Patient information · Orthopaedics and hand
Dupuytren's contracture
when to leave it, and when to act
Dupuytren's is a thickening of the tissue in the palm that gradually pulls one or more fingers towards the palm. It is painless, slow, and often needs no treatment at all. The judgement is about function — and there is a simple test that tells you when to seek an opinion.
Seek prompt assessment if you have
- a rapidly growing or painful lump in the palm
- numbness, tingling or colour change in the fingers
- a finger that has become fixed suddenly rather than gradually
- skin breakdown or ulceration in the crease of a bent finger
- a lump in the palm that is hot, red or spreading
Dupuytren's is painless and slow. Pain, rapid growth or neurological symptoms suggest something else and need assessing rather than assuming.
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.
The tabletop test
Place your hand flat on a table, palm down. If you can lay it completely flat, no treatment is needed however visible the cord. If you cannot flatten the hand, that is the point at which to seek an opinion. It is a simple, reliable threshold, and it is the one hand surgeons use. Repeat it every few months and photograph the result to track progress.
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.
Why come to us. Most people with Dupuytren's need reassurance and monitoring rather than an operation, and it is worth knowing which group you are in. We assess the hand, perform the tabletop test and measure the contracture properly so progression can be tracked, check for the associated conditions — diabetes in particular, with bloods taken in-house — and refer to hand surgery at the right point rather than too early or too late. Orthopaedic and physiotherapy input under one roof, seven days a week.
Assessed, measured and monitored properly
Orthopaedics and hand therapy on site, seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.