Dupuytren's Disease Info
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Video transcript
Dupuytren's disease is a gradual thickening of the tissue layer just beneath the skin of the palm. Firm lumps, and later cords, form in the palm, and can slowly pull one or more fingers down towards it. It is usually painless, but over time the affected fingers become harder to straighten fully. A useful early sign is not being able to lay the hand flat on a table. It tends to run in families, is sometimes called the Viking disease because it is most common in people with Northern European ancestry, comes on slowly over years, and most often affects the ring and little fingers. In the early stages, when the hand still works well, it often just needs watching, as not every case progresses. There is no cream or medication that reverses the thickening. When a cord begins to bend a finger, a less-invasive option is a needle release, where the cord is divided through the skin with a fine needle, straightening the finger without an open operation. This can suit a suitable cord, though the bend can gradually return over time. When the contracture is more severe, surgery gives a more complete and longer-lasting correction. The operation for Dupuytren's is a fasciectomy, where the diseased cord is carefully removed through an incision in the palm and finger. This frees the finger to straighten again, and takes the tension off the joints. The skin is closed, sometimes with a small graft if needed, and the hand is supported in a dressing. It is usually day surgery, done with the arm numbed or under a general anaesthetic. The aim is to straighten the finger and restore the use of the hand. A hand therapist guides your recovery, which is an important part of a good result. A splint is often worn, especially at night, to hold the finger straight while it heals. Gentle movement starts early to keep the finger supple and prevent stiffness. The hand can be swollen and tender for a few weeks, settling steadily as it heals. Most people regain good straightening and use of the hand over the following weeks to months.
Dupuytren’s disease causes palm thickening and finger contracture—options range from observation to needle aponeurotomy or surgical excision.
What you're feeling
You may notice a lump or thickening in the palm of your hand. Over time, this can pull your fingers into a bent position. This bent finger is called a contracture. You might find it hard to place your hand flat on a table. Simple tasks like tucking in your shirt or reaching behind your back to fasten a bra become difficult.
Many people feel pain or tenderness in the palm, especially when the disease is active. The pain often flares at night or after using your hand for daily activities. You might wake up with a stiff hand that feels better after you move it around. Some patients report that the skin on their palm feels tight or itchy before the fingers start to bend.
If you have had surgery to release a trigger finger, you might develop new symptoms of Dupuytren disease sooner than expected. This condition is common in the general population, and most people with diagnosed disease undergo treatment. While surgery helps your hand feel more normal, you may still experience some stiffness or discomfort as you recover. Your surgeon will guide you through these changes to help you regain function.
What's actually happening
Dupuytren's disease starts when the tissue under your skin, called the palmar fascia, begins to thicken and tighten. Think of this tissue as a rope made of many fibers. Over time, these fibers clump together and form hard cords. These cords pull your fingers toward your palm, making it hard to straighten them. This tightening is what we call a contracture.
You might notice this problem after hand trauma or repetitive stress. The disease affects the way your hand moves by pulling on the tendons that straighten your fingers. As the cords tighten, they create a deformity that stops you from placing your hand flat on a table. While the condition can affect any finger, it often starts in the ring or little finger.
Your surgeon sees this as a mechanical problem where the "rope" of tissue is too short. Surgery aims to cut or remove these tight cords to restore your hand's normal shape. While the disease can return, limited fasciectomy is currently the most reliable long-term treatment. Even with some impairment in bending your fingers, many patients achieve a functional range of motion five years after treatment with collagenase injections.
What we can do about it
Your journey often begins with self-management and physiotherapy. These steps aim to keep your hand moving and manage symptoms while the disease is mild. While there is limited evidence to guide the exact management of this condition, many patients find that therapy helps link your specific problems to appropriate choices. You may try these methods first, but please note that little agreement exists on treatment recommendations among international hand surgeons for common presentations.
Medical management focuses on comfort and function when simple measures are not enough. Your surgeon may discuss perioperative corticosteroid administration if you proceed to surgery, as this appears safe and improves early range of motion. It also helps improve DASH scores, which measure your hand's ability to function. For some, injections like cortisone or hyaluronic acid might be considered, though the evidence notes that outcomes for recurrent disease are not always perfectly predictable. If you have had a trigger finger release, be aware that you have a significantly higher rate of needing further treatment for Dupuytren's compared to other interventions.
Surgery is considered the gold-standard treatment when your contracture becomes progressive and limits your daily life. It remains the most reliable option in the long term for correcting the deformity and restoring function. Your surgeon will choose from several procedural options, such as limited palmar fasciectomy, which is the most common choice, or a needle fasciotomy for advanced cases. If conservative care reaches its limit, surgery offers substantial long-term benefits in terms of disease control and hand normality.
When to see someone
See your GP if you notice a lump in your palm or a finger that won't straighten. Ask for a specialist review if the condition worsens suddenly, causes persistent pain that rest does not fix, or makes your hand feel weak or unstable. You should also seek help if your finger locks, gives way, or if symptoms interfere with your sleep or work. While most diagnosed individuals undergo treatment, early recognition helps manage the disease. If you have had a trigger finger release, be aware you may develop Dupuytren's disease sooner and require further treatment like fasciectomy.
