Dupuytren and deserve urgent imaging and specialist review.

Treatment

How Dupuytren's is treated in the UK.

Watchful waiting for nodules, needle aponeurotomy or limited fasciectomy for functional contracture - and dermofasciectomy for aggressive or recurrent disease.

  • Watchful waiting

    Isolated painless nodules without contracture rarely need intervention - most people are simply reviewed periodically.

  • Hand therapy and splinting

    Adjunct to surgery or needle release - splints and stretches help maintain gains but do not reverse established disease.

  • Cortisone injection

    Intralesional steroid can soften tender nodules and slow early progression in selected cases - not a definitive treatment.

  • Needle aponeurotomy

    A percutaneous needle divides the cord under local anaesthetic - short recovery, good option for MCP contracture, higher recurrence.

  • Collagenase injection

    Enzymatic dissolution of the cord followed by manipulation - availability in the UK is limited and varies by centre.

  • Limited (regional) fasciectomy

    The most common UK operation - the diseased cord is excised through a zig-zag incision. Longer recovery, lower recurrence.

  • Dermofasciectomy

    Fasciectomy plus skin excision and full-thickness graft - reserved for recurrent or aggressive disease.

  • Radiotherapy (early disease)

    Low-dose radiotherapy is used in some European centres for early, progressing disease - UK availability is limited.

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 patient information.

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

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

  • International Dupuytren Society. Consensus on assessment, ectopic disease and diathesis.

Red flags

When Dupuytren's needs urgent attention.

Most Dupuytren's is manageable at a planned pace. These are the situations that aren't - and where a specialist opinion is needed.

  • Rapid or painful progression

    Dupuytren is usually slow and painless. Fast, painful growth or ulceration deserves urgent specialist review to exclude other tumours.

  • Fixed PIP joint contracture

    PIP joint contracture is harder to fully correct once established. Early referral gives the best functional outcome.

  • Aggressive diathesis

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

  • Nerve or vessel symptoms

    Numbness, colour change or cold fingers alongside a cord may reflect neurovascular involvement and needs surgical assessment.

  • Recurrence after surgery

    Recurrence rates vary by procedure and diathesis. Persistent or worsening contracture after treatment deserves a specialist re-assessment.

  • Diabetes-associated cheiroarthropathy

    Waxy, stiff hands in long-standing diabetes can mimic or coexist with Dupuytren - endocrine and rheumatology input may help.

  • Ectopic ulceration

    Ulcerating or bleeding plantar or penile plaques are not typical Dupuytren and need urgent review.

  • Suspicion of epithelioid sarcoma

    A firm palmar mass in a young adult that grows or is painful is a mimic that needs imaging and biopsy.

  • Loss of hand function

    Inability to grasp, wash the face or put a hand in a pocket is a functional trigger for definitive treatment.

Living with it

A treatable condition, timed to your function.

Four things that make the biggest difference year to year - track the disease, treat when function is affected, address modifiable factors, and take rehab seriously.

A quiet reminder

Function first, imaging second, surgery third.

The presence of a nodule is not itself a reason to operate. Loss of function is. Choose the least invasive option that restores what you need.

  1. 01 Track

    Photograph and measure

    A monthly photograph of the flat hand and a note of the tabletop test tells you and your surgeon whether disease is progressing.

  2. 02 Function

    Base decisions on function, not fear

    Treatment is guided by what you cannot do, not by the presence of a nodule. Wait until function is affected before intervening.

  3. 03 Habits

    Address modifiable factors

    Smoking cessation, alcohol moderation and good diabetic control are worth doing on their own merits and are associated with Dupuytren.

  4. 04 Rehab

    Take rehabilitation seriously

    After needle release or fasciectomy, hand therapy and splinting protect the correction you have earned.

Frequently asked

Everything we get asked about Dupuytren's disease.

Quick answers on nodules, contracture, ectopic sites and the choice between needle release and fasciectomy.

  • What is Dupuytren disease and how is it different from Dupuytren contracture?

    Dupuytren disease is the whole spectrum - from a single painless palmar nodule to established finger contracture and even ectopic sites like Ledderhose in the sole and Peyronie in the penis. Dupuytren contracture is one late feature of that disease, once the cord has pulled the finger into flexion. This guide covers the full disease. For the contracture-focused page see /conditions/dupuytren-contracture/ or the alternate spelling /conditions/dupuytrens-contracture/.

  • Do I need treatment for a nodule that is not bending my finger?

    Usually not. Isolated painless palmar nodules without contracture are typically watched. Treatment is offered when the fingers no longer straighten, the tabletop test becomes positive, or hand function is meaningfully affected.

  • What are Ledderhose, Peyronie and Garrod?

    They are the three main ectopic forms of Dupuytren disease. Ledderhose affects the plantar fascia of the sole, Peyronie affects the tunica albuginea of the penis, and Garrod knuckle pads sit over the dorsum of the PIP joints. Having one or more of these predicts more aggressive hand disease.

  • Is Dupuytren disease inherited?

    There is a strong genetic component - Dupuytren diathesis. Early onset, family history, bilateral hands and ectopic disease all point to a more aggressive genotype and a higher chance of recurrence after treatment.

  • Needle aponeurotomy or open surgery - which is better?

    They are complementary. Needle aponeurotomy is faster, done under local anaesthetic and has quicker recovery but higher recurrence. Limited fasciectomy has a longer recovery and lower recurrence and is often preferred for PIP contracture or recurrent disease. Your surgeon will match the option to the joint, the diathesis and your goals.

  • Can Dupuytren come back after treatment?

    Yes. All treatments have a recurrence rate that depends on the procedure, the joint and the underlying diathesis. Aggressive diathesis with ectopic disease has the highest recurrence. This is why treatment is timed to function rather than done at the first nodule.

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