Overview
what it is and why it mattersImage pendingPhotograph of a hand with Dupuytren
Dupuytren's contracture is a slow build-up of scar-like tissue in the palm of your hand. The thin layer of fibrous tissue under the skin gradually forms small lumps (nodules), then thick rope-like cords, that pull one or more fingers — most often the ring and little finger — into a permanently bent position. The exact cause is unknown, but genes play a big role: it's especially common in men of Northern European descent over age 50.
It's usually painless. The real problem is the gradual loss of being able to flatten your hand — which gets in the way of wearing gloves, shaking hands, washing your face, or reaching into pockets.
Symptoms
what you may noticeThe earliest sign is usually a firm nodule — a small, painless lump — in the palm near the base of your ring or little finger. Over months to years, a thick cord develops under the skin that you can see and feel running from the palm toward the finger. The finger gradually curls into a bent position that you can't straighten on your own.
The contracture is usually painless, which is why many people wait years before seeking treatment. The real problem is functional: you can't flatten your hand on a table, wearing gloves becomes difficult, and reaching into pockets or washing your face feels awkward. Both hands are affected in about half of patients, and the condition sometimes runs in families.
Diagnosis
exam first, imaging secondThe diagnosis is made by exam alone — nodules and cords are easy to feel and see in the palm. Your surgeon will use the tabletop test (placing your palm flat on a table) to gauge how much you can no longer flatten the hand, and measure the bend at each finger joint. No imaging is needed. The bend at the middle finger joint (PIP) matters most for prognosis — it gets harder to fully reverse the longer it's been there.
Treatment Path
how care progresses at OSI1
Observation
Mild Dupuytren's that isn't getting in the way of daily activities is simply watched — it doesn't always progress, and it's reasonable to wait until function is affected before treating.
2
Collagenase injection (Xiaflex)
An FDA-approved enzyme injection (Xiaflex) that dissolves the cord chemically; the next day, your surgeon manipulates the finger to break the weakened cord — done in the office, no operating room. Best for cords pulling on the knuckle joint (MCP); less reliable for cords pulling on the middle finger joint (PIP).
3
Needle aponeurotomy
Your surgeon uses a needle through the skin to weaken and break the cord in the office. Quick recovery, lower cost, but higher chance the cord re-forms over the years compared with surgery.
Surgical Options at OSI
if non-operative care isn't enoughSurgery is recommended when the bend at the knuckle joint reaches about 30° (roughly when the tabletop test fails), or when any bend develops at the middle finger joint — that one becomes harder to fully reverse the longer it stays bent.
Providers Who Treat Dupuytren's Contracture
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: