Dupuytren’s contracture is a progressive condition in which the connective tissue (fascia) just beneath the skin of the palm gradually thickens and tightens into firm cords. Over time these cords can pull one or more fingers toward the palm, making it difficult or impossible to straighten them fully. It is usually painless and tends to develop slowly over months to years.

In its early stages, Dupuytren’s contracture often appears as a small, firm lump (nodule) in the palm, typically near the base of the fingers. As the disease progresses, this tissue can thicken into a tough, rope-like cord that gradually pulls one or more fingers toward the palm - most commonly the ring finger and little (pinky) finger.

Dupuytren’s is usually painless, but it can still take a real toll on daily life. As the affected finger bends inward, it becomes harder - and eventually impossible - to lay your hand flat. That loss of motion can interfere with simple, routine tasks such as washing your hands, putting on gloves, reaching into a pocket, or gripping objects securely.

A simple self-check - the “tabletop test.” Place your palm flat on a table. If you cannot lay your hand and fingers completely flat, it may be a sign that a contracture is developing.

Diagnosis of Dupuytren’s contracture begins with a thorough physical examination of the hand. In most cases the diagnosis is clinical, based on examining the nodules and cords and assessing how far the affected fingers can straighten. Depending on the severity of the contracture, which joints are involved, and how long it has been present, treatment may range from non-surgical to surgical approaches.

Although renowned for his surgical ability, Dr. Cohen is a firm believer in pursuing the least invasive effective option before turning to open surgery. For early or mild Dupuytren’s disease that isn’t yet limiting hand function, this may mean careful monitoring over time. When treatment is warranted, less invasive in-office options - such as needle release (needle aponeurotomy) or collagenase (Xiaflex) injection - are discussed before open surgery.