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杜普伊特伦病

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

Updated Jun 2026
一幅手绘插图，展示了一只手掌向上的手，由于杜普伊特伦挛缩症，无名指弯曲并被拉向掌心。
杜普伊特伦挛缩：手掌中的坚韧索状物使手指向下弯曲。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

杜普伊特伦挛缩（Dupuytren’s disease）是一种进行性疾病，会改变您手掌的组织。您可能会注意到手部皮肤下有增厚或紧绷的条索。这些变化发生得很缓慢，且进展速度因人而异。有些人可能在数年内才观察到变化，而另一些人则发现变化更快。您可能会在手掌感觉到一个小肿块或结节，这通常是第一个迹象。在某些情况下，您还可能在手背看到隆起。

随着疾病进展，紧绷的条索会将您的手指拉向手掌。这使得完全伸直手指变得困难。您可能会发现环指或小指开始向内卷曲。日常任务变得困难。您可能难以将衬衫塞进裤腰、洗脸或戴手套。将手伸到背后扣内衣或拉夹克拉链可能变得不可能。您的手可能再也无法放入口袋或手套中。这种功能丧失被称为临床重要疾病。这种情况很常见，许多患有此病的人最终会寻求治疗。

该病在男性中更常见，但女性也会出现类似症状。女性可能在手指的中节指间关节出现更严重的屈曲，但治疗效果通常相同。病因尚不明确，在某些家族中有遗传倾向。虽然该病是进行性的，但并不总是迅速恶化。许多人长期伴有轻微症状。然而，如果屈曲影响了您的生活，您的外科医生可以提供帮助。手术仍然是矫正畸形和改善功能的最可靠方法。也存在其他非手术选择。最佳选择取决于手部受累程度及其对日常活动的影响。

实际发生了什么

杜普伊特伦挛缩（Dupuytren’s disease）是一种进行性疾病，影响位于手掌皮肤下方的一层致密组织，称为掌腱膜。可以将这层腱膜想象成一张绳索网络，正常情况下它允许您的手指自由伸直和弯曲。在杜普伊特伦挛缩中，这些“绳索”变得增厚且紧绷。随着时间的推移，它们会形成坚硬的结节或索条，将您的手指拉向弯曲位置。

这种紧绷导致了特征性的畸形。随着索条缩短，它们阻止您的手指平贴在桌面上。这种进展的速度因人而异。对于某些患者，变化可能在数年内缓慢发生；而对于其他患者，紧绷可能进展得更快。由于该疾病具有进行性，如果不进行治疗，手指的弯曲可能会加重。

根本问题不在于关节本身，而在于关节周围组织。增厚的腱膜就像一根短而硬的系带。当您尝试伸直手部时，这根系带会产生阻力，导致疼痛或僵硬。虽然许多人有不影响功能的小结节，但具有临床意义的疾病很常见。大多数确诊患者接受手术治疗，因为畸形会干扰握手、洗脸或戴手套等日常活动。

国际手外科医生对于治疗该疾病常见表现的最佳方法缺乏一致意见。这是因为该疾病在每个人身上的表现差异很大。有些患者需要轻微的调整，而另一些患者则需要更重大的干预措施。您的外科医生将评估您特定索条的严重程度及其对活动的限制程度。无论手术还是非手术治疗，其目标都是释放这些紧绷的索条，以便您恢复伸直手指的能力并改善手部功能。

我们能做什么

杜普伊特伦挛缩是一种进展性疾病，但其进展速度因人而异。由于国际手外科医生对常见表现的最佳治疗方案尚未达成共识，您的外科医生将根据您的具体情况制定个性化计划。对许多人而言，第一步是自我管理和治疗。治疗干预有助于将您的具体问题与合适的选择联系起来。您可能需要在治疗师的帮助下保持手部活动并管理僵硬。这种方法旨在您在监测疾病随时间变化的同时维持功能。

如果您经历疼痛或明显紧绷感，可考虑药物治疗。尽管特定药物的证据基础有限，但您的外科医生可能会讨论有助于缓解不适的选项。部分患者接受注射以管理症状。例如，高能聚焦体外冲击波疗法已被证明可在某些情况下缓解疼痛，但需要更多研究来确认其作为非侵入性选项的价值。其他治疗方式包括胶原酶注射。解脩梭菌胶原酶（CCH）是一种安全有效的治疗手段，可改善手部功能。与CCH相关的大多数不良事件均为轻微且可自行缓解的。在初始CCH治疗三年后，未报告长期不良事件。然而，CCH可能无法提供持久的挛缩矫正，其复发率与其他标准治疗相当。如果您希望避免手术，它仍然是一个可行的非手术选择。

对于限制您日常生活的进行性杜普伊特伦挛缩，手术仍是金标准治疗方案。当保守治疗达到极限且畸形干扰您使用手部功能时，通常考虑手术干预。目前发表的最佳证据表明，以部分或选择性筋膜切除术形式的手术治疗是最可靠的方法。该手术涉及切除导致手指弯曲的紧绷组织。在75%的病例中，可实现完全或近乎完全矫正。存在多种治疗选择，每种都有其特定的并发症谱，因此您的外科医生将讨论哪种方法能为您提供最佳的风险与获益平衡。

预期情况

杜普伊特伦挛缩（Dupuytren’s disease）是一种进行性疾病，影响手掌皮下组织。该病较为常见，大多数确诊患者最终都会寻求治疗。该病会导致组织形成增厚的条索，使手指弯曲。这会导致难以伸直手部或将其平放在桌面上。

这种进展的速度因人而异。对某些患者而言，变化在多年内缓慢发生；而对另一些患者而言，病情可能进展更快。无法准确预测您的病情进展速度。由于该病具有遗传性，且涉及胶原基质的改变，它倾向于持续存在，而不会自行消退。

如果您选择接受治疗，可以预期获得显著的功能改善。手术矫正或其他干预措施可以帮助伸直手指，并改善手部执行日常任务的能力。对于晚期病例，如筋膜切除术（dermofasciectomy）等手术在功能恢复和疾病控制方面可提供显著的长期益处。即使接受治疗后，疾病仍有复发的可能。复发率因所用方法而异，但有时在一段时间内需要再次干预。

如果未对病情进行治疗，挛缩可能会加重。这会导致洗脸、戴手套或握手等简单活动日益困难。虽然部分患者在早期阶段可通过非手术选项或夹板进行管理，但这些方法无法逆转潜在的组织改变。

您的外科医生将根据您的具体情况讨论最佳治疗方案。男性和女性的预后总体相似，但女性中指的关节受累可能更为严重。最终目标是尽可能长时间地维持手部的功能和舒适度。

何时就诊

杜普伊特伦挛缩的进展速度因人而异。您可能会注意到手掌皮肤增厚或出现结节。这些变化可能导致手指弯曲，使您难以伸直手部或将其放入口袋。如果这种僵硬影响了日常活动或睡眠，您应就诊于全科医生。您的外科医生会使用特定的分期系统来评估畸形的进展程度。早期评估有助于确定是否需要治疗。虽然许多病例症状较轻，但严重的挛缩会限制手部功能。不要等到手部完全无法伸直时才就医。如果您感觉手部力量减弱或僵硬加重，请寻求专科医生评估。

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

[1] Variation in Treatment Recommendations for Dupuytren Disease. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.08.023 [2] Prevalence and incidence of doctor-diagnosed Dupuytren’s disease: a population-based study. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687914 [3] Dupuytren Disease: Is Collagenase Better Than Needling?. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00282 [4] Complications after treating Dupuytren's disease. A systematic literature review. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2017.07.002 [5] Management of Dupuytren's Disease – Clear Advice for an Elusive Condition. The Annals of The Royal College of Surgeons of England. 2006. DOI: 10.1308/003588406x83104 [6] Treatment of Dupuytren’s contracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b9.bjj-2017-1194.r2 [7] Dupuytren Disease Management Trends: A Survey of Hand Surgeons. HAND. 2018. 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. DOI: 10.1177/1753193415601353 [30] Examining the Efficacy and Maintenance of Contracture Correction after Collagenase Clostridium Histolyticum Treatment for Dupuytren's Disease. HAND. 2013. DOI: 10.1007/s11552-013-9524-7 [31] High-energy focused extracorporeal shockwave therapy relieved pain in Dupuytren's disease: a series of seven hands. European Journal of Physical and Rehabilitation Medicine. 2020. DOI: 10.23736/s1973-9087.18.05498-9 [32] Gender Ratio of Dupuytren's Disease in the Modern U.S. Population. HAND. 2007. DOI: 10.1007/s11552-007-9076-9 [33] Fasciectomy for Dupuytren Contracture. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2018.04.002 [34] Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.11.006 [35] Dupuytren's Contracture—Therapy and Result Following Percutaneous Fasciotomy With Xiaflex (Collagenase). Journal of Hand Therapy. 2010. 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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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.