Symptoms
Most people describe:
- A firm lump in the palm, most often in line with the ring or little finger. It can be tender early on and usually stops being tender as it matures
- Puckering, dimpling or a small pit in the skin of the palm over the lump
- A cord that can be felt, and often seen, running from the palm into a finger
- A finger that will not straighten fully, often first noticed putting a hand in a pocket, washing your face, or shaking hands
- Difficulty laying the hand flat on a table
- Catching the finger on things, and in longstanding cases difficulty keeping the palm and the finger crease clean
Dupuytren’s is not usually a painful condition. Where there is pain it is generally early, in the nodule itself, and it settles.
The table top test
Put your hand flat, palm down, on a table. If it lies completely flat there is no significant contracture and no urgency. If the fingers will not go down and there is a gap under the hand, treatment is worth discussing.
This is the standard test for judging when an operation is worthwhile, and it is worth repeating at home every few months. What matters is less how bent the finger is on any one day than whether it is changing.
Which joint is affected matters
A contracture at the knuckle joint, where the finger meets the palm, corrects reliably even when it is severe, because that joint tolerates being held bent for a long time without stiffening.
A contracture at the middle joint of the finger is a harder problem. That joint stiffens, and the structures around it shorten and adapt to the bent position, so a longstanding contracture there may not fully correct even after well performed surgery. This is the strongest single reason not to leave a finger joint bent for years before doing anything about it.
Causes and risk factors
Dupuytren’s is largely determined by genetics. Contributing factors include:
- Family history. By far the strongest factor. It runs in families and is much more common in people of northern European descent, which is where the old name Viking disease comes from. Where a parent or sibling is affected, expect an earlier onset and a more determined course.
- Age and sex. More common in men, and men tend to develop it earlier and more severely. Onset is usually after the age of fifty.
- Diabetes. Clearly associated, although the contractures tend to be milder and to involve the middle and ring fingers.
- Epilepsy and some anticonvulsant medication.
Manual work does not cause Dupuytren’s disease, and neither does a single injury, although an injury or an operation on the hand can bring existing disease to notice or make it progress faster.
A more aggressive pattern
Some people have what is called a Dupuytren’s diathesis: onset before the age of fifty, a strong family history, both hands affected, involvement of the thumb or index finger, firm patches over the knuckles, and similar tissue in the soles of the feet.
That pattern predicts earlier and more frequent recurrence after any treatment. It is not a reason to avoid treatment. It is a reason to set expectations, timing and technique accordingly, and we will tell you where you sit.
How it is diagnosed
Dupuytren’s is diagnosed by examination. The feel of the nodule and the cord, the puckering of the skin and the pattern of the contracture are characteristic, and no scan or blood test is needed to make the diagnosis.
At the consultation we measure the contracture at each joint, record the table top test, check the sensation and circulation of the finger, and look for the features above. Those measurements become the baseline against which any progression, and the result of any surgery, is judged.
Ultrasound and MRI have no routine role. A lump in the palm that is painful, growing quickly, or not in the usual position is a different problem and worth having looked at.
Non-surgical treatment
What does not work
Splinting does not prevent a contracture and does not straighten one that has already formed. Stretching a cord does not lengthen it. Massage, ultrasound and vitamin E have all been tried and none of them changes the course of the disease. If you have been offered one of these as a treatment for a contracture, it is not.
Corticosteroid injection
Where a nodule in the palm is painful, and there is no contracture to correct, a cortisone injection is a reasonable option and can settle the pain. It treats the symptom. It does not stop the disease progressing and it will not straighten a finger.
Collagenase
Collagenase, the enzyme injection used to dissolve the cord without an operation, is no longer available in Australia. It was withdrawn commercially rather than for any safety reason, and there is currently no enzyme option in this country.
Radiotherapy
Radiotherapy is used in some centres for early nodular disease before any contracture has formed. It is not something we would offer as a matter of course, and it is worth discussing at your consultation if it is something you have read about.
Surgery
No operation cures Dupuytren’s disease. Surgery straightens the finger, and the disease can return. The decision is about when the loss of function justifies an operation and a recovery period, not about eradicating the condition.
Nodules on their own, in a hand that still lies flat, are generally left alone. Surgery is worth considering when the hand no longer goes flat on a table, when the contracture is getting worse, or when the bent finger is genuinely getting in the way.
Selective fasciectomy
Selective fasciectomy is the operation we use. The diseased tissue is removed rather than simply divided, which is why the correction lasts.
An incision is made over the cord. The diseased fascia is dissected out from around the nerves and tendons and removed, and the finger is straightened. Where the joint itself has tightened, a joint release may be needed to gain the last of the correction. The skin is closed in a zig-zag fashion, using Z-plasties, which lengthens the scar line so that it does not tighten again as it heals. Occasionally a small skin graft is needed to close the wound.
It is a day surgery procedure, under a general anaesthetic with a local anaesthetic for pain relief afterwards, and takes about 20 to 45 minutes per finger. A tape bandage covers the wound under a soft hand dressing or a plaster splint.
For advanced contractures we ask you to take vitamin C, 1000 mg a day, from one week before surgery until six weeks afterwards.
Needle fasciotomy, in which the cord is divided with a needle rather than removed, is an option in selected cases. We are happy to go through the options and our reasoning with you at your consultation.
A short recovery
The dressing is small. The soft dressing comes off on day 4 or 5, leaving only a tape bandage on the skin, and most people are back to driving and office work at that point. The wounds are usually healed at two to three weeks. Light manual work generally follows at two to four weeks and heavy work at four to six weeks.
Recovery, week by week
Indicative, and it varies. Your own timeline will depend on how many fingers were treated and how much dissection was needed.
Timeframe
What to expect
The correction gained in theatre is not the same thing as the correction you keep. Much of the difference between those two is made in the weeks afterwards, through the exercises, looking after the scar, and the night splint where one is needed.
Day of surgery
Some or all your fingers may feel numb or tingly for 6-36 hours due to the local anaesthetic. You can start to move and use your thumb and fingers not covered by the dressing for light duties before you leave the hospital.
Days 1 to 5
Keep the dressing clean and dry. On day 4 or 5 you can take the soft dressing off, leaving the tape bandage on the skin intact. Where a night splint is needed, a hand therapist fits a custom made removable one and starts you on exercises.
Days 4 to 5
Most people are back to driving and to office and light work at this point, once the soft dressing is off and you can grip the wheel comfortably.
Days 5 to 14
The tape bandage can get wet in the shower or when you wash your hand. Dab it dry afterwards. If it separates, use new tape or a bandaid to protect the sutures. Use the hand as tolerated and avoid heavy duties.
Two weeks
Your progress is reviewed by the doctor, hand therapist or practice nurse, and the skin sutures are removed at this visit. The skin edges will be dry and peeling, with some scabs and raw areas, which is normal. If needed, a new tape bandage goes on for another three to five days.
Two to four weeks
The wounds have usually healed by two to three weeks and normal hand use can start shortly afterwards. Light manual work is generally manageable through this period. It is common for the area around the scar to stay tender or swollen for two, and sometimes six, weeks after surgery. Moisturising and gentle massage of the palm help.
Four to six weeks
Return to heavy work. A further follow up appointment if one is needed to monitor your progress. Most everyday activity is unrestricted by this point.
Beyond six weeks
Where a night splint was fitted, it is sometimes worn for longer than six weeks. The scar continues to soften over several months.
Hand therapy
Hand therapy matters more after Dupuytren’s surgery than after most hand operations, because the result depends on holding the correction while the wound heals. Our therapists work on the scar, give you the exercises that keep the finger moving without losing what was gained, and fit and adjust a night splint where one is needed. Having therapy on site means this starts the same week rather than after another referral and another wait.
Risks and complications
Surgery for Dupuytren’s contracture is routine and safe, and complications are uncommon. When they occur they can include:
- Incomplete correction. The finger may not straighten completely, particularly where the middle joint has been bent for a long time.
- Wound healing problems or infection. Usually superficial and treated with antibiotics.
- Bleeding or bruising. Usually minor and settles on its own.
- Nerve injury. The small nerves to the finger can be wound tightly around a cord and displaced from their normal position, which is a large part of why the dissection is painstaking and why the operation takes the time it does. Injury is uncommon and causes numbness along one side of the finger.
- Stiffness. More likely after a bigger dissection, and the main reason therapy starts early.
- Ongoing tenderness around the scar, or slower than expected recovery.
- Recurrence, or new disease elsewhere in the hand.
Recurrence
Dupuytren’s disease is not removed by removing a cord. Surgery removes the diseased tissue that is there now. The underlying tendency remains, so cords can come back in the same finger or appear in a finger that was previously clear.
After a selective fasciectomy, about 80% of people are still free of recurrence in the operated finger five years later. Recurrence is more likely in younger patients, in those with the more aggressive pattern described above, and in the little finger, which is both the hardest finger to correct and the most prone to bending again.
A recurrence is not a failure of the first operation and it can be treated, although revision surgery is more demanding than the first procedure because of the scarring. This is worth understanding before the first operation rather than after it.
When to be seen sooner
Contact us, or see your GP, if you have:
- A hand that no longer lies flat on a table
- A contracture that is clearly worse over a few months rather than a few years
- The middle joint of a finger starting to bend, not just the knuckle
- Numbness, colour change or coldness in the finger
- A lump in the palm that is painful, growing quickly, or in an unusual position
- Skin breaking down or becoming difficult to keep clean in the crease of a bent finger
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Is Dupuytren’s disease a cancer?
No. It is a benign thickening of the fibrous tissue in the palm. It does not spread anywhere else in the body and it is not dangerous. It is a problem of hand function, not of health.
Will it get worse, and how fast?
It is genuinely unpredictable. It can progress over months, or stay unchanged for years and never need anything done. A lump in the palm on its own, with a hand that still goes flat on a table, needs no treatment at all. Use the table top test every few months. If the hand stops lying flat, or a finger is clearly more bent than it was, that is the point to be seen.
How long does the operation take, and will I be asleep?
About 20 to 45 minutes per finger. It is a day surgery procedure under a general anaesthetic, with a local anaesthetic given at the same time for pain relief afterwards, and you go home the same day.
How long will I have a bandage on?
The soft hand dressing comes off on day 4 or 5. Underneath it there is only a tape bandage on the skin, which can get wet in the shower from day 5 and stays until your two week review. If a new tape bandage is needed after the sutures come out, it goes on for another three to five days.
When can I drive?
Most people are driving again four to five days after surgery, once the soft dressing is off and you can grip the wheel and perform an emergency stop without hesitating. There is no legislation covering surgery and driving, so the test is whether you can control the car safely. Be aware that some insurers will not cover damage or liability if you have had recent surgery, were wearing a splint or cast while driving, or were taking pain medication that could affect your driving, so it is worth contacting your insurer first.
When can I go back to work?
Office and light work, usually four to five days. Light manual work, two to four weeks. Heavy work involving gripping, vibration or load through the palm, four to six weeks. We will give you a realistic estimate for your specific job before the operation, and a certificate.
Will my finger be completely straight afterwards?
Usually, where the contracture is at the knuckle joint. Where the middle joint of the finger has been bent for a long time, full correction is not always achievable, because that joint and the structures around it have adapted to the bent position. We will tell you before the operation which of those two situations you are in, and what a realistic result looks like for your hand.
Will it come back?
It can. Surgery removes the diseased tissue that is present, but not the tendency to form it. After a selective fasciectomy, about 80% of people are still free of recurrence in the operated finger five years later. Recurrence is more likely in younger patients, in those with a strong family history, and in the little finger. If it does come back it can be treated again.
Do you offer needle fasciotomy?
Selective fasciectomy is the operation we use. Needle fasciotomy is an option in selected cases, and we are happy to discuss the options with you at your consultation.
Why vitamin C?
For advanced contractures we ask you to take 1000 mg a day, from one week before surgery until six weeks afterwards. It is a simple, low risk measure aimed at supporting wound healing and reducing the swelling and stiffness that can follow a larger dissection.
Can more than one finger be done at once?
Yes. Where more than one finger on the same hand is affected, they are treated in the same procedure. We would not usually operate on both hands at the same time, because you need one working hand through the first week or two.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund’s contribution before anything is booked.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 1 September 2026