Dupuytren’s disease is a condition where the tissue just under the skin in your palm becomes abnormally thick and tight. Over time, this can form firm bands that pull one or more fingers into a bent position, making it hard to straighten them fully.

What Causes Dupuytren’s Disease?

We do not know the exact cause of Dupuytren’s disease, but we do know it is not your fault and it is not caused by a single injury. It appears to be a problem with how the palmar tissue heals and remodels over time.

Several factors are known to increase the chance of developing Dupuytren’s disease:

• Genetic predisposition: The condition often runs in families. If parents or grandparents had bent fingers or “knots” in the palm, your risk is higher.
• Northern European background: Dupuytren’s is more common in people with ancestry from Northern Europe. It is sometimes called “Viking disease” for this reason, although it can occur in any ethnic group.
• Age: It is more common after age 50 and tends to become more noticeable with age.
• Diabetes: People with diabetes have a higher rate of Dupuytren’s disease than the general population.
• Alcohol use: Regular heavy alcohol use has been linked to a higher risk.
• Other factors: Smoking and some liver conditions have also been associated in studies, but they are not the sole cause.

Most people have more than one risk factor. Having these risk factors does not mean you will definitely develop Dupuytren’s disease, but it makes it more likely over a lifetime.

What Are the Symptoms?

Dupuytren’s disease usually develops slowly over months or years. Many people do not have pain, so the early changes are easy to ignore. Common symptoms include:

• Nodules: Small, firm lumps in the palm, often near the base of the ring finger or small finger.
• Cords: Rope-like bands under the skin that run from the palm toward the fingers.
• Finger contracture: One or more fingers, most often the ring and small fingers, gradually bend toward the palm and can no longer be fully straightened.
• Skin changes: The skin over the affected area may look puckered, dimpled, or feel stuck down to the tissue underneath.
• Difficulty flattening the hand: Trouble placing the hand flat on a table or sliding it into a pocket, glove, or narrow space.

The thumb and index finger are usually less affected. Many patients have little or no pain. If there is discomfort, it is often a dull ache or tenderness over the nodules early in the disease.

How Is Dupuytren’s Disease Diagnosed?

Dupuytren’s disease is most often diagnosed with a careful physical exam. In typical cases, no special tests are needed.

• History: We will ask when you first noticed changes, how quickly things have progressed, and whether the hand is limiting daily activities.
• Examination: The palm and fingers are checked for nodules, cords, skin puckering, and areas of tightness.
• Range of motion: Each finger is gently straightened and bent to measure how much contracture is present.
• “Table-top test”: A simple test is whether you can place your palm flat on a table with the fingers straight. If you cannot, there is usually a meaningful contracture.

X-rays, MRI scans, and ultrasound are usually not required to diagnose Dupuytren’s disease. They may be used only if there is concern about another problem in the hand.

Treatment Options

Not every patient with Dupuytren’s disease needs treatment right away. The decision depends on how much the fingers are bent, how much function is limited, your general health, and your goals. Treatment options fall into three main groups.

1. Observation (Watchful Waiting)

If you have small nodules and minimal or no finger contracture, careful monitoring is often the best approach.

• Regular self-checks at home to watch for increasing bend in the fingers.
• Periodic exams with a hand surgeon to follow any changes.
• Gentle stretching and keeping the joints moving; this does not stop the disease but can help maintain comfort and motion.

This approach is reasonable when you can still place your hand flat on a table and your activities are not limited.

2. Needle Aponeurotomy (Needle Fasciotomy)

Needle aponeurotomy is a minimally invasive procedure done under local anesthesia. A fine needle is used through the skin to carefully weaken and divide the tight cord, allowing the finger to straighten.

• Usually done in the office or procedure room.
• Very small puncture sites instead of longer incisions.
• Most patients return to light activities within a few days.
• Best suited for certain patterns of cords and contractures, especially when the skin is healthy and the joints are still flexible.

Because the diseased tissue is released but not removed, there is a realistic chance that the contracture can return over time.

3. Collagenase Injection (Xiaflex)

Collagenase clostridium histolyticum (Xiaflex) is an enzyme injected directly into the Dupuytren’s cord. It weakens the collagen so that the cord can be gently stretched and broken the next day.

• Given in the office with a small needle into the cord.
• After about 24 hours, the finger is extended to help break the softened cord.
• Bruising, swelling, and temporary soreness are common and usually settle with time.
• Rare but important risks include tendon injury, skin tears, and allergic reactions.

Availability and insurance coverage for collagenase injections change over time and vary by location. Your surgeon will discuss whether this option is currently reasonable for your situation.

4. Surgical Fasciectomy

Surgical fasciectomy is the most traditional operation for Dupuytren’s disease. Through an incision in the palm, and sometimes into the finger, the diseased tissue is carefully removed while protecting the nerves, blood vessels, and tendons.

• Usually done under regional or general anesthesia.
• Allows direct removal of the thickened bands and better correction of complex contractures.
• Often provides a more durable result than needle or injection treatments, especially in advanced disease.
• Requires wound healing, hand therapy, and splinting afterward.

Surgery is generally recommended when the contracture is significant (often around 30 degrees or more), when daily function is clearly affected, or when other treatments are not likely to give a good or lasting result.

No treatment can guarantee that Dupuytren’s disease will never return. Recurrence is possible after any option, but the pattern and timing vary from person to person.

Recovery After Treatment

Recovery time depends on the type of treatment and how stiff the fingers were before treatment. In general, less invasive options have shorter recovery but may have higher recurrence rates; surgery has a longer recovery but may offer a more durable correction for severe disease.

Splinting

After needle treatment, collagenase injection, or surgery, a custom splint is often used to help keep the finger straighter, especially at night.

• Typically worn at night for several weeks or months.
• Helps maintain the correction while the tissue heals.
• Must be adjusted if there is any rubbing or skin irritation.

Hand Therapy

A certified hand therapist can guide you through exercises and scar care to get the best possible result.

• Gentle range-of-motion and stretching exercises.
• Scar massage and techniques to keep the scar flexible.
• Swelling control with elevation, compression, or other methods as needed.
• Advice on safely returning to work, sports, and hobbies.

Typical Timelines

• After needle aponeurotomy or collagenase injection: Many people are back to light daily activities within a few days. Some soreness, swelling, or bruising is expected. Night splinting and exercises usually continue for several weeks.
• After surgical fasciectomy: Stitches are often removed around 10–14 days after surgery. Formal therapy and splinting may continue for several weeks. Swelling and stiffness can take several months to fully settle.

Your exact plan will be tailored to your procedure, your hand, and your job or activity level.

Frequently Asked Questions

Is Dupuytren’s disease painful?

Most people with Dupuytren’s disease have little or no pain. Some feel tenderness or aching in the palm when nodules are first forming. Pain alone does not mean the condition is rapidly worsening, but it is a good reason to have your hand examined.

Will it come back after treatment?

Dupuytren’s disease is a chronic condition. No current treatment can guarantee it will never return. Less invasive options like needle aponeurotomy and collagenase injections often have quicker recovery but may have a higher chance of recurrence. Surgery may provide a more durable correction for many patients, but recurrence is still possible over time.

Do I need surgery?

Not everyone needs surgery. Many patients are safely managed with observation for years. Others are good candidates for needle or injection treatments. Surgery is usually recommended when the finger contracture is more severe, when function is clearly limited, or when other options are not appropriate for the pattern of disease in your hand.

Can I wait to have treatment?

You can often wait if the bend in the finger is mild and your daily activities are not affected. However, if you cannot place your hand flat on a table, or if tasks like shaking hands, washing your face, or putting on gloves are becoming difficult, it is better to be evaluated sooner. Long-standing, severe contractures can be harder to correct and may leave more stiffness even after treatment.

When Should You See a Hand Surgeon?

You should consider seeing a hand surgeon if you notice new nodules or cords in your palm, if a finger is starting to curl toward your palm, or if you fail the table-top test and cannot place your hand flat on a surface. It is especially important to be seen if the contracture is beginning to interfere with work, hobbies, or basic self-care.

Seeing a specialist early does not mean you must have treatment right away. It does allow you to understand your specific pattern of disease and to plan the timing of treatment in a thoughtful way.

If you are concerned about Dupuytren’s disease, you do not need to wait until the fingers are severely bent before seeking advice.

If you have noticed lumps in your palm, difficulty straightening your fingers, or trouble laying your hand flat, an in-person evaluation can clarify what is happening and whether treatment makes sense now or later. At Sports Orthopedics & Spine in Jackson, TN, Dr. Keith Michael Nord evaluates and treats Dupuytren’s disease using both non-surgical and surgical options tailored to your hand and your goals. To discuss your situation and learn about your choices, please contact our office to schedule an appointment.