Changes in the palmar fascia
Dupuytren’s disease affects the fascia, a layer of tissue under the skin of the palm. Firm nodules can form within this tissue. A cord may develop and pull a finger toward the palm, producing a contracture. The tendons that move the finger are separate structures beneath the involved fascia.
A lump in the palm does not automatically require a procedure. The ability to straighten the finger, the pattern of progression, and the effect on hand use guide the decision. A family history can be relevant. Tell the clinician when you first noticed a nodule and whether the finger position has changed since then.
Finger position and hand function
A finger that stays bent can interfere with putting a hand in a pocket or glove. Washing the face, shaking hands, or placing the palm on a surface can also become difficult. Skin pits or a firm band under the skin may accompany the change in position. Discomfort can occur around a nodule.
The tabletop test can help describe loss of extension. Place the hand gently on a flat surface and observe whether the palm and fingers can lie flat without force. This observation is useful to discuss at an appointment. It does not measure every affected joint or determine which treatment is appropriate. A formal examination establishes the pattern of contracture.
Assessment of the cords and joints
The clinician measures finger extension and examines the cords, skin, and joints. The assessment distinguishes restriction from the fascia from stiffness within a joint. Feeling and circulation are checked because nerves and vessels travel near the tissues considered for treatment. Previous surgery or injections can change the anatomy and influence the next step.
Photographs taken with the hand in a consistent position can help document a change over time. Bring details of earlier treatment, including the finger treated and the result. Discuss the specific activity that has become difficult. Observation may be appropriate when hand function remains satisfactory, with reassessment if finger position or daily use changes.
Needle and injection procedures
A needle procedure can divide a selected cord through small skin openings. Suitability depends on cord position, skin condition, and the nearby nerves and tendons. An enzyme injection followed by a controlled finger-straightening procedure is another option in selected cases. Availability and clinical suitability should be discussed with the treating surgeon.
These procedures address the contracture, and the underlying disease can remain active. A cord may recur or a new area may become involved. Risks include skin tears, swelling, bruising, nerve injury, and tendon injury. Ask which joint is expected to gain motion and how much residual stiffness could remain. Treatment selection should account for your priorities and previous care.
Surgery to remove affected tissue
Surgery can remove diseased fascia and release the tissue restricting finger extension. The extent of surgery depends on the cord pattern, skin involvement, and prior treatment. A skin graft may be considered when the skin is involved or additional coverage is needed. The surgeon protects the nerves and blood vessels during the release.
Recovery requires attention to wound healing and finger motion. Risks include infection, wound problems, stiffness, altered sensation, and persistent or recurrent contracture. A finger with an established joint contracture may retain some loss of extension after the cord is treated. Discuss the likely functional benefit and the rehabilitation required before deciding on an operation.
Hand therapy and monitoring
Hand therapy can support wound care, swelling control, and a prescribed movement program after treatment. A splint may be used according to the procedure and the finger's position. Follow the individualized schedule because aggressive stretching can irritate healing tissues. Comfortable motion and safe hand use remain the practical goals.
Ongoing monitoring matters because Dupuytren’s disease can change after treatment. Contact the treating team for increasing redness, drainage, new numbness, or a finger that becomes cold or discolored after a procedure. For gradual changes, record which daily tasks are affected and arrange reassessment. A treatment plan should include how to recognize recurrence and when to discuss another intervention.
The position of each affected joint matters when planning treatment. Ask the surgeon to explain which part of the restriction comes from a cord and which comes from joint stiffness.
Further reading: ASSH: Dupuytren’s disease