In short

Dupuytren's disease is a slow, mostly painless thickening of the tissue under the skin of your palm. Over months and years, it can pull one or more of your fingers down into a bent position you cannot straighten. It is common, particularly in people of Northern European background and in men over fifty. There is no cure. There are good treatments to straighten the finger when the bend starts to interfere with your hand function — and when to have one of those treatments, and which one, are decisions that belong with you, with the support of an honest conversation with your hand surgeon.
This page is the patient-facing summary. The two operations are described in more detail on the Percutaneous Needle Fasciotomy page and the Limited Fasciectomy page. A separate, more technical FESSH preparation article is written for hand surgeons and trainees.

What Dupuytren's disease is

Underneath the skin of your palm there is a thin sheet of fibrous tissue called the . Its normal job is to anchor the skin to the underlying tendons and bones so that you can grip without the skin sliding around. In , parts of this fascia start to thicken. The earliest sign is usually a small firm lump in the palm — a — that you might first notice as a bump in line with one of your fingers. Many people first notice it when they put their hand flat on a table.
Over time — months in some patients, years or decades in others — the nodule may extend into a thickened band that runs from the palm into the finger. This band is called a . As the cord matures, it shortens, and the finger it lies under is gradually pulled into a bent position. The most commonly affected fingers are the ring finger and the little finger; the thumb and index finger are affected less often.
Dupuytren's disease is not the same thing as a Dupuytren's contracture. Many people with the disease have nodules that do not progress and never produce a contracture. Treatment is offered when the contracture starts to limit the function of your hand — not because the nodule is there.

What causes it

Dupuytren's disease has a strong genetic component. Studies in Danish twins suggest the condition is approximately 80 per cent heritable.1 Other factors that contribute include older age, male sex, alcohol intake, smoking, and diabetes. The role of manual work and vibration exposure is contested — some occupational-medicine studies show a modest association, and others do not.
A common question is whether something you did caused it. The honest answer is almost always no: Dupuytren's disease is, in most patients, an inherited tendency that expresses itself with age. It is not caused by an injury, and it is not contagious or related to overuse.
People sometimes have a stronger or more aggressive version of the disease — what is called a strong . The features of strong diathesis include onset before age fifty, the disease in both hands, family history, and similar fibrous-tissue conditions in the soles of the feet () or, in men, the penis (). Strong diathesis means the disease is more likely to come back after treatment. It does not change whether you should be treated, but it can change how.

How common is it

In Northern European populations, around eight in every hundred adults have at least mild Dupuytren's disease, rising sharply with age.23 It is more common in men than in women, particularly before age 65. In New Zealand it is one of the more common conditions seen in adult hand surgery practice.

How it is diagnosed

The diagnosis is clinical — that is, your surgeon makes it from the history and the examination, with no imaging or blood test required in the typical case. The sequence is:
  • the history: when you first noticed it, how it has changed, whether anyone in your family has had it, what activities it interferes with;
  • inspection: the surgeon looks at the palm for nodules, the cords, any pitting or dimpling of the skin, and any knuckle pads on the back of the fingers;
  • palpation: the surgeon feels for the cord and traces its extent into the finger;
  • the — you place your hand flat on a level surface and try to lay the palm and fingers flat; the test is positive if you cannot;
  • measurement of the bend at each affected finger joint with a small protractor (a goniometer).
Imaging — ultrasound or MRI — is occasionally needed when the diagnosis is uncertain. In the typical case it is not.

When to consider treatment

The conventional rule is that surgery is offered when:
  • the is positive, and
  • the contracture is interfering with what you want to do with your hand.
A positive tabletop test on its own is not enough. Many patients live for years with mild contractures that do not bother them; there is no benefit, and some risk, to operating on a finger that is not causing trouble. The threshold for considering treatment is function, not appearance: typical thresholds are difficulty washing your face without poking yourself, putting your hand into a pocket, gripping the steering wheel of a car, or doing the work your job requires.
Pain is uncommon in Dupuytren's. If your hand is painful, the explanation is more likely to be something else — most commonly an inflamed flexor tendon (trigger finger) or a thumb-base arthritis — and it is worth saying so at the consultation.

How the disease behaves over time

Dupuytren's is slow. Most patients describe a gradual worsening over years, with occasional periods of relative stability. There is no reliable medical treatment that prevents progression: the things that have been tried — including a long list of injections, ultrasound, and physical therapy — do not change the natural history.
Steroid injection (triamcinolone) into a tender nodule may soften the nodule and reduce its tenderness, but it does not prevent the nodule from later forming a cord, and it is not used routinely. Radiation therapy in early disease has a small body of supporting evidence in the German-speaking literature, but it is not part of standard New Zealand practice.

Treatment options when surgery is needed

There are two principal operative options. A third option — collagenase clostridium histolyticum injection, marketed as Xiaflex — was withdrawn from New Zealand in 2019 and from Europe in 202045 and is no longer available in either market. Trial data shows it is not superior to needle fasciotomy at two- and five-year follow-up.67
The two contemporary options are:

Percutaneous needle fasciotomy

Percutaneous needle fasciotomy is a small, office-based procedure to weaken the tight cord by passing a fine needle through the skin several times along the length of the cord. There is no cut and no stitches. The needle holes seal themselves within a day. Most patients are back to normal activities within a few days.
The trade-off is that the cord can come back over time. In one randomised trial, around 85 per cent of patients had measurable recurrence within five years.8 The procedure can be repeated when this happens, and many patients prefer this — a small intervention with a fast recovery, repeated as needed — to a single larger operation. It works best when the cord is in the palm and the bend is at the base of the finger; it is less suitable when the bend is at the middle joint of the finger, when the cord runs in a spiral pattern, or when there has been previous surgery in the same area.

Limited fasciectomy

Limited fasciectomy is the open operation to remove the diseased cord through a zigzag or longitudinal cut, with stitches to close the skin afterwards. It is performed in the operating theatre under regional anaesthesia (an injection that numbs the whole arm) with a tourniquet on the upper arm so the surgeon can see the small nerves and vessels clearly during the dissection.
Limited fasciectomy is more durable than needle fasciotomy: in the same randomised trial, around 21 per cent of patients had recurrence within five years.8 The trade-off is a longer recovery — typically two weeks to return to office work and six to twelve weeks to return to heavier activity — and a higher rate of complications including digital nerve injury, slow wound healing, and stiffness. A patient-reported audit of more than a thousand fasciectomy patients in the United Kingdom found that around three quarters achieved a full or near-full straightening, around one in seven had some recurrence within two years, and around half reported at least one complication along the way.9
You will be seen by a hand therapist after the operation, usually within the first one to two weeks, who will guide your exercises, manage swelling, and help plan your return to work.

Choosing between them

Neither operation is universally better. The choice belongs with you within an honest conversation with your surgeon. The factors that point one way or the other:
  • if you value rapid recovery and accept that the cord may come back, needle fasciotomy is the better fit;
  • if you value durability and accept a longer recovery and higher complication rate, limited fasciectomy is the better fit;
  • if your contracture is mostly at the middle joint of the finger, or if the cord is in a spiral pattern, or if you have had previous surgery in the same finger, limited fasciectomy is usually the safer choice;
  • if you have a strong family history and the disease is aggressive, your surgeon may discuss a slightly larger operation called dermofasciectomy with a skin graft, which has the lowest recurrence rate of all but the longest recovery.
These are not absolute rules. A clear preference on your part — for low-morbidity, rapid recovery, repeatable interventions, or for durability and one-stage correction — is a legitimate driver of the choice, and your surgeon should respect it.

What to expect realistically

Two specific points about realistic expectations:
The base of the finger straightens better than the middle joint. The joint at the base of the finger (the knuckle) usually straightens fully or near-fully after either treatment. The middle joint of the finger is much more variable — particularly when the contracture there is severe and longstanding. If you go in with a finger bent 90 degrees at the middle joint, do not expect to come out with it perfectly straight. Your surgeon will discuss the realistic gain at each joint with you before the procedure.
Recurrence is the rule, not the exception. Dupuytren's disease is a lifetime tendency, not a single problem to be cured. Whatever operation you have, there is a meaningful chance of new disease developing — sometimes in the same finger, sometimes in a different finger, sometimes in the other hand. This is not a failure of your operation; it is the natural history of the condition. Most patients who develop a recurrence can be treated again successfully, and the choice of treatment for a recurrence is a fresh conversation that you will have with your surgeon at the time.

When to seek attention

Make an appointment with your GP or with a hand surgeon if:
  • you can feel a firm lump or a thickened band in your palm, particularly if it is changing or if it sits in line with one of your fingers;
  • you cannot lay your palm flat against a table top;
  • you are starting to find that the bend in the finger is interfering with what you want to do with your hand;
  • you have had treatment for Dupuytren's before and the cord is coming back, or a new finger is becoming affected.
You do not need to wait until the contracture is severe before seeing a surgeon. An early consultation lets you understand what you have, plan around it, and choose your moment for treatment when the timing is right for your work and your life.
After surgery, contact the practice if the hand becomes swollen, red, or hot in the days after the operation; if a finger becomes numb or starts to feel cold; if the dressing becomes wet or comes loose; or if pain is not controlled by simple painkillers.
This page is general information, not personal medical advice. Individual circumstances vary, and the decisions described here should be made in consultation with your own surgeon. Last clinically reviewed 5 May 2026.