Dupuytren's Contracture

Symptoms and Signs

  • Common
  • Usually arises in middle age or later
  • More common in men than women.
  • May be genetic, or associated with diabetes, smoking, alcohol or previous trauma
  • Characterised by lumps, pits, cords and nodules in palmar/fingers
  • Finger flexion contracture develops over months/years
  • Nodules over back of the PIP joints (Garrod's pads)
  • Not usually painful
  • No cure

For information if patients ask about treatments:
  • Steroid injections: These may help with local tenderness, but have no significant effect on the disease and are therefore not recommended. 
  • Xiapex(Collagenase) injection: This drug has now been withdrawn from the market for treatment of Dupuytren's.
  • Radiotherapy: Radiotherapy is an experimental treatment offered in some research centres. It is NOT available on the NHS on Scotland. 

Initial Management

Advice and information:
  • Palmar nodule only: no active treatment required
  • NO role for MSK Physiotherapy

Useful Resources

Who to Refer

People wishing to consider surgery with:
  • Contracture or significantly reduced handed function. Those who cannot put hand flat on a table. 
  • If fixed contracture 15° at PIP joint, or 15-30 ° MCP joint refer for opinion on surgery

Who not to refer

  • Tendon thickening/nodules only 
  • Not affecting hand function (able to place hand flat on table)

How to Refer

  • SCI Gateway/Hand Surgery. Patient may be appointed to Advanced Practitioner initially.
  • Please include photograph showing contracture.