Hand & Wrist

Dupuytren's Contracture

Dupuytren's contracture is a progressive condition of the palm in which the connective tissue beneath the skin thickens and tightens, eventually forming cords that pull the fingers into a bent position. Many patients first notice a painless nodule in the palm near the ring or small finger. Over months to years, that nodule may develop into a firm cord stretching into the finger, gradually preventing full extension. At Maryland Orthopedic Specialists, our hand surgeons offer all three major treatment options — needle aponeurotomy, collagenase injection, and surgical fasciectomy — and help each patient choose the approach best suited to their anatomy, severity, and lifestyle.

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What is dupuytren's contracture?

Dupuytren's contracture arises from pathological transformation of the normal palmar fascia — the sheet of fibrous tissue that lies just beneath the palm skin — into thickened, collagen-rich nodules and cords. These structures contract over time, tethering the overlying skin and eventually causing fixed-flexion contracture at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the affected fingers.

The ring finger is most commonly affected, followed by the small, middle, and index fingers. The thumb is rarely involved. Bilateral disease is present in approximately 45% of patients at diagnosis.

Dupuytren's Diathesis

Dupuytren's diathesis refers to a constellation of features associated with a more aggressive disease course and higher recurrence after treatment: bilateral hand disease, plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie's disease), knuckle pads (Garrod's pads), young age at onset (before 50), and a strong family history. Patients with high diathesis scores may choose more definitive surgical treatment over needle or injection-based options due to higher expected recurrence rates.

Risk Factors

Northern European (Scandinavian, British, Irish, Dutch) ancestry
Male sex (7:1 male-to-female ratio)
Age over 50
Family history
Diabetes mellitus (associated with atypical "diabetic cheiroarthropathy")
Alcohol use, smoking, and manual labor (less strongly supported by evidence)

Treatment options

Needle Aponeurotomy

This is the least invasive option, done right in the office using a needle to break up the cord through small skin punctures. Recovery is quick — most patients are back to light activity within a day or two. It works well for straightening fingers bent at the knuckle, but the cord is more likely to return over time compared to surgery.

Collagenase Injection (Xiaflex)

An enzyme is injected into the cord during an office visit, which weakens the cord's structure. The patient returns the next day so the doctor can gently straighten the finger and complete the release. This is a good option for a single cord affecting the knuckle joint, and the whole process takes just two office visits.

Surgical Procedure

Dupuytren's Fasciectomy

Surgical removal of the diseased palmar fascia cord causing Dupuytren's contracture, allowing the finger to fully extend. Partial fasciectomy removes the affected cord while carefully preserving surrounding neurovascular structures.

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Frequently Asked Questions

Is Dupuytren's painful?

Early nodules can be tender when pressed. Established cords and contractures are typically not painful. If significant hand pain accompanies a Dupuytren's-appearing condition, other diagnoses should be considered.

Will it keep getting worse without treatment?

Dupuytren's follows a variable course. Some patients have stable disease for many years; others progress rapidly. Treatment is typically not recommended for nodules alone or for small contractures, as the risks of intervention outweigh the benefits at that stage.

Which treatment is best?

There is no universally "best" option. Our hand surgeons review the degree of contracture, cord anatomy, diathesis score, and patient goals to recommend a personalized approach.

Can Dupuytren's come back after surgery?

Yes. Recurrence is the rule rather than the exception for all treatment methods, though surgery offers the lowest rates, especially with dermofasciectomy. Recurrence is more likely in patients with diathesis features and when all diseased tissue cannot be safely removed near digital nerves.

How long does recovery take after needle aponeurotomy or surgery for Dupuytren's contracture?

Recovery time depends on the treatment chosen: needle aponeurotomy (needle fasciotomy) has a rapid recovery, with most patients returning to light activity within a few days, though recurrence rates are higher. Open surgical fasciectomy requires a longer recovery of four to eight weeks, with hand therapy to restore finger extension and manage scarring. Collagenase injection (Xiaflex) falls in between, with initial finger manipulation followed by weeks of splinting and therapy. Your MOS hand surgeon will recommend the approach best suited to your degree of contracture, finger involvement, and lifestyle needs.

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Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Medically reviewed by Peter G. Fitzgibbons, MD, MD

Last reviewed May 1, 2026