Dupuytren's typically presents with some of the following:

• skin thickening or pitting in the palm
• firm nodules that can be tender and inflamed in the early stages
• fibrous, tendon-like cords
• contractures of the cords:
  • flexion deformity at the metacarpophalangeal / interphalangeal joints
  • confirmed if the person is unable to lay their hand flat on a table top
• one or both hands may be affected
• the ring finger is most commonly affected, followed by little and middle fingers
• the thumb and index fingers are usually spared
• family history often positive

Clinical diagnosis

Differentials include:

Callus, ganglion cyst, giant cell tumour, inclusion cyst, ulnar nerve palsy, trigger finger, post trauma/infection, joint disease, diabetic cheiroarthropathy, camptodactyly, Volkmann’s contracture, epithelioid sarcoma (rare)

Treatment is not commissioned in cases where there is no contracture, and in patients with mild (less than 20°) contractures, or one which is not progressing and does not impair function

For these patients:

• provide explanation of the condition and advice; this can be a progressive, but benign disease, with finger contractures developing later
• no treatment is necessary whilst there are no contractures
• advise the person to return when they cannot flatten their outstretched hand

Dupuytren’s disease begins with nodules in the palm, which are sometimes tender. Reassure patients that tender nodules are likely to become less tender over time.

Painful nodules in the absence of contracture may be referred for assessment if there is diagnostic uncertainty.

Consider injecting intolerably painful nodules with steroid. If steroid injection is not available in primary care, consider referral to Orthopaedics.

Referral criteria

Treatment is not commissioned in cases where there is no contracture, and in patients with mild (less than 20°) contractures, or one which is not progressing and does not impair function.

Reassure patients that tender nodules are likely to become less tender over time.

Painful nodules in the absence of contracture may be referred if there is diagnostic uncertainty.

Consider injecting intolerably painful nodules with steroid. If steroid injection is not available in primary care, consider referral to Orthopaedics.

Refer to Hand Clinic

Surgical intervention (needle fasciotomy, fasciectomy and dermofasciectomy) is commissioned for:

• a) Finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint

or

• b) Severe thumb contractures which interfere with function

(For further information see link to the NHS Devon Dupuytren's Contracture Treatment commissioning policy)

Referral Instructions

Refer to the Hand Clinic (Orthopaedics)

Please refer using the e-Referral Service

• Specialty: Orthopaedics
• Clinic Type: Hand and Wrist
• Service: DRSS-E-Hand & Wrist (not for patient attendance)-Devon ICB-15N

Referral Form

DRSS Referral Form

GP Information

NHS Devon Dupuytren's Contracture Treatment commissioning policy

2023-12-11_Hand-surgery_Pathway_Dupuytrens.drawio.pdf (gettingitrightfirsttime.co.uk)

Patient Information

MyHealth patient information -Dupuytren's

Dupuytren's Contracture patient information

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: March 2017

Updated: May 2025