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1 · SNAPSHOT

Dupuytren's Contracture body chart — Illustrative, not diagnostic. Canva body chart for Dupuytren's Contracture.

The diagnosis is easy, and the useful skill is knowing what you can and can't change.

Illness script in one line: painless thickening in the palm that becomes a firm cord, usually to the ring or little finger, slowly pulling the finger into flexion over years — often bilateral, often familial, and noticed because the hand no longer goes flat.

Caseload frequency: common as a background finding, less common as a referral in its own right. Read further: modifiable risk factors [1], smoking [2].

It's not a stretching problem — and that's the most useful thing on this page

This is a fibrotic disease of the palmar fascia driven by myofibroblasts, not a tight structure that has shortened through disuse. Read further: pathogenic mechanisms of palmar fascia fibrosis [3], myofibroblasts as a treatment target [4].

"Avoid aggressive passive stretch in established contracture" is right, and the biology is the reason why.

So what does a physiotherapist actually contribute?

What students expect to do	What actually helps
Stretch it out	Nothing verified. No trial of stretching or splinting altering the natural history is in our library
Fix it conservatively	You can't. It's a progressive fibrotic disease
Discharge, because there's nothing to do	Also wrong — and this is the mistake
—	Measure it properly, so progression is documented rather than guessed
—	Time the referral, using function rather than a degree threshold alone
—	Do the post-intervention rehab well, which is where the physiotherapy evidence actually sits

That is a real job, and it is more useful than a home stretching programme that changes nothing.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Main problem

"My finger won't straighten," or "I can't put my hand flat." Gradual onset thickening or nodules in palmar fascia; finger(s) (usually 4th/5th) progressively flex at MCP/PIP joints.

The presenting complaint is almost always functional, not painful. Can't put the hand flat in a pocket, can't wash their face, can't put on a glove, catches the finger reaching into a bag.

Body chart

Palm, usually the ulnar side, over the ring and little rays. Management of Dupuytren disease of the little finger has been described separately [5], which tells you something about how often that ray is the difficult one.

Ask them to point to where they first noticed it, and whether the other hand does anything similar. Often bilateral or recurrent.

Behaviour

Painless initially, then tightening or grip interference.

Painless is the word that matters diagnostically. A painful, rapidly changing lump in the palm is a different conversation — see section 4.

Aggs: nothing mechanical, which is itself informative. Function fails progressively rather than symptoms flaring.
Eases: nothing. It doesn't have good days and bad days.

History

Years, not weeks. Slowly progressive, with plateaus. Read further: progression after surgery versus needle fasciotomy [6].

Ask for a timeline in function, not in degrees: when did you last put your hand flat on a table? When did buttons get hard? When did you stop being able to get it in your pocket? That gives you a rate of change, which is the thing that decides urgency.

Special / screening questions

Common in males >50 yrs; familial or diabetic link.

Family history. Ask specifically about a parent or sibling with the same hands.
Diabetes. Ask.
Smoking and alcohol. Worth raising once, without turning the consultation into a lecture. Read further: modifiable risk factors (Kang et al. 2024), smoking (Chai et al. 2026).
Occupation and hobbies. Not to blame them — to understand what the hand has to do.
Both hands, and the feet. Nodules on the soles or elsewhere suggest a more aggressive pattern and are worth naming in a referral letter.

Assessing this region? Download the Wrist & Hand assessment template →

3 · HYPOTHESIS RANKING

Pattern	The one discriminating feature
Dupuytren's contracture	A palpable cord or nodule in the palm, painless, with skin puckering or tethering, and a fixed flexion the patient cannot passively correct.
Trigger finger (stenosing flexor tenosynovitis)	It catches and releases rather than staying bent, the nodule is over the A1 pulley and moves with the tendon, and it's often painful. A locked trigger finger looks similar for about ten seconds.
Fixed joint contracture (PIP capsular)	No cord. Post-traumatic, post-immobilisation, or inflammatory. If there's nothing to feel in the palm, it isn't this.
Flexor tendon adhesion or injury	Active extension lost but passive extension available — the opposite of a cord, which blocks both.
Soft-tissue mass	Painful, rapidly enlarging, or with abnormal sensation. Rare, and the reason section 4 exists.
Ulnar neuropathy with clawing	Sensory changes and intrinsic wasting, no cord, and the deformity is postural rather than fixed.

The discriminator that does most of the work: can you feel a cord, and does the finger stay bent when they relax.

4 · RED FLAGS — DON'T MISS THIS

Free forever. Never gated.

Dupuytren's itself is not dangerous. Three things on this page are.

1. It isn't Dupuytren's

Expected OE: normal neurovascular exam. That finding is doing red-flag work and deserves to be read as one.

Question the diagnosis if there is:

Pain. Early Dupuytren's is painless. A painful palmar lump is a different problem.
Rapid enlargement. Dupuytren's takes years.
No palpable cord or nodule with a fixed flexion deformity — that's a joint or tendon problem.
Any sensory change or vascular compromise. Not part of this.
A young patient whose 'Dupuytren's' keeps recurring. Epithelioid sarcoma has mimicked it, clinically and on first histology — case-report level, but it's why age and recurrence go in the referral (Papas et al. 2025) [21].

Action: don't treat it as Dupuytren's, and don't reassure. Refer for a medical opinion and say what you're not sure about.

2. A new sensory deficit after intervention

This is the one a physiotherapist is genuinely positioned to catch, because you are the person seeing them in the weeks after the procedure.

Digital nerve injury is a recognised complication of intervention for this condition. The frequency and reporting of complications after Dupuytren contracture interventions has been systematically reviewed and meta-analysed [7]. That the reporting is inconsistent is itself the finding.

What to do: test sensation on both sides of every operated digit at the first post-operative session and write it down. A new or asymmetrical deficit goes back to the surgeon, not into a rehab plan.

Also watch for: disproportionate pain, swelling, stiffness and vasomotor change out of keeping with the procedure. That combination needs escalating, not persevering with.

3. Skin problems over a cord

Skin puckering or tethering possible. Puckering is expected. Skin breakdown, ulceration or a wound that isn't healing over a cord — particularly after a needle procedure — is not, and needs review.

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Guideline anchor

No Australian guideline for this presentation; anchored to the Dutch multidisciplinary guideline (Kemler et al. 2023).

It makes treatment recommendations in eight modules: needle techniques, radiotherapy, primary conservative therapy, surgery, lipofilling, operative arthrolysis, salvage techniques and the postoperative protocol (PMID 36974283). The treatment-comparison sources are a randomised controlled trial of progression comparing surgery and needle fasciotomy in Plastic and Reconstructive Surgery (Karjalainen et al. 2026, PMID 41334972), a systematic review comparing treatment approaches in JAAOS (Pistone et al. 2026, PMID 40811833), a meta-analysis of outcomes of limited fasciectomy, needle fasciotomy and collagenase injection in the Journal of Hand Surgery (European) (van den Berge et al. 2025, PMID 40391547) and a network meta-analysis of surgical management (Nann et al. 2024, PMID 37246411). The physiotherapy anchor is a systematic review of night orthosis after surgical correction in the Journal of Hand Surgery (Samargandi et al. 2017, PMID 28867249).

PubMed Source

The Dutch guideline is a national multidisciplinary treatment guideline (evidence searched to August 2020), not an Australian document and not a physiotherapy guideline; its primary conservative therapy and postoperative protocol modules sit closest to physiotherapy. The other sources are treatment comparisons between surgical and interventional options. The night orthosis review is the closest thing to a physiotherapy evidence anchor for this condition, and it is about the post-operative period only.

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Sources · 20

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Every source on this page resolves and title-verifies against PubMed. Newest first.

2024Kang et al. (2024). Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study. Plastic and reconstructive surgery, 153(2), 363e-372e. https://doi.org/10.1097/PRS.0000000000010774
2026Chai et al. (2026). Association between Smoking and Dupuytren Contracture: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery, 157(5), 867-874. https://doi.org/10.1097/PRS.0000000000012484
2025Pirri (2025). Palmar Fascia Fibrosis in Dupuytren's Disease: A Narrative Review of Pathogenic Mechanisms and Molecular Insights. International journal of molecular sciences, 27(1). https://doi.org/10.3390/ijms27010382
2023Ziegler et al. (2023). Targeting Myofibroblasts as a Treatment Modality for Dupuytren Disease. The Journal of hand surgery, 48(9), 914-922. https://doi.org/10.1016/j.jhsa.2023.06.007
2025Moscovici et al. (2025). Management of Dupuytren disease of the little finger. Journal of orthopaedic surgery and research, 20(1), 789. https://doi.org/10.1186/s13018-025-06176-2
2026Karjalainen et al. (2026). Progression of Dupuytren Contracture: A Randomized Controlled Trial Comparing Surgery, Needle Fasciotomy, and Collagenase Injection. Plastic and reconstructive surgery, 158(1), 101-112. https://doi.org/10.1097/PRS.0000000000012666
2025Raval et al. (2025). Frequency and Reporting of Complications after Dupuytren Contracture Interventions: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery, 155(1), 115-125. https://doi.org/10.1097/PRS.0000000000011440
2022Bradet-Levesque et al. (2022). Measuring functional outcome in Dupuytren's disease: A systematic review of patient-reported outcome measures. Journal of hand therapy : official journal of the American Society of Hand Therapists, 35(4), 613-627. https://doi.org/10.1016/j.jht.2021.04.010
2023van den Berge et al. (2023). Patient-Perceived Hand Function Can Predict Treatment for Dupuytren Disease. Plastic and reconstructive surgery, 152(5), 867e-875e. https://doi.org/10.1097/PRS.0000000000010515
2017Samargandi et al. (2017). Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review. The Journal of hand surgery, 42(10), 839.e1-839.e10. https://doi.org/10.1016/j.jhsa.2017.06.100
2026Mon et al. (2026). Effectiveness of splinting after percutaneous needle fasciotomy for Dupuytren's contracture. The Journal of hand surgery, European volume, 51(4), 509-511. https://doi.org/10.1177/17531934251350463
2026Pistone et al. (2026). Comparing Treatment Approaches for Dupuytren Contracture: Percutaneous Needle Fasciotomy With and Without Corticosteroids. The Journal of the American Academy of Orthopaedic Surgeons, 34(1), e87-e96. https://doi.org/10.5435/JAAOS-D-25-00526
2025van den Berge et al. (2025). Outcomes of limited fasciectomy, needle fasciotomy and collagenase injection for Dupuytren's disease: a systematic review and meta-analysis of individual patient data. The Journal of hand surgery, European volume, 50(7), 878-890. https://doi.org/10.1177/17531934251338349
2025Shaheen et al. (2025). Effectiveness and Safety of Dupuytren Contracture Treatments: A Systematic Review and Meta-Analysis Using the GRADE Approach. Plastic and reconstructive surgery, 156(3), 375e-384e. https://doi.org/10.1097/PRS.0000000000011816
2024Nann et al. (2024). Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses. Hand (New York, N.Y.), 19(8), 1283-1292. https://doi.org/10.1177/15589447231174175
2025Cevik et al. (2025). Collagenase clostridium histolyticum for Dupuytren's disease: a comprehensive systematic review and comparative analysis against percutaneous needle aponeurotomy and limited fasciectomy. Journal of plastic surgery and hand surgery, 60, 27-34. https://doi.org/10.2340/jphs.v60.42750
2026Nocek et al. (2026). Likelihood of Dupuytren Contracture Recurrence After Limited Fasciectomy, Needle Aponeurotomy or Collagenase Clostridium histolyticum: Systematic Review of Prospective Data With 2- to 7-Year Follow-up. Journal of hand surgery global online, 8(3), 100979. https://doi.org/10.1016/j.jhsg.2026.100979
2024Eckerdal et al. (2024). Bias in published randomized trials that compare collagenase injection with percutaneous needle fasciotomy in the treatment of Dupuytren disease: a systematic review. EFORT open reviews, 9(7), 625-631. https://doi.org/10.1530/EOR-23-0211
2024Gray et al. (2024). Industry Sponsorship Bias in Collagenase Clinical Trials for Dupuytren Disease: A Meta-analysis. Annals of plastic surgery, 92(4), 389-394. https://doi.org/10.1097/SAP.0000000000003831
2024Yazdani et al. (2024). The Effects of Shock Wave Therapy on the Symptoms and Function of Individuals With Dupuytren Disease: A Systematic Review. Archives of physical medicine and rehabilitation, 105(10), 1985-1992. https://doi.org/10.1016/j.apmr.2024.05.030

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