What is Dupuytren's contracture, and when does it need surgery?
In short
Dupuytren's contracture is a thickening of the tissue under the skin of the palm that forms a cord and pulls a finger toward the palm. Surgery is considered when the finger stops straightening rather than when it starts hurting, and the measurement of how far it falls short of straight is what drives the decision.
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What Dupuytren's contracture is
Put your other hand on your palm and press. Underneath that skin is a tough sheet of tissue, or what we call the palmar fascia, that runs from the middle of the palm out toward the fingertips and lies over the tendons, the nerves and the blood vessels.1 In Dupuytren's disease that sheet thickens, first into a lump you can feel, and then into a cord that runs forward into a finger. The cord shortens, and the finger is drawn down.
The word contracture is the description of the result. The finger is held bent and will not straighten all the way, though the hand still closes normally, which is why so many people notice this at a handshake or reaching into a pocket rather than at the gym.
The distinction people get wrong: pain is not the signal
The reflex is to treat a hand problem when it starts hurting. Dupuytren's does not work that way, and treating it by pain is how a finger gets left too long.
The lumps are usually painless from the start, and where there is tenderness early on it commonly settles by itself.12 Meanwhile the thing that matters, loss of straightening, is often painless the whole way through. The test is not how it feels. It is whether the finger still goes flat.
Lay your hand palm down on a table. If the palm and every finger make contact with the surface, you have full extension. If a finger will not reach the table, that is the finding worth an appointment.
When surgery is on the table
The two joints that get drawn in are the knuckle, where the finger meets the hand, and the middle joint of the finger. They behave differently, and the difference sets the threshold.
| Joint | What Dr. Knight says triggers surgery |
|---|---|
| The knuckle, where the finger meets the hand | About thirty degrees of bend from straight.2 |
| The middle joint of the finger | Any loss of straightening at all, because that joint is the harder one to get back.2 |
The reason those two thresholds differ is not arbitrary. Contractures of the middle joint are harder to treat and less likely to recover fully after treatment than contractures at the knuckle.1 Waiting costs more at the middle joint than it does at the knuckle.
Before an operation is discussed, Dr. Knight names two treatments commonly done in an office setting: an enzyme injection, and a needle release through the skin.2 Which one suits a hand depends on where the cord sits and which joint it is pulling, and that is decided in the room.
Where surgery is the answer, the operation removes the thickened fascia through a zigzag incision rather than a straight one, for a reason he explains below.
When to call us
- A finger that will not lie flat when your hand is on a table.
- A cord you can feel running from your palm into a finger.
- A lump in your palm that is thickening or reaching forward toward a finger.
- Any loss of straightening at the middle joint of a finger, however small.
- A finger that catches on your pocket, a glove or a handshake.
- Numbness or colour change in a finger, which is a different problem and wants looking at sooner.
What else do patients ask about this?
Does Dupuytren's contracture go away on its own?
No. It can sit still for years and never become troublesome, and for some people it never goes beyond lumps in the palm. What it does not do is reverse.
Will a splint stop it getting worse?
Splinting is not known to prevent a finger contracture from progressing. It has a role after surgery, to protect the site while it heals.
Which fingers does it affect?
The ring and little fingers most often, though any finger and the thumb can be involved.
Is a cord in the palm the same as a tendon?
No. The cords can look like tendons under the skin, but the tendons themselves are not involved in Dupuytren's.
Sources
- OrthoInfo, American Academy of Orthopaedic Surgeons. Dupuytren's Disease Read 2026-09-04.
- Dr. John T. Knight, The Hand and Wrist Institute video library, 2014. Dupuytren's Surgery Read 2026-09-04.