Skip to content

Patients › Rehabilitation

Liberação de Dupuytren

PDF Evidence

Rehabilitation after Dupuytren's fasciectomy — the extension splint regime and exercise program, with hand-therapist follow-up.

Updated Jun 2026
Ilustração de uma mão com contratura de Dupuytren, com os dedos anelar e mínimo fletidos em direção à palma.
Contratura de Dupuytren: cordões firmes na palma da mão puxam os dedos em direção à mão. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Este protocolo orienta a sua recuperação após a liberação cirúrgica da contratura de Dupuytren (fasciectomia) com o Dr. Kieran Hirpara no Mater Private Hospital Rockhampton. Os dois pilares para um bom resultado são a tala, que mantém os dedos libertos estendidos enquanto tudo cicatriza, e o programa de exercícios, que os mantém em movimento. Leve esta página ou o seu PDF ao seu terapeuta da mão para que a sua reabilitação seja coordenada.

Se tiver alguma preocupação sobre a sua ferida após a cirurgia, entre em contacto com a clínica. É frequentemente útil tirar uma fotografia da ferida e enviá-la por e-mail para avaliação.

O que esperar

A cirurgia para a doença de Dupuytren remove os cordões de tecido doentes que estavam puxando seus dedos para a palma da mão, restaurando a capacidade de estendê-los. A condição em si é explicada na página Doença de Dupuytren; não há cura permanente, e o objetivo da cirurgia é excindir o tecido doente e restaurar a extensão dos dedos.

Geralmente, você será encaminhado a um terapeuta da mão 2–3 dias após a cirurgia. O terapeuta fabricará uma tala plástica personalizada que manterá os dedos operados em posição de extensão (retos) e iniciará o programa de exercícios suaves abaixo. A tala e os exercícios atuam em conjunto: a tala protege a extensão conquistada pela cirurgia, e os exercícios mantêm a flexibilidade dos dedos para evitar rigidez.

Mantenha a ferida limpa e seca até a remoção dos pontos. Após a remoção dos pontos, você pode molhar a pele, mas evite mergulhar ou submergir a mão em água por mais uma semana. A página de cuidados com a ferida da prática aborda em detalhes curativos, sinais de infecção e cuidados com a cicatriz. A massagem na cicatriz é importante após a cirurgia de Dupuytren, e seu terapeuta a orientará assim que a ferida tiver cicatrizado.

Cuidados com a sua cicatriz

A cicatriz na palma da mão costuma ser firme, elevada e sensível nas primeiras semanas após a cirurgia de Dupuytren, antes de amolecer gradualmente e clarear ao longo dos meses seguintes. A massagem da cicatriz é uma parte rotineira do cuidado de terapia da mão na Austrália: em uma pesquisa nacional com terapeutas da mão credenciados, quase todos a utilizaram após cirurgias na mão (geralmente iniciando por volta da remoção dos pontos, após a cicatrização completa da ferida) para amolecer a cicatriz, melhorar o deslizamento da pele sobre os tecidos subjacentes e reduzir a sensibilidade da cicatriz, geralmente combinada com gel ou película de silicone, em vez de ser usada isoladamente [6]. As evidências científicas sobre a massagem da cicatriz ainda estão em desenvolvimento, mas apoiam seu uso para reduzir o desconforto relacionado à cicatriz e melhorar a mobilidade [6]. Seu terapeuta demonstrará a técnica e poderá adicionar um produto de silicone, frequentemente utilizado à noite junto com a tala.

Recuperação, trabalho e longo prazo

O inchaço e a rigidez são normais nas primeiras semanas e diminuem à medida que a mão é utilizada; o conforto, a amplitude de movimento e a força de preensão melhoram geralmente ao longo de vários meses. Manter a mão elevada e realizar movimentos suaves nessas primeiras semanas ajuda a reduzir o inchaço e protege contra o endurecimento das pequenas articulações. A extensão obtida na cirurgia é geralmente bem mantida durante este período. Num ensaio randomizado de reabilitação após a libertação da doença de Dupuytren, a maioria dos dedos operados manteve ou melhorou a extensão nos primeiros três meses de terapia da mão [2].

O afastamento do trabalho depende da natureza das suas atividades manuais. Num estudo com mais de 2.500 pessoas tratadas para a doença de Dupuytren, o retorno ao trabalho após a fasciectomia aberta foi de aproximadamente duas semanas, e cerca de nove em dez pessoas regressaram ao trabalho dentro do ano; os trabalhos fisicamente exigentes demoraram mais tempo [4]. O Dr. Hirpara discutirá o timing para o seu trabalho específico na consulta de revisão; o trabalho manual mais pesado geralmente aguarda até que a ferida esteja cicatrizada de forma sólida e a preensão seja confortável.

Como a doença de Dupuytren é uma condição para a vida, alguma rigidez pode retornar ao longo dos anos, e as taxas de recidiva relatadas variam amplamente entre os estudos, dependendo de como a recidiva é definida. O panorama a longo prazo é geralmente tranquilizador: num seguimento de 142 fasciectomias ao longo de aproximadamente quatro anos, utilizando a definição consensual moderna, a recidiva verdadeira da contratura ocorreu em cerca de 3–4% das mãos, embora cerca de um terço mantivesse alguma curvatura residual, geralmente leve e muito aquém da contratura corrigida na cirurgia [5]. A talabarte, os cuidados com a cicatriz e o programa de exercícios destinam-se todos a proteger o seu resultado; se um dedo começar a ficar rígido novamente em qualquer momento, informe a equipa.

A sua talabarte

  • Primeira semana ou mais: use a talabarte dia e noite, retirando-a apenas para os seus exercícios (e lavagem, uma vez permitida).
  • Após a primeira semana: a maioria das pessoas passa a usar a talabarte apenas à noite e pode começar a utilizar a mão para atividades leves durante o dia.
  • A talabarte noturna continua durante cerca de 3 meses (e, em alguns casos, até 6 meses) para proteger contra o desvio dos dedos de volta para a palma, enquanto os tecidos amadurecem.
  • O seu terapeuta da mão e o Dr. Hirpara aconselharão especificamente sobre o seu horário de uso da talabarte e atividade. Os horários acima são o padrão habitual, não uma regra fixa.

Não deve conduzir enquanto a mão estiver na talabarte. Assim que passar para o uso apenas noturno, a condução diurna pode ser retomada conforme o conforto e uma pegada segura no volante o permitirem.

Para o seu fisioterapeuta / terapeuta da mão:

Gestão

  • Encaminhamento 2–3 dias pós-operatórios para a fabrico de uma talabarte de extensão em termoplástico
  • Regime de talabarte: dia e noite durante aproximadamente a primeira semana (removida para os exercícios), depois apenas à noite com uso funcional leve durante o dia; a talabarte noturna continua durante aproximadamente 3 meses (até 6 meses, se necessário), conforme revisão do cirurgião/terapeuta
  • Programa de exercícios em casa conforme os cartões abaixo: extensão ativa, flexão do DIP bloqueada, flexão do DIP/PIP sobre uma caneta, flexão composta, tenodese do punho
  • Cuidados com a ferida conforme as diretrizes de cuidados com a ferida da prática; gestão da cicatriz após a cicatrização
  • Repetições e frequência diária definidas pelo terapeuta tratante

Precauções

  • Manter a ferida limpa e seca até à remoção dos pontos; não mergulhar/submergir por mais uma semana após
  • A adesão ao uso da talabarte é central para manter a extensão obtida na cirurgia
  • Não conduzir enquanto a mão estiver na talabarte

Estes são os exercícios do seu folheto, iniciados com o seu terapeuta da mão e continuados em casa.

Seus exercícios

Após o seu protocolo

Este protocolo foi elaborado em colaboração com Ruby Doolan, Terapeuta da Mão Acreditada, Extend Rehabilitation. Este protocolo complementa os conselhos gerais de recuperação da prática clínica: consulte o controlo da dor pós-operatória, os cuidados com a ferida e os fundamentos da terapia da mão. Para a operação em si, consulte a fasciectomia de Dupuytren.

As expectativas de recuperação, os dados sobre o retorno ao trabalho e as orientações sobre os cuidados com a cicatriz acima referidos baseiam-se em ensaios publicados, revisões e inquéritos sobre a reabilitação após cirurgia de Dupuytren, incluindo ensaios randomizados e uma revisão sistemática sobre o uso de talas e terapia da mão após fasciectomia [1–3]. O regime de talas e o programa de exercícios são da responsabilidade da prática clínica, acordados entre o Dr. Hirpara e o seu terapeuta da mão, e o seu horário de uso da tala é individualizado nas suas consultas de acompanhamento.

Referências

[1] Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D, Barrett E, Vaughan SP. Imobilização noturna após fasciectomia ou dermo-fasciectomia para contratura de Dupuytren: um ensaio controlado randomizado pragmático e multicêntrico. BMC Musculoskeletal Disorders. 2011;12:136. https://pmc.ncbi.nlm.nih.gov/articles/PMC3146906/ [2] Collis J, Collocott S, Hing W, Kelly E. O efeito de órteses de extensão noturna após a liberação cirúrgica da contratura de Dupuytren: um estudo controlado randomizado de um único centro. Journal of Hand Surgery (American). 2013;38(7):1285–1294.e2. https://doi.org/10.1016/j.jhsa.2013.04.012 [3] Karam M, Kahlar N, Abul A, Rahman S, Pinder R. Comparação da terapia manual com ou sem imobilização após fasciectomia para contratura de Dupuytren: revisão sistemática e meta-análise. Journal of Hand and Microsurgery. 2022;14(4):308–314. https://pmc.ncbi.nlm.nih.gov/articles/PMC10042625/ [4] Blake SN, Poelstra R, Andrinopoulou ER, et al. Retorno ao trabalho e custos associados após o tratamento da doença de Dupuytren. Plastic and Reconstructive Surgery. 2021;148(3):580–590. https://pubmed.ncbi.nlm.nih.gov/34292887/ [5] Radhamony NG, Nair RR, Sreenivasan S, et al. Deformidade residual versus recidiva após fasciectomia palmar de Dupuytren — acompanhamento a longo prazo de 142 casos. Annals of Medicine and Surgery. 2022;73:103224. https://pmc.ncbi.nlm.nih.gov/articles/PMC8767281/ [6] Scott HC, Robinson LS, Brown T. Massagem cicatricial como intervenção para cicatrizes pós-cirúrgicas: uma pesquisa de prática de terapeutas manuais australianos. Hand Therapy. 2024;29(1):21–29. https://pmc.ncbi.nlm.nih.gov/articles/PMC10901164/

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

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

Dupuytren Contracture — Surgical Release & Post-operative Hand-Therapy Rehabilitation (Open Fasciectomy)

Topic scope: post-operative rehabilitation after open excision of diseased palmar/digital fascia for Dupuytren contracture — limited/regional fasciectomy, extending to dermofasciectomy (fascia plus overlying involved skin, replaced with a graft) for aggressive or recurrent disease. The procedure-selection literature (fasciectomy vs needle aponeurotomy vs collagenase) is summarised only as far as it frames recurrence expectations and rehabilitation; the rehab focus is the post-fasciectomy pathway — early active and passive finger extension and flexion, oedema control, scar management, and night extension splinting.

Defining principle of this rehab: fasciectomy removes diseased tissue and restores extension that the disease had taken away — it does not cure the diathesis, and the corrected finger sits in a tissue bed that wants to contract back. So the rehab is a "regain-and-hold" pathway: early motion to keep the freed joints supple and prevent the new flexor-tendon and skin-glide planes from binding down, oedema and scar control so the soft tissues mature without tethering, and a night extension orthosis to defend the surgical correction during healing. The defining clinical question is not whether a construct needs protection (there is no construct), but how aggressively to splint — and here the evidence has shifted decisively toward selective, not routine, splinting.

A. PROCEDURE OUTCOMES & RECURRENCE (context for the rehab)

Open partial (limited) fasciectomy is the long-standing reference operation for Dupuytren contracture and gives the most durable correction of the three mainstream options:

  • Correction is reliable and recurrence is the dominant long-term limitation. Across modern series the operation restores extension well, but Dupuytren is a lifelong diathesis and some tightening returns over years. Reported recurrence rates vary enormously because studies define recurrence differently (any palpable disease vs a threshold extension loss vs need for re-intervention). Using the modern consensus definition, true recurrence of contracture is low at medium-term follow-up, though a substantial minority retain mild residual curvature well short of the pre-operative deformity [corpus: jhsa.2012.06.032; literature: Radhamony 2022].
  • Fasciectomy vs minimally invasive options. Compared with needle aponeurotomy/fasciotomy and collagenase Clostridium histolyticum, open fasciectomy has a longer recovery and higher minor complication rate but lower recurrence — the recurring trade-off in this disease. Needle and collagenase are quicker with faster return to function but recur sooner [corpus: jhsa.2021.05.022; jhsa.2011.08.004; 1753193418786947]. This trade-off is why fasciectomy is typically chosen for denser, multi-ray or PIP-predominant contractures — the same cases whose rehab is hardest and whose splinting is most likely to be justified.
  • Repeat limited fasciectomy for recurrence is safe and effective, supporting fasciectomy as a durable, repeatable mainstay rather than a one-shot procedure [corpus: bjj-2020-1393.r2].

Why this matters for rehab: recovery counselling and splint expectations must be framed against a disease that cannot be cured, only corrected — the rehab protects a correction, it does not prevent the diathesis.

B. THE SPLINTING CONTROVERSY (the central rehab question)

Historically, every patient was issued a static night extension orthosis after fasciectomy on the assumption it preserved the correction. The best available evidence does not support routine splinting — it supports selective splinting for patients who lose extension.

  • Jerosch-Herold 2011 (pragmatic multi-centre RCT, n = 154). Hand therapy alone vs hand therapy + night splinting after fasciectomy/dermofasciectomy. No between-group difference in self-reported function (DASH), finger range of motion, or satisfaction. Authors concluded routine night splinting for all patients is not recommended, reserving it for cases where extension deficits recur [literature: Jerosch-Herold 2011, BMC Musculoskelet Disord].
  • Collis 2013 (single-centre RCT, n = 56). Night extension orthosis + hand therapy vs hand therapy alone after surgical release. No significant difference in total active extension or any secondary outcome at 3 months. Same conclusion: provide an orthosis selectively, when extension loss occurs, not universally [corpus: jhsa.2013.04.012; literature: Collis 2013].
  • Karam 2022 (systematic review + meta-analysis, 4 RCTs, n = 295). Pooling the splint-vs-no-splint trials found no significant difference in total active flexion/extension, DASH, pain, grip or satisfaction. The collective signal is consistent and now moderately strong: adding a splint to good hand therapy does not improve the average outcome [corpus: 1055/s-0041-1725221; literature: Karam 2022].
  • Earlier/smaller work (e.g., post-fasciectomy splinting pilot studies) pointed the same way — splinting is low-yield as a blanket policy [corpus: 1753193412437631].

Practical reading for this protocol. The practice's pattern — splint day-and-night for ~1 week, then night-only with a low threshold to continue (or reinstate) splinting if a finger starts to drift back into flexion — is a reasonable, evidence-aligned middle path: it defends the correction during the highest-risk early healing window and during sleep, while honouring the trial finding that indefinite routine splinting adds little. The trials measured average outcomes; they do not say splinting is useless for the individual who is losing extension, which is exactly the subgroup the authors carved out. This is a defensible selective-splinting stance, not a contradiction of the protocol.

C. HAND-THERAPY & EXERCISE EVIDENCE

  • Early supervised hand therapy is the backbone of recovery and is where the demonstrable benefit lies (the splint trials all compared against a hand-therapy baseline, not against nothing). Active and passive extension and flexion, oedema control and scar management are standard from the first post-operative therapy visit, typically 2–3 days after surgery.
  • Most operated fingers hold or improve their extension over the first three months of hand therapy — the window in which the protocol concentrates splinting and exercise [corpus: jhsa.2013.04.012, control arm; literature: Collis 2013].
  • Scar management. Scar massage is near-universal in hand-therapy practice after Dupuytren surgery to soften the palmar scar, improve skin glide and settle sensitivity, generally combined with silicone gel/sheeting and begun around suture removal once the wound is healed. The supporting evidence is developing rather than definitive but favours reduced scar-related discomfort and improved movement [literature: Scott 2024, Australian hand-therapist survey].
  • Return to work. In a large cohort, median return after open fasciectomy was ~2 weeks with ~90% back at work within the year; physically demanding jobs took longer [literature: Blake 2021].
  • Pre-operative hand therapy has a thinner evidence base and is not a substitute for the post-operative programme [corpus: 17589983241227162].

Phased rehabilitation timeline (matching the synthesis phases)

Phase Window Splint Movement / use Scar & oedema Notes
I — Protect & mobilise ~Days 2–7 Custom thermoplastic extension orthosis day & night, off for exercises Gentle active extension + active DIP/PIP and composite flexion from the first therapy visit; wrist tenodesis Oedema control (elevation, gentle movement); wound kept clean & dry Therapy referral 2–3 days post-op; splint defends the surgical correction during the highest-risk window
II — Restore motion ~Week 1 → 6–8 Transition to night-only; light functional day use of the hand Progress active + passive extension and flexion; restore full composite fist and full extension Scar massage + silicone once wound healed (around suture removal) Most extension is held or regained through this window; daytime driving resumes once out of the splint and grip is safe
III — Strengthen & return ~Week 6–8 → 3 months Night-only continues ~3 months (up to ~6 months selectively if extension is being lost) Grip and functional strengthening; return to heavier manual work as wound is soundly healed and grip comfortable Ongoing scar maturation over months Splinting beyond this window is selective, driven by extension loss — not routine (see §B)

The phase structure and timings are protocol/consensus, agreed between the surgeon and hand therapist; the trials inform the splinting policy within them, not the exact week boundaries.

D. COMPLICATIONS (rehab-relevant)

  • Flare reaction / early CRPS-spectrum. A proportion of patients develop a post-operative inflammatory "flare" — disproportionate swelling, stiffness, redness and pain — which can progress to complex regional pain syndrome (CRPS type 1). Early recognition, oedema control, gentle continued motion and analgesia matter; CRPS is one of the more feared rehab-derailing complications after hand surgery [corpus: jht.2024.09.002 (Dupuytren CRPS-1 case); hcl.2009.11.001 (CRPS after hand surgery)].
  • Digital nerve / vessel injury. The neurovascular bundles are displaced by Dupuytren cords, especially in recurrent disease and at the PIP; injury is a recognised operative risk. New sensory change post-operatively warrants surgeon review [corpus: hansur.2017.07.002 — complications systematic review; 17531934231206317 — surgical complications/adverse events].
  • Wound healing, haematoma, infection, stiffness. Open fasciectomy has a higher minor-complication rate than the minimally invasive options; meticulous wound care and early motion mitigate stiffness and tethering [corpus: hansur.2017.07.002].
  • Incomplete correction / residual PIP deficit. PIP contractures correct less completely than MCP; residual deficit may persist and is the usual trigger for selective ongoing splinting.

E. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Routine vs selective splinting — the headline controversy, now reasonably settled toward selective: three RCTs and a meta-analysis show no average benefit from adding a static night orthosis to good hand therapy, with all authors carving out the extension-loss subgroup. The practice's "night-only, low threshold to continue if drifting" approach is consistent with this. Moderate (multiple RCTs + SR/MA).
  2. Recurrence is definition-dependent — headline recurrence figures are not comparable across studies; the consensus definition gives lower, more credible rates. Counsel against the cure expectation. Moderate.
  3. Procedure choice frames rehab — fasciectomy trades a longer recovery and more minor complications for lower recurrence than needle/collagenase. The fasciectomy cohort is, by selection, the harder-rehab cohort. Moderate.
  4. The phase timings are consensus — drawn from surgeon/therapist protocols, not a rehab RCT. The splinting policy within them is trial-informed; the week boundaries are typical, not trial-derived. Weak/consensus.

F. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE (multiple RCTs + SR/MA): routine night splinting adds no average benefit over hand therapy alone after fasciectomy — splint selectively for extension loss (Jerosch-Herold 2011; Collis 2013; Karam 2022 meta-analysis of 4 RCTs / 295 patients).
  • MODERATE (cohorts / comparative): fasciectomy gives durable correction with lower recurrence but longer recovery and more minor complications than needle aponeurotomy/collagenase; repeat fasciectomy is safe and effective; CRPS and digital-nerve injury are recognised rehab-relevant complications.
  • WEAK / CONSENSUS: the post-operative phase structure and timings themselves (surgeon + hand-therapist protocol; no defining rehab RCT). Scar-massage benefit is supportive but the evidence base is still developing.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Correction of contracture and recurrence rates of Dupuytren contracture following fasciectomy. J Hand Surg Am. 2012. DOI: 10.1016/j.jhsa.2012.06.032
  • Repeat limited fasciectomy is a safe and effective treatment for recurrence of Dupuytren's contracture. Bone Joint J. 2021. DOI: 10.1302/0301-620X.103B5.BJJ-2020-1393.R2
  • Limited fasciectomy versus collagenase Clostridium histolyticum for Dupuytren contracture. J Hand Surg Am. 2021. DOI: 10.1016/j.jhsa.2021.05.022
  • The efficacy and safety of fasciectomy and fasciotomy for Dupuytren's contracture. J Hand Surg Eur. 2011. DOI: 10.1177/1753193410397971
  • Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for Dupuytren contracture. J Hand Surg Am. 2011. DOI: 10.1016/j.jhsa.2011.08.004
  • Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection. J Hand Surg Eur. 2018. DOI: 10.1177/1753193418786947
  • The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-centre RCT. J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.04.012
  • Comparison of hand therapy with or without splinting postfasciectomy for Dupuytren's contracture: systematic review and meta-analysis. J Hand Microsurg. 2022. DOI: 10.1055/s-0041-1725221
  • Does use of a night extension orthosis improve outcomes in patients with Dupuytren contracture? J Hand Surg Glob Online. 2021. DOI: 10.1016/j.jhsg.2021.05.001
  • A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy. J Hand Surg Eur. 2012. DOI: 10.1177/1753193412437631
  • Pre-operative hand therapy management of Dupuytren's disease: a systematic review. Hand Ther. 2024. DOI: 10.1177/17589983241227162
  • Current concepts in the management of Dupuytren disease of the hand. J Am Acad Orthop Surg. 2020. DOI: 10.5435/JAAOS-D-20-00190
  • Complications after treating Dupuytren's disease: a systematic literature review. Hand Surg Rehabil. 2017. DOI: 10.1016/j.hansur.2017.07.002
  • Surgical complications: errors and adverse events (hand surgery). J Hand Surg Eur. 2023. DOI: 10.1177/17531934231206317
  • The case of a woman with bilateral Dupuytren's contractures who developed CRPS-1. J Hand Ther. 2024. DOI: 10.1016/j.jht.2024.09.002
  • Complex regional pain syndrome after hand surgery. Hand Clin. 2009. DOI: 10.1016/j.hcl.2009.11.001

Splinting & hand-therapy literature (URLs)

  • Jerosch-Herold C, Shepstone L, Chojnowski AJ, et al. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial. BMC Musculoskelet Disord. 2011;12:136. https://pmc.ncbi.nlm.nih.gov/articles/PMC3146906/
  • Collis J, Collocott S, Hing W, Kelly E. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-centre, randomised, controlled trial. J Hand Surg Am. 2013. https://pubmed.ncbi.nlm.nih.gov/23790420/
  • Karam M, Kahlar N, Abul A, et al. Comparison of hand therapy with or without splinting postfasciectomy for Dupuytren's contracture: systematic review and meta-analysis. J Hand Microsurg. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC10042625/
  • Blake SN, Poelstra R, Andrinopoulou ER, et al. Return to work and associated costs after treatment for Dupuytren's disease. Plast Reconstr Surg. 2021. https://pubmed.ncbi.nlm.nih.gov/34292887/
  • Radhamony NG, Nair RR, Sreenivasan S, et al. Residual deformity versus recurrence following Dupuytren's palmar fasciectomy — long-term follow-up of 142 cases. Ann Med Surg. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC8767281/
  • Scott HC, Robinson LS, Brown T. Scar massage as an intervention for post-surgical scars: a practice survey of Australian hand therapists. Hand Ther. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10901164/

Society guidance & published rehab protocols

  • The British Society for Surgery of the Hand (BSSH) — Dupuytren's disease patient and professional guidance. https://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease
  • BSSH — Assessing the outcome of surgery for Dupuytren's disease of the hand. https://www.bssh.ac.uk/assessing_the_outcome_of_surgery_for_dupuytrens_disease_of_the_hand.aspx

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.