Dupuytren's disease: Should I have hand surgery?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to relieve symptoms of Dupuytren's disease.
Try other treatments instead, such as finger exercises, physical therapy, or steroid shots.

Key points to remember

Surgery can improve, but may not completely restore, the use of your hands.
Dupuytren's disease comes back after surgery nearly half the time. You may need another surgery to keep the use of your hands.
If you are able to move your fingers and do daily activities, you might benefit from other treatments first, such as finger exercises, physical therapy, or steroid shots.
Delaying surgery until your condition is severe—for example, waiting until you are unable to use your hands to do daily activities—could make the surgery and your recovery harder.

FAQs

What is Dupuytren's disease?

Dupuytren's disease (say "doo-pwee-TRAHZ") is an abnormal thickening of tissue beneath the skin in the palm of the hand. The first symptom often is a small lump (nodule) in the palm, often near the base of the fingers. In some people, a fibrous cord may form in the palm tissue. The cord pulls the finger toward the palm. This is called Dupuytren's contracture .

If the disease gets worse, over time you may not be able to flatten your palm on a flat surface, such as a table. Severe forms of the disease can make everyday activities, such as picking up items, putting on gloves, or washing hands, difficult or impossible.

What kinds of surgery are done for Dupuytren's disease?

There are two types of surgery that can help you use your hand again:

Fasciectomyis the most common surgery. It involves removing the thick and fibrous tissue beneath the skin of the palm. If your palm skin is stuck to the fibrous tissue, the skin may be removed along with the tissue.
Fasciotomy is less common. The surgery involves using small cuts to divide the cords of fiber in the palm. It is only done in people who aren't likely to benefit from fasciectomy or whose disease has come back.¹

Delaying surgery until your condition is severe—for example, waiting until you are unable to use your hands to do daily activities—could make the surgery and your recovery harder.

What are other treatments for Dupuytren's disease?

In mild cases of the disease, regular stretching of the fingers may be enough to keep the use of your hand. Twice-daily sessions of massaging the hand and gently stretching your fingers back relieves tightness and helps keep your fingers flexible.
Physical therapy and range-of-motion exercises may help you keep the use of your hand.
Shots of lidocaine or steroid medicine or both may relieve symptoms for a while.
Splinting may provide some relief.

What are the risks from surgery for Dupuytren's disease?

Complications after surgery for Dupuytren's disease occur in about 1 out of 5 cases.² Problems can include:

Delayed wound healing. This is the most common problem, and it is often mild.
Infection of the wound.
Stiffness or contracture, with the fingers still being curled.
Nerve injury.
Loss of circulation in the fingers.
A mass of blood or blood clots under the skin (hematoma).
Damage to the skin, caused by trying to surgically separate the skin from the fibrous tissue.
Reflex sympathetic dystrophy.

Surgery can improve, but may not completely restore, the use of your hands. And it can't cure the disease.³ The disease comes back after surgery nearly half the time. Even after a successful surgery, you may need another surgery later to keep the use of your hands.

What follow-up treatment is needed after surgery?

Home treatment and physical therapy are important to the success of your surgery.

Exercises

A physical or occupational therapist can teach you how to do exercises to gently move your fingers through their normal range of motion. These exercises help prevent stiff joints. Range-of-motion exercises should not stress or overextend the joint.

Splints

Splints may be used after surgery for about 8 to 10 weeks to help restore the use of the hand and keep symptoms from coming back. Splints support your palm and help straighten your fingers during recovery.

In some cases, splints are worn only at night, but in others they are worn at all times, except when the wound needs cleaning or during finger exercises. Your doctor can teach you how and when to wear the splint.

Why might your doctor recommend surgery?

Your doctor might suggest surgery if:

You have been doing finger exercises regularly, but your fingers are increasingly bent to the palm and you can't flatten your hand.
You have pain from nodules.

2. Compare Options

	Have surgery for Dupuytren's disease	Don't have surgery for Dupuytren's disease
What is usually involved?	Surgery takes 30 minutes to 2 hours. You may be asleep or awake, depending on the type of surgery. You can go home the same day. You'll need to do finger exercises. You may wear a splint for 8 to 10 weeks after surgery.	You do regular finger exercises and stretching. You do physical therapy and range-of-motion exercises. You may receive shots of lidocaine or steroid medicine. You may wear a splint.
What are the benefits?	Surgery can restore at least some of the use of your hands and fingers.	You may be able to keep the use of your hand and fingers without surgery.
What are the risks and side effects?	The disease can come back in the same place or in a new area of your hands. You may need another surgery to keep the use of your hands. All surgery has risks, including bleeding, infection, and nerve damage. Your age and your health can also affect your risk.	Delaying surgery until your symptoms are severe—for example, waiting until you are unable to use your hands to do daily activities—may make surgery and recovery harder. Steroid shots are not a long-term treatment, because repeated shots can weaken tissue.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Dupuytren's Disease.

Personal stories about having surgery for Dupuytren's disease

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have a mild case of Dupuytren's disease, which means my ring finger is somewhat curled and won't lie flat. I know there is some research going on for new nonsurgical treatments, and I'm hoping that my daily exercises will help me keep my flexibility for as long as possible. Surgery is not a choice for me right now. "

— Richard, age 50

"My fingers have lost most of their mobility and it's increasingly difficult for me to drive or wash the dishes. For over 10 years, my doctor and I have been talking about the possibility of surgery, and I think it's time. I'm aware that the disease may return, but it's worth it to have some relief and to be able to use my hands again. "

— Margaret, age 65

"My parents both have Dupuytren's disease, and I developed a nodule when I was still in my 30s. I have been able to avoid surgery so far by exercising my hands several times a day. That seems like a lot, but my physical therapist believes these range-of-motion exercises are working. My fingers are getting a little more and more bent all the time, but I can still pick up objects, button my clothes, and put on gloves. I'm concerned about the risks of surgery and the good possibility that the condition will return after surgery. I'm going to continue to work with my doctor and physical therapist and see if I can avoid surgery entirely. "

— Jim, age 59

"I have had symptoms of Dupuytren's disease for decades, but they are getting a lot worse. I can't stick my hands in my pockets, or pick up things, or even write. I've held off having surgery and did really well with exercises, but with the loss of finger movement, I am welcoming the relief that should come from a release of this contracture. "

— Ken, age 81

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for Dupuytren's disease

Reasons not to have surgery

I can't do daily activities, such as picking up things or washing my hands.

I'm still able to do everyday activities.

More important

Equally important

More important

I've done finger exercises, and they aren't helping me.

Finger exercises have helped me.

More important

Equally important

More important

I understand that my symptoms may come back after surgery.

I'm not sure I want to have surgery if my symptoms might come back.

More important

Equally important

More important

The risks and complications of surgery don't concern me.

I'm worried about the risks and complications of surgery.

More important

Equally important

More important

Whatever it takes to let me use my hands again is worth it.

I'm not willing to have surgery to regain the use of my hands.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery for Dupuytren's disease

NOT having surgery for Dupuytren's disease

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Will surgery cure your Dupuytren's disease?

Yes
No
I'm not sure

Yes, that's right. Dupuytren's disease comes back after surgery nearly half the time. You may need another surgery to keep the use of your hands.

2. If your condition is very bad and you delay surgery, can it make your recovery harder?

Yes
No
I'm not sure

That's right. Delaying surgery when your condition is very bad can make the surgery and your recovery harder.

3. Can other treatments be a good choice if you are still able to do daily activities?

Yes
No
I'm not sure

You are right. If you are able to move your fingers and do daily activities, you might benefit from other treatments first.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Gudmundsson KG, et al. (2003). Guillaume Dupuytren and finger contractures. Lancet, 362(9378): 165–168.
Brown AN, Gilkeson GS (2005). Fibrosing diseases: Diabetic stiff hand syndrome, Dupuytren's contracture, palmar and plantar fasciitis, retroperitoneal fibrosis, and Peyronie's disease. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2093–2108. Philadelphia: Lippincott Williams and Wilkins.
Townley WA, et al. (2006) Dupuytren's contracture unfolded. BMJ, 332(7538): 397–400.