®Making a fist
Bend your fingers towards the lower crease in your palm to make a fist, then open your hand. Work gently, within a pain-free range.
10 reps, 4–6 times a day1 in 3In roughly one in three people, the lumps in the palm develop into a cord that bends the finger
30 degreesThe minimum finger bend at which surgery is usually considered
2 weeksRecovery time after needle release; 4–12 weeks after surgery
154 peopleThe trial in which a night splint after surgery gave no extra benefit for hand function
Symptoms
- A hard lump, pitting or ridge-like thickening in the palm, often in line with the ring finger.
- A cord you can feel under the skin, running from the palm to the finger.
- The ring and little fingers bending towards the palm and not straightening fully, often in both hands.
- Sometimes pads over the finger joints, or lumps on the sole of the foot.
It is usually painless. New lumps can be tender when pressed; this discomfort almost always settles with time.
Who is more likely to get it?
- Middle age and older; more common in men than in women.
- More common in people of Northern European descent; it often runs in families.
- It is linked with smoking, heavy drinking, diabetes and epilepsy, but it also occurs in many people who have none of these.
- Heavy manual work is not thought to be a cause.
The table-top test
Place your palm and fingers flat on a table. If you cannot put your hand completely flat, or you are struggling with everyday tasks, you can see your doctor. In the early stage, while the fingers can still straighten, treatment is usually not needed.
Treatment options
- MonitoringIf your fingers can straighten fully, no treatment is needed; you can repeat the table-top test from time to time.
- Needle releaseUnder local anaesthetic, the cord is loosened with a needle and the finger is straightened. You go home the same day and recovery takes up to 2 weeks; the condition is more likely to come back than after surgery.
- FasciectomyThe diseased tissue is removed surgically. You usually go home the same day and recovery takes 4–12 weeks; it is the option with the lowest risk of the condition coming back.
- DermofasciectomyThe diseased tissue is removed together with the skin over it, and a skin graft is put in its place. The risk of it coming back is lower but recovery takes longer; it is usually used for recurrent or widespread disease.
- Collagenase injectionAn injection of an enzyme that softens the cord, followed a few days later by straightening the finger. It works for some patients; it is not available in every country, as its marketing authorisation in the European Union was withdrawn in 2020 at the manufacturer’s request.
After any treatment, the finger may not be completely straight or as strong as before, and the condition can come back over the years.
After a procedure
- Keep the dressing clean and dry until the stitches are out and the wound has healed; you can protect your hand with a plastic bag in the shower.
- When sitting and sleeping, keep your forearm raised on pillows; keep moving your wrist, elbow and shoulder.
- Avoid heavy lifting and pulling for the first few weeks; for heavy work this period is at least 6 weeks.
- Once the wound has healed, you can massage the scar, rubbing it with an unscented moisturiser.
- You can drive when your pain allows and you feel fully in control of the car; check with your insurer first.
- Report signs of infection straight away, such as a bad smell, discharge, redness, fever or increasing pain.
Exercises at home
Six exercises to keep your hand moving
These exercises are taken from the post-procedure advice of an NHS musculoskeletal guide in Scotland; depending on swelling and inflammation, they are done 4–6 times a day. After a procedure, the programme your hand therapist gives you comes first. They also help keep the hand moving before a procedure, but they do not stop the condition from progressing.
Straightening and spreading the fingers
Straighten your fingers as far as they go without pain and spread them apart, then bring them together. This is important for keeping the straightness gained with the procedure.
10 reps, 4–6 times a dayHook fist
Keeping the joints at the base of your fingers straight, bend only the middle and end joints, then straighten your fingers.
10 reps, 4 times a dayTendon gliding
Start with your fingers straight; move in turn into a hook fist, a full fist and a straight fist (knuckles bent, fingers straight), holding each for a few seconds.
The sequence 10 times, 4 times a dayThumb movements
Move your thumb as far away from your palm as you can, then bring it back towards it. Do the movement without forcing it, within a pain-free range.
10 reps, 4 times a dayMoving the wrist up and down
Rest your forearm on a table with your hand over the edge. Lift your wrist as far as is comfortable, then lower it.
10 reps, 4 times a dayFrequently asked questions
Do exercise or a splint stop the condition from progressing?
No. There is no known cure for Dupuytren’s, and exercise or splinting has not been shown to stop it from progressing. An NHS musculoskeletal guide in Scotland notes that the evidence for splints and ultrasound is limited. The exercises are mainly for regaining and keeping finger movement after a procedure.
When is treatment needed?
If you can straighten your fingers fully, you do not need surgery. When you cannot put your hand flat on a table, or you are struggling with everyday tasks, it is time to talk to a hand surgeon. According to Scotland’s national patient leaflet, surgery is usually done when the finger is bent by at least 30 degrees.
Needle release or surgery?
Needle release (needle fasciotomy) is done under local anaesthetic, you go home the same day and recovery takes up to 2 weeks; however, the condition is more likely to come back. With surgical removal of the diseased tissue (fasciectomy), recovery takes 4–12 weeks and the risk of it coming back is the lowest. Surgery with a skin graft (dermofasciectomy) reduces the risk of recurrence further, but recovery takes longer. The decision can be made together with your surgeon, after discussing the state of your finger, your work and your expectations.
Does the collagenase injection work?
In the DISC trial in the UK, with 672 people, a collagenase enzyme injection was compared with limited surgery. In the first year the injection was slightly less effective but cheaper; in the second year the gap widened. The injection group had more side effects overall, while moderate to severe side effects were more common in the surgery group. The medicine’s marketing authorisation in the European Union was withdrawn in 2020 at the manufacturer’s request, for commercial reasons; so it may not be available in every country.
Should I wear a night splint after surgery?
It may not be needed for everyone. In a UK trial with 154 people who had surgery, adding a night splint to hand therapy did not change hand function or finger straightness at 12 months. The researchers suggest using a splint only if the finger starts to bend again. Follow the advice of your surgeon and hand therapist.
Will the condition come back?
It can. After any treatment, the finger that was treated or another part of the hand can bend again within a few years. Even so, most patients who need surgery have only one operation in their lifetime.
For a finger that catches and then suddenly springs open, see the trigger finger guide; for pain and stiffness in the hand and finger joints, see the hand and finger osteoarthritis guide.
When should you see a doctor?
- If you cannot put your hand flat on a table
- If the bending is progressing quickly or making everyday tasks difficult
- If there are signs of infection, or increasing pain and numbness, after a procedure
- If the finger starts to bend again after a procedure: you can discuss whether you need a splint
Sources
- NHS. Dupuytren’s contracture, Treatment and Recovery. Page last reviewed 18 June 2024.
- Health Service Executive (HSE). Dupuytren’s contracture. Last reviewed 4 October 2023.
- British Society for Surgery of the Hand. Dupuytren’s disease: patient information. 2016.
- NHS Scotland. National Dupuytren’s disease patient information leaflet.
- NHS Greater Glasgow and Clyde, Right Decisions. MSK Index: Dupuytren’s. Last reviewed 9 May 2024.
- 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.
- European Medicines Agency. Xiapex: withdrawal of the marketing authorisation in the European Union. Withdrawn 1 March 2020.
- Dias J, et al. Collagenase injection versus limited fasciectomy surgery to treat Dupuytren’s contracture in adult patients in the UK: DISC, a non-inferiority RCT and economic evaluation. Health Technol Assess. 2024;28(78):1–262.