Private dupuytren's contracture clinic in London, same-day physiotherapy.

How it progresses

• A firm nodule in the palm, most often in line with the ring or little finger. Sometimes mildly tender at first, then painless.
• A cord forming under the skin, running from the palm towards the finger.
• Puckering or dimpling of the overlying skin.
• Gradual contracture — the finger no longer straightens fully.
• Progress is unpredictable: some people change little over decades, others progress over a year or two.

Who gets it

• more common in men, and with increasing age
• strongly hereditary — often several family members affected
• traditionally associated with Northern European ancestry
• associated with diabetes, epilepsy and its treatment, and heavy alcohol use
• linked with Peyronie's disease and with plantar fibromatosis in the foot, which share the same tendency
• Not caused by manual work or hand use, despite the common assumption

Treatment options

• Observation — entirely reasonable while the hand still flattens. There is no evidence that early intervention prevents progression.
• Needle fasciotomy — a needle used under local anaesthetic to divide the cord through the skin. Quick, minimal downtime, done in clinic. Recurrence is higher than with surgery but it can be repeated.
• Limited fasciectomy — surgical removal of the diseased cord. The most durable option, with a longer recovery and hand therapy afterwards.
• Dermofasciectomy — removing the overlying skin as well, with a graft, for severe or recurrent disease.
• Splinting, stretching, massage and ultrasound do not work and do not slow progression. Steroid injection may soften an early painful nodule but does not reverse contracture.

Afterwards

• Hand therapy is essential after surgery — the result depends on it as much as on the operation.
• A night splint is often worn for several months.
• Swelling, stiffness and altered sensation are common for weeks; full recovery takes two to three months after open surgery.
• Recurrence is common whatever the treatment, particularly in younger people with a strong family history. This is not treatment failure but the nature of the condition.