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Dupuytren's Disease

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Dupuytren’s disease causes palm thickening and finger contracture—options range from observation to needle aponeurotomy or surgical excision.

Updated Aug 2026
A hand-drawn illustration of a palm-up hand with the ring finger bent down and drawn toward the palm by Dupuytren's disease.
Dupuytren's disease: firm cords in the palm draw the fingers down. Kieran Hirpara 4.0

What you're feeling

You may notice a thickening or hardening of the skin on your palm. This is caused by Dupuytren’s disease, a condition where the tissue under your skin thickens and tightens. Over time, this can pull your fingers into a bent position. You might feel small lumps or cords under the skin of your palm. These are usually not painful, but they can feel tight or uncomfortable.

As the condition progresses, you may find it difficult to straighten your fingers. This makes everyday tasks harder. You might struggle to put on gloves or shake hands. Washing your face or applying lotion can become challenging if your fingers are curled inward. Some people find it hard to place their hands flat on a table or in their pockets.

The tightness can worsen with cold weather or stress. You might feel more stiffness when you first wake up in the morning. After using your hands for tasks like typing or driving, the discomfort may increase. Nighttime pain is less common, but some people report aching or tingling sensations.

If you have trigger finger alongside Dupuytren’s disease, you might experience additional symptoms. Trigger finger causes your finger to catch or lock when you bend or straighten it. This can add to the difficulty in using your hand.

It is important to note that not everyone with Dupuytren’s disease needs treatment. Many people manage their symptoms with simple adjustments to their daily activities. However, if the tightness affects your ability to use your hand, you should speak with your surgeon. They can help you understand your options and decide if treatment is right for you.

Your surgeon will assess the severity of your condition and discuss the best approach for you. Treatment options may include surgery, injections, or needle fasciotomy. Each option has its own benefits and risks. Your surgeon will guide you through the decision-making process to ensure you receive the care that best suits your needs.

What's actually happening

Dupuytren’s disease is a condition where the tissue in your palm thickens and tightens. You might notice small lumps or cords forming under the skin of your palm. Over time, this tissue shrinks, pulling your fingers into a bent position. This makes it difficult to straighten them fully. The condition often affects the ring and little fingers first.

The problem lies in the fascia, a layer of connective tissue that supports your hand. Think of this fascia like a tight rope running from your palm into your fingers. In Dupuytren’s disease, the collagen fibres within this rope become disorganized and clump together. These clumps form knots that shorten the rope. As the rope shortens, it pulls your finger joints out of alignment. This is why you lose the ability to extend your fingers straight.

This tightening impacts the extensor mechanism, which is responsible for straightening your hand. When the fascia pulls too hard, it overpowers the muscles that try to straighten your fingers. The result is a fixed bend in the joint. This deformity can make everyday tasks difficult, such as shaking hands or placing your hand flat on a table.

Hand trauma, including previous surgeries or repetitive stress, can trigger this process. The disease progresses differently for everyone. For some, it stays mild. For others, the cords tighten significantly, leading to more severe contractures. Your surgeon will assess how much the tissue has tightened and how it affects your hand function.

Treatment aims to release this tension. Procedures like fasciectomy involve removing or cutting the tight tissue to allow your fingers to straighten again. While the disease can recur, surgical correction often provides significant functional benefits. Many patients regain the ability to use their hands normally after treatment. The goal is to restore your hand’s natural position and improve your daily function.

What we can do about it

How Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic is through a clear, step-by-step plan. We believe in starting with the least invasive options and moving to surgery only when your hand function is significantly limited. Our goal is to help you keep your hand as mobile and useful as possible.

You can begin by managing the condition at home. Gentle stretching exercises may help maintain flexibility in your fingers. Our hand therapists can guide you through specific movements to prevent the fingers from stiffening further. We often recommend wearing a splint at night to keep your fingers straight while you sleep. This non-operative care focuses on slowing the progression of the disease and managing discomfort. It is important to give this approach time to work. Many patients find that these measures help them manage their symptoms for months or even years without needing an operation.

If home care and therapy are not enough, we may discuss medical management to help with pain and inflammation. You might take over-the-counter pain relievers or anti-inflammatory medications. In some cases, we may offer injections into the palm. Cortisone injections can reduce swelling and pain in the short term. Hyaluronic acid or platelet-rich plasma (PRP) injections are sometimes used to support tissue health, though their long-term effects vary. These treatments do not remove the cords causing the contracture, but they can make daily tasks more comfortable while you decide on further steps.

Surgery is considered when the contracture stops you from performing everyday tasks, such as washing your face or putting on gloves. At this stage, conservative care has reached its limit. We may recommend a procedure called a fasciectomy to remove the tight tissue. This is the most reliable long-term treatment for progressive Dupuytren contractures. It allows us to straighten your fingers and restore function. We discuss all risks and benefits with you before proceeding. For most patients, this surgery leads to significant improvement in hand function and a return to normal daily activities.

What to expect

Dupuytren’s disease is a long-term condition where thickened tissue in your palm causes your fingers to curl inward. Without treatment, this tightening usually persists and can gradually worsen over time. It does not typically resolve on its own. Many people find that the condition progresses slowly, affecting their ability to grip objects or place their hand flat on a table.

When you choose treatment, the outlook is generally positive for restoring function. Surgery, such as removing the thickened tissue, is considered the most reliable long-term option for progressive cases. Most patients gain significant functional benefit after the deformity is corrected. Your hand normality scores, which measure how well your hand functions, tend to improve after surgical treatment. This means you can expect to use your hand more effectively in daily tasks.

However, it is important to understand that recurrence is common. Even with successful treatment, the disease can return. Studies show that recurrence is frequent within a few years of treatment. For example, about 10% of patients treated with collagenase injections required surgery within five years. Long-term reintervention rates are higher with collagenase injections compared to surgical fasciectomy. This means you may need further treatment in the future, regardless of the method chosen.

If you have had trigger finger surgery in the past, be aware that you have a higher chance of developing new-onset Dupuytren’s disease. This condition may appear sooner than it would otherwise. If you notice new tightening or nodules in your palm, let your surgeon know early.

Recovery involves managing swelling and stiffness. While some treatments like needle fasciotomy have a lower risk of complications, surgical options carry a significant risk of complications. Your surgeon will discuss which approach fits your specific case. The goal is to improve your hand’s range of motion and reduce pain. With proper care, you can regain the use of your hand, but you should remain vigilant for any signs of the disease returning. Regular follow-ups help monitor your progress and address any changes promptly.

When to see someone

Ask for a specialist review if you notice your fingers curling inward and cannot straighten them fully. See your GP if you experience persistent pain that does not improve with rest. Seek care if you feel weakness or instability in your hand. Watch for symptoms that interfere with sleep or daily work tasks. Sudden worsening of finger stiffness also warrants a check-up. Early assessment helps your surgeon determine the best path forward. While many cases progress slowly, timely evaluation ensures you understand your options. Whether you need simple monitoring or active treatment, getting a clear picture of your hand’s condition is the first step toward better function.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [1].
  • Clinically important Dupuytren's disease is common in the general population [2].
  • A majority of diagnosed individuals with Dupuytren's disease undergo treatment [2].
  • The best treatment for Dupuytren contractures continues to be fiercely debated [3].
  • Dupuytren disease is progressive [3].
  • The pace of Dupuytren disease progression is unique to each patient [3].
  • Best treatments for Dupuytren disease remain uncertain [3].
  • The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications [4].
  • The literature lacks a standardized definition for complications in Dupuytren's disease [4].
  • Patients with Dupuytren's disease may gain significant functional benefit following surgical improvement or correction of the deformity [5].
  • There remains limited evidence to guide the management of patients with Dupuytren's contracture [6].
  • Several procedural options exist for the treatment of Dupuytren disease [7].
  • Advancements in surgical and therapy management for Dupuytren's disease include indications, surgical options, non-surgical techniques, and therapy interventions [9].
  • Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease [14].
  • Dermofasciectomy offers substantial long-term benefits in terms of function and disease control for advanced Dupuytren disease [14].
  • Surgery remains the gold-standard treatment for progressive Dupuytren contractures [17].
  • Limited palmar fasciectomy is the most common surgical option for Dupuytren's disease [17].
  • Many treatment options exist for Dupuytren contracture, each with its own complication profile [19].
  • Surgical treatment in the form of partial or selective fasciectomy remains the most reliable method for treating Dupuytren's disease [24].
  • Partial or selective fasciectomy is the most widely used method for treating Dupuytren's disease [24].

Anatomy & Pathophysiology

  • Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [1].
  • Patients with Dupuytren's disease may gain significant functional benefit following surgical improvement or correction of the deformity [5].
  • Several procedural options exist for the treatment of Dupuytren disease [7].
  • A revised severity staging system incorporating total flexion deformity and additional clinical risk factors provides a more objective and precise method for assessing Dupuytren's disease severity and may predict surgical outcomes [8].
  • Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy being the most common option [17].
  • Collagenase clostridium histolyticum (CCH) is a safe, effective treatment to improve hand function in Dupuytren's contracture, with most adverse events being minor and self-resolving [25].
  • A simple staged procedure is a valid alternative in the management of severe Dupuytren's proximal interphalangeal joint (PIPJ) contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes [28].
  • Safety and social issues of hand function and quality of life have an evident association with functional recovery after surgery and hand therapy [34].
  • Hand therapy after collagenase treatment is utilized to discuss results and support recovery [35].
  • Hand therapy should acknowledge patients' individual experiences and support self-modifications and development of new skills [37].
  • The incidence of skin tears after collagenase injection does not affect patient-reported outcomes six months later, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits [38].
  • No differences were observed in self-reported upper limb disability or active range of motion between patients receiving routine night-time splinting and those receiving hand therapy only after fasciectomy or dermo-fasciectomy [39].
  • Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events compared to initial treatment [40].
  • Female sex and release of more than one digit are significant predictors of developing Complex Regional Pain Syndrome (CRPS) following treatment of Dupuytren contracture [41].
  • Soft tissue distraction prior to radialization can successfully realign the carpus and wrist over the ulna, but some minor recurrence must still be expected in the mid-term [44].
  • There were no significant differences in the reduction of PIP contracture, range of motion, and patient-reported outcomes between percutaneous needle fasciotomy and collagenase treatment at 2-year follow-up [46].
  • A novel patient-specific visual analogue survey (PVS) is validated in patients treated with collagenase injection for Dupuytren's disease and is readily adaptable for use in other musculoskeletal diseases [47].
  • Clinically relevant contracture correction was comparable between limited fasciectomy (LF), percutaneous needle fasciotomy (PNF), and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence [48].
  • In the absence of evidence that collagenase effects on cord morphology are better than needle fasciotomy, needle fasciotomy remains the first line of treatment for an uncomplicated Dupuytren's cord at the metacarpophalangeal (MCP) joint [49].

Classification

  • Dupuytren disease is a progressive condition of genetic origin [10].
  • The pathophysiology of Dupuytren disease is multifactorial, involving myofibroblast proliferation and altered collagen matrix composition [10].
  • Clinically important Dupuytren's disease is common in the general population [2].
  • A majority of diagnosed individuals with Dupuytren's disease undergo treatment [2].
  • The prevalence of Dupuytren's disease varies extremely across different geographical locations [21].
  • It is unclear whether the geographical variation in Dupuytren's disease prevalence is due to genetic, environmental, or combined factors [21].
  • Dorsal Dupuytren's nodules are encountered only in patients with Dupuytren's disease [12].
  • Dorsal Dupuytren's nodules are especially prevalent among patients with strong diathesis [12].
  • Histological staging is a reliable method for predicting recurrence of Dupuytren's disease [23].
  • Histological Type I (proliferative) carries the highest risk of recurrence [23].
  • Histological Type III (fibrotic) carries the lowest risk of recurrence [23].
  • The revised Tubiana's staging system incorporates total flexion deformity and additional clinical risk factors to assess disease severity [8].
  • The revised Tubiana's staging system provides a more objective and precise method for assessing Dupuytren's disease severity compared to prior methods [8].
  • The revised Tubiana's staging system may predict surgical outcomes [8].
  • The URAM scale is the first patient-reported functional measure for assessing Dupuytren's disease–specific disability [15].

Clinical Presentation

  • Dupuytren disease is a progressive condition of genetic origin with a multifactorial pathophysiology involving myofibroblast proliferation and altered collagen matrix composition [10].
  • Histological specimens of Dupuytren's disease are not characterized by apoptotic cells, suggesting proliferating cells may be primed for death if they fail to receive an appropriate survival signal [22].
  • Dermal fibromatosis exists in the absence of clinical features of skin involvement, and the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought [29].
  • Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment [2].
  • The prevalence of Dupuytren's Disease in different geographical locations is extremely variable, and it is not clear whether this is genetic, environmental, or a combination of both [21].
  • Dorsal Dupuytren's nodules are encountered only in Dupuytren's disease patients, especially among those with strong diathesis [12].
  • Dupuytren's disease in women presents similarly to men with more severe PIP joint involvement but equivalent surgical outcomes regarding final contracture correction, recurrence, and complication rates [16].
  • The pace of Dupuytren disease progression is unique to each patient [3].
  • There is as much unknown as known about Dupuytren's disease, and even current knowledge may not be absolutely correct [18].
  • The revised Tubiana's staging system incorporates total flexion deformity and additional clinical risk factors to provide a more objective and precise method for assessing Dupuytren's disease severity [8].
  • The URAM scale is the first patient-reported functional measure for Dupuytren's disease [15].

Investigations

  • Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment [2].
  • Dupuytren disease is a progressive condition of genetic origin with a multifactorial pathophysiology involving myofibroblast proliferation and altered collagen matrix composition [10].
  • The pace of disease progression is unique to each patient [3].
  • Dorsal Dupuytren's nodules are encountered only in Dupuytren's disease patients, especially among those with strong diathesis [12].
  • Dupuytren's disease in women presents similarly to men with more severe proximal interphalangeal (PIP) joint involvement but equivalent surgical outcomes regarding final contracture correction, recurrence, and complication rates [16].
  • The revised Tubiana's staging system, which incorporates total flexion deformity and additional clinical risk factors, provides a more objective and precise method for assessing Dupuytren's disease severity and may predict surgical outcomes [8].
  • Histological staging is a reliable method for predicting recurrence of Dupuytren's disease, with Type I (proliferative) having the highest risk and Type III (fibrotic) the lowest [23].
  • The URAM scale is the first patient-reported functional measure for Dupuytren's disease [15].
  • There is limited evidence to guide the management of patients with Dupuytren's contracture [6].
  • Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [1].
  • The best treatment for Dupuytren contractures continues to be fiercely debated, and best treatments remain uncertain [3].
  • The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications as well as the lack of a standardized definition [4].
  • Despite extensive literature, there is as much unknown as known about Dupuytren's disease, and even current knowledge may not be absolutely correct [18].

Treatment

  • Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [1].
  • Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment [2].
  • The best treatment for Dupuytren contractures continues to be fiercely debated [3].
  • Dupuytren disease is progressive, but the pace is unique to each patient [3].
  • Best treatments for Dupuytren disease remain uncertain [3].
  • The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications [4].
  • The literature lacks a standardized definition for complications in Dupuytren's disease [4].
  • Patients with Dupuytren's disease may gain significant functional benefit following surgical improvement or correction of the deformity [5].
  • There remains limited evidence to guide the management of patients with Dupuytren's contracture [6].
  • Several procedural options exist for the treatment of Dupuytren disease [7].
  • Advancements in surgical and therapy management for Dupuytren's disease include indications, surgical options, non-surgical techniques, and therapy interventions [9].
  • Therapy interventions assist in linking patient-specific problems to appropriate treatment choices [9].
  • There is a low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [11].
  • Segmental aponeurectomy with Z-Plasty has a role in the management of Dupuytren's disease with flexion contracture predominantly involving the MCPJ [13].
  • Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease [14].
  • Dermofasciectomy offers substantial long-term benefits in terms of function and disease control for advanced Dupuytren disease [14].
  • Surgery remains the gold-standard treatment for progressive Dupuytren contractures [17].
  • Limited palmar fasciectomy is the most common surgical option for Dupuytren contractures [17].
  • Many treatment options exist for Dupuytren contracture, each with its own complication profile [19].
  • The recurrence rate of Collagenase Clostridium Histolyticum (CCH) is comparable to other standard treatments [20].
  • There is an absence of long-term adverse events 3 years after initial CCH treatment [20].
  • CCH is an effective and safe treatment for Dupuytren contracture [20].
  • The best available published evidence indicates that surgical treatment in the form of partial or selective fasciectomy remains the most reliable method for treating Dupuytren's disease [24].
  • Partial or selective fasciectomy is the most widely used method for treating Dupuytren's disease [24].
  • CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture [25].
  • Most adverse events associated with CCH are minor and self-resolving [25].
  • CCH may not provide durable contracture reduction [30].
  • CCH remains a viable nonsurgical treatment for Dupuytren's disease [30].
  • High-energy focused extracorporeal shockwave therapy relieved pain in Dupuytren's disease in a series of seven hands [31].
  • A doublemasked randomized controlled trial is warranted to elucidate the value of extracorporeal shockwave therapy in Dupuytren's disease as a non-invasive treatment option to reduce pain [31].
  • Surgical intervention for Dupuytren contractures achieves a high rate of full or almost full correction (75%) [33].

Complications

  • There is little agreement among international hand surgeons on treatment recommendations for common presentations of Dupuytren disease [1].
  • Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment [2].
  • The best treatment for Dupuytren contractures remains uncertain and is fiercely debated [3].
  • Dupuytren disease is progressive, but the pace of progression is unique to each patient [3].
  • The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications [4].
  • There is a lack of a standardized definition for complications in Dupuytren's disease literature [4].
  • Patients with Dupuytren's disease may gain significant functional benefit following surgical improvement or correction of the deformity [5].
  • There remains limited evidence to guide the management of patients with Dupuytren's contracture [6].
  • The revised Tubiana's staging system incorporates total flexion deformity and additional clinical risk factors to assess disease severity [8].
  • The revised severity staging system provides a more objective and precise method for assessing Dupuytren's disease severity [8].
  • The revised severity staging system may predict surgical outcomes [8].
  • Dupuytren disease is a progressive condition of genetic origin [10].
  • Dupuytren disease has a multifactorial pathophysiology involving myofibroblast proliferation and altered collagen matrix composition [10].
  • There is a low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [11].
  • Dorsal Dupuytren's nodules are encountered only in Dupuytren's disease patients [12].
  • Dorsal Dupuytren's nodules are especially prevalent among patients with strong diathesis [12].
  • Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease [14].
  • Dermofasciectomy offers substantial long-term benefits in terms of function and disease control for advanced Dupuytren disease [14].
  • Dupuytren's disease in women presents similarly to men with more severe proximal interphalangeal (PIP) joint involvement [16].
  • Women with Dupuytren's disease have equivalent surgical outcomes regarding final contracture correction, recurrence, and complication rates compared to men [16].
  • There is as much unknown as known about Dupuytren's disease despite extensive literature [18].
  • Even current knowledge about Dupuytren's disease may not be absolutely correct [18].
  • Many treatment options exist for Dupuytren contracture, each with its own complication profile [19].
  • The recurrence rate of collagenase clostridium histolyticum (CCH) treatment is comparable to other standard treatments [20].
  • There is an absence of long-term adverse events 3 years after initial CCH treatment [20].
  • CCH is an effective and safe treatment for Dupuytren contracture [20].
  • Long-term overall reintervention rates following treatment of Dupuytren contracture affecting a single digit were higher with CCH than with surgical fasciectomy [26].
  • Perceived recurrence rates following treatment of Dupuytren contracture affecting a single digit were higher with CCH than with surgical fasciectomy [26].
  • These findings compare groups with similar baseline characteristics [26].
  • At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement [27].
  • Large-scale epidemiological studies are needed to accurately report Dupuytren's disease in the modern U.S. population [32].

Recovery

  • Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment [2].
  • Dupuytren disease is a progressive condition of genetic origin with a multifactorial pathophysiology involving myofibroblast proliferation and altered collagen matrix composition [10].
  • The pace of Dupuytren disease progression is unique to each patient [3].
  • Histological specimens of Dupuytren's disease were not characterized by apoptotic cells, suggesting proliferating cells may be primed for death if they fail to receive an appropriate survival signal [22].
  • Patients with Dupuytren's disease of the hand may gain a significant functional benefit following surgical improvement or correction of the deformity [5].
  • Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control [14].
  • Dupuytren's disease in women presents similarly to men with more severe PIP joint involvement but equivalent surgical outcomes regarding final contracture correction, recurrence, and complication rates [16].
  • Hospitalization for surgery for Dupuytren's disease in France still represents a meaningful economic burden despite shortening of hospital stays over time [45].
  • There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [11].
  • The recurrence rate following treatment with Collagenase Clostridium Histolyticum (CCH) is comparable to other standard treatments [20].
  • There is an absence of long-term adverse events 3 years after initial treatment with CCH, indicating it is an effective and safe treatment for Dupuytren contracture [20].
  • Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with CCH treatment than surgical fasciectomy when comparing groups with similar baseline characteristics [26].
  • Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures following collagenase injection [42].
  • Recurrence following collagenase injection was generally less severe than the initial contracture in the MCP group [42].
  • At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement [27].
  • Static night splintage may have a role in the treatment of early stages of Dupuytren's disease, with greatest benefit noted in the early proliferative phase [43].
  • Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [1].
  • The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications as well as the lack of a standardized definition [4].
  • The best treatment for Dupuytren contractures continues to be fiercely debated, and best treatments remain uncertain [3].
  • The Unité Rhumatologique des Affections de la Main (URAM) scale is the first patient-reported functional measure for Dupuytren's disease [15].

Key Evidence

  • [L4] Little agreement exists on treatment recommendations for common presentations of Dupuytren disease in this sample of international hand surgeons. [1] (10.1016/j.jhsa.2017.08.023)
  • [L3] Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment. [2] (10.1177/1753193416687914)
  • [L5] The best treatment for Dupuytren contractures continues to be fiercely debated; what is known is that Dupuytren disease is progressive, but the pace is unique to each patient, and best treatments remain uncertain. [3] (10.2106/jbjs.18.00282)
  • [L4] The literature does not provide evidence in favor of a specific procedure for Dupuytren's disease due to inconsistencies in reporting complications as well as the lack of a standardized definition. [4] (10.1016/j.hansur.2017.07.002)
  • [L4] Patients with Dupuytren's disease of the hand may gain a significant functional benefit following surgical improvement or correction of the deformity. [5] (10.1308/003588406x83104)
  • [L2] Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. [6] (10.1302/0301-620x.100b9.bjj-2017-1194.r2)
  • [L4] There are several procedural options for the treatment of Dupuytren disease. [7] (10.1177/1558944718787281)
  • [L4] The revised severity staging system, which incorporates total flexion deformity and additional clinical risk factors, provides a more objective and precise method for assessing Dupuytren's disease severity and may predict surgical outcomes. [8] (10.1007/s11552-007-9071-1)
  • [L5] The article highlights advancements in surgical and therapy management for Dupuytren's disease, reviewing indications, surgical options, non-surgical techniques, and therapy interventions to assist in linking patient-specific problems to appropriate treatment choices. [9] (10.1016/j.jht.2013.10.006)
  • [L5] Dupuytren disease is a progressive condition of genetic origin with a multifactorial pathophysiology involving myofibroblast proliferation and altered collagen matrix composition. [10] (10.5435/00124635-201112000-00005)
  • [L1] There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture. [11] (10.1177/1558944721994220)
  • [L3] Dorsal Dupuytren's nodules are encountered only in Dupuytren's disease patients, especially among those with strong diathesis. [12] (10.1016/j.jhsa.2010.06.001)
  • [Paper] It has a role in the management of Dupuytren's disease with flexion contracture predominantly involving the MCPJ. [13] (10.1016/j.otsr.2019.08.016)
  • [L3] Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control. [14] (10.1016/j.jhsa.2025.02.007)
  • [L4] We provide the first patient-reported functional measure for Dupuytren's disease. [15] (10.1002/acr.20564)
  • [L3] Dupuytren's disease in women presents similarly to men with more severe PIP joint involvement but equivalent surgical outcomes regarding final contracture correction, recurrence, and complication rates. [16] (10.1016/j.jhsa.2007.06.015)
  • [L4] Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy being the most common option. [17] (10.1016/j.jhsa.2011.03.002)
  • [L5] Despite extensive literature, there is as much unknown as known about Dupuytren's disease, and even current knowledge may not be absolutely correct. [18] (10.1177/1753193417715773)
  • [L5] Many treatment options exist for Dupuytren contracture, each with its own complication profile. [19] (10.1016/j.hcl.2018.03.007)
  • [L4] The recurrence rate, which is comparable to other standard treatments, and the absence of long-term adverse events 3 years after initial treatment indicate that CCH is an effective and safe treatment for Dupuytren contracture. [20] (10.1016/j.jhsa.2012.09.028)
  • [L4] The prevalence of Dupuytren's Disease in different geographical locations is extremely variable, and it is not clear whether this is genetic, environmental, or a combination of both. [21] (10.1007/s11552-008-9160-9)
  • [L4] Histological specimens of Dupuytren's disease were not characterized by apoptotic cells, suggesting proliferating cells may be primed for death if they fail to receive an appropriate survival signal. [22] (10.1054/jhsb.1999.0251)
  • [L3] Histological staging is a reliable method for predicting recurrence of Dupuytren's disease, with Type I (proliferative) having the highest risk and Type III (fibrotic) the lowest. [23] (10.1177/1753193408103729)
  • [L5] The best available published evidence indicates that surgical treatment in the form of partial or selective fasciectomy remains the most reliable and the most widely used method for treating Dupuytren's disease. [24] (10.1016/j.jhsa.2008.05.027)
  • [L2] CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture, with most adverse events being minor and self-resolving. [25] (10.1177/1558944720974119)
  • [L4] Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with CCH treatment than surgical fasciectomy when comparing groups with similar baseline characteristics. [26] (10.1016/j.jhsa.2021.05.022)
  • [L2] At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement. [27] (10.1177/1753193415617385)
  • [L4] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. [28] (10.1177/1753193412439673)
  • [L3] Dermal fibromatosis exists in the absence of clinical features of skin involvement, and we hypothesize that the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought. [29] (10.1177/1753193415601353)
  • [L4] While initially effective, CCH may not provide durable contracture reduction, but remains a viable nonsurgical treatment for Dupuytren's disease. [30] (10.1007/s11552-013-9524-7)
  • [L4] A doublemasked randomized controlled trial is warranted to elucidate the value of extracorporeal shockwave therapy in Dupuytren's disease of the hand as a non-invasive treatment option to reduce pain. [31] (10.23736/s1973-9087.18.05498-9)
  • [L3] Large-scale epidemiological studies are needed to accurately report Dupuytren's disease in the modern U.S. population. [32] (10.1007/s11552-007-9076-9)
  • [L5] Surgical intervention for Dupuytren contractures achieves a high rate of full or almost full correction (75%). [33] (10.1016/j.hcl.2018.04.002)
  • [L4] Safety and social issues of hand function and quality of life had an evident association with functional recovery. [34] (10.1016/j.jht.2014.11.006)
  • [L2] Results after 9 month follow-up, hand therapy after treatment will be presented in detail and discussed. [35] (10.1016/j.jht.2010.09.006)
  • [L4] A clinical implication for hand therapy is to acknowledge patients' individual experiences and support self-modifications and development of new skills. [37] (10.1016/j.jht.2019.04.004)
  • [L2] The incidence of skin tears after collagenase injection does not affect patient-reported outcomes six months later, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits. [38] (10.1177/1753193420941329)
  • [L1] No differences were observed in self-reported upper limb disability or active range of motion between patients receiving routine night-time splinting and those receiving hand therapy only. [39] (10.1186/1471-2474-12-136)
  • [L4] Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events compared to initial treatment. [40] (10.1016/j.jhsa.2023.03.026)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [41] (10.1177/1558944720963915)
  • [L4] Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. [42] (10.1016/j.jhsa.2010.01.003)
  • [L4] This study indicates that there may be a role for static night splintage in the treatment of early stages of Dupuytren's disease, with greatest benefit noted in the early proliferative phase. [43] (10.1177/175899830200700302)
  • [L4] Soft tissue distraction prior to radialization can successfully realign the carpus and wrist over the ulna, but some minor recurrence must still be expected in the mid-term. [44] (10.1177/17531934221095681)
  • [L3] Despite shortening of hospital stays over time, hospitalization for surgery for Dupuytren's disease in France still represents a meaningful economic burden. [45] (10.1016/j.otsr.2014.05.013)
  • [L2] There were no significant differences in the reduction of PIP contracture, range of motion, and patient-reported outcomes between the two treatments. [46] (10.1016/j.jhsa.2018.06.093)
  • [L2] It is also readily adaptable for use in other diseases, particularly within musculoskeletal medicine. [47] (10.1136/jisakos-2019-000301)
  • [L1] Overall, the clinically relevant contracture correction was comparable between LF, PNF and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence. [48] (10.1177/17531934251338349)
  • [L2] In the absence of evidence that collagenase effects on cord morphology are better, needle fasciotomy remains the first line of treatment for an uncomplicated Dupuytren's cord at the MCP joint. [49] (10.1177/1753193417711594)

References

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DOI: 10.1177/1558944718787281 [8] Revised Tubiana's Staging System for Assessment of Disease Severity in Dupuytren's Disease—Preliminary Clinical Findings. HAND. 2007. DOI: 10.1007/s11552-007-9071-1 [9] Surgical and therapy update on the management of Dupuytren's disease. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.10.006 [10] Dupuytren Disease: An Evolving Understanding of an Age-old Disease. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201112000-00005 [11] Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis. HAND. 2021. DOI: 10.1177/1558944721994220 [12] Dorsal Pads Versus Nodules in Normal Population and Dupuytren's Disease Patients. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.001 [13] Segmental aponeurectomy with Z-Plasty as a treatment option in Dupuytren's disease: A retrospective cohort study. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.08.016 [14] A Longitudinal Analysis of 281 Cases of Dermofasciectomy Efficacy in Advanced Dupuytren Disease Cases: A 20-Year Perspective. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.02.007 [15] Unité Rhumatologique des Affections de la Main (URAM) scale: Development and validation of a tool to assess Dupuytren's disease–specific disability. Arthritis Care & Research. 2011. DOI: 10.1002/acr.20564 [16] Results of Surgical Treatment of Dupuytren’s Disease in Women: A Review of 109 Consecutive Patients. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.06.015 [17] The Treatment of Dupuytren Disease. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.002 [18] Dupuytren’s disease: my personal view. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417715773 [19] Complications of Treatment for Dupuytren Disease. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2018.03.007 [20] Dupuytren Contracture Recurrence Following Treatment with Collagenase Clostridium Histolyticum (CORDLESS Study): 3-Year Data. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.09.028 [21] Epidemiological Evaluation of Dupuytren's Disease Incidence and Prevalence Rates in Relation to Etiology. HAND. 2009. DOI: 10.1007/s11552-008-9160-9 [22] Is Dupuytren’s Disease Caused by an Imbalance between Proliferation and Cell Death?. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0251 [23] Histological Staging and Dupuytren's Disease Recurrence or Extension after Surgical Treatment: A Retrospective Study of 124 Patients. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408103729 [24] Nonoperative Treatment of Dupuytren's Disease. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.05.027 [25] Treatment of Dupuytren’s Contracture With Collagenase: A Systematic Review. HAND. 2021. DOI: 10.1177/1558944720974119 [26] Limited Fasciectomy Versus Collagenase Clostridium histolyticum for Dupuytren Contracture: A Propensity Score Matched Study of Single Digit Treatment With Minimum 5 Years of Telephone Follow-Up. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.05.022 [27] One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren’s contracture: A two-centre prospective randomized clinical trial. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415617385 [28] Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412439673 [29] Skin involvement in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2015. 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DOI: 10.1016/j.jht.2010.09.006 [37] Experiences of men living with Dupuytren's disease—Consequences of the disease for hand function and daily activities. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.04.004 [38] The influence of skin tears following collagenase treatment of Dupuytren’s disease on treatment outcomes. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420941329 [39] Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-136 [40] Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.03.026 [41] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915 [42] Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.01.003 [43] The Use of Splinting as a Non-Surgical Treatment for Dupuytren's Disease: A Pilot Study. The British Journal of Hand Therapy. 2002. DOI: 10.1177/175899830200700302 [44] Patient’s perspective of treatment in Dupuytren’s Disease: collagenase versus limited fasciectomy. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221095681 [45] Hospitalization for Dupuytren's disease: A French national descriptive analysis, 2002 to 2009. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2014.05.013 [46] Equivalent Treatment Effect After Percutaneous Needle Fasciotomy and Collagenase Treatment for Dupuytren Contracture: 2-Year Results of a Randomized Controlled Trial With Ultrasonographic Evaluation. The Journal of Hand Surgery. 2018. 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