Dupuytrens Contracture Surgery Patient Guide (2023)

Article Sections

  1. Introduction
  2. Anatomy
  3. Rationale
  4. Preparation
  5. Surgery
  6. Complications
  7. After Surgery
  8. Rehabilitation


Welcome to Method Wellness and Physical Therapy's resource on Dupuytren's Contracture Surgery.

Dupuytrens Contracture Surgery Patient Guide (1)

Dupuytren's contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. Although the exact cause is unknown, it occurs most often in middle-aged, white men and is genetic in nature, meaning it runs in families. This condition is seven times more common in men than women. It is more common in men of Scandinavian, Irish, or Eastern European ancestry. Interestingly, the spread of the disease seems to follow the same pattern as the spread of Viking culture in ancient times. The disorder may occur suddenly but more commonly progresses slowly over a period of years. The disease usually doesn't cause symptoms until after the age of 40.

Both non-surgical and surgical treatment options are available for Duputryen’s contracture, but this guide will focus on the surgical option. For more information on the non-surgical options, refer to A Patient's Guide to Dupuytren's Contracture.

In regards to surgical procedures a partial palmar fasciectomy remains the “gold standard” procedure, although at earlier stages of this disease a less invasive surgical procedure called a needle aponeurectomy may be done.

It should be noted that surgical treatment does not always stop or cure this disease process, so recurrence can occur.

This guide will help you understand:

  • what your surgeon hopes to achieve

  • what happens during the operation

  • what to expect after the procedure

  • Method Wellness and Physical Therapy’s approach to rehabilitation after surgery

    (Video) Dupuytren's contracture. Post-operative instructions - Dr. Jean-Paul Brutus


What part of the hand is affected?

The palmar fascia lies under the skin on the palm of the hands and fingers. This fascia is a thin sheet of connective tissue shaped somewhat like a triangle. It covers the tendons of the palm of the hand and holds them in place. It also prevents the fingers from bending too far backward when pressure is placed against the front of the fingers. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones. Dupuytren's contracture forms when the palmar fascia begins to thicken and tighten, causing the fingers to bend.

Dupuytrens Contracture Surgery Patient Guide (2)

This condition commonly first shows up as a thick nodule (knob), or a short cord in the palm of the hand, just below the ring finger. More nodules form and the tissues thicken and shorten until the finger cannot be fully straightened.

Dupuytrens Contracture Surgery Patient Guide (3)

Related Document: Method Wellness and Physical Therapy's Guide to Hand Anatomy


What is the goal of surgery?

Many cases of Dupuytren's contracture progress to the point where surgery is needed. The goal of surgery is to remove the diseased fascia, allowing the finger to straighten out again. By removing the tight cords and fascia, the tension on the finger is released. Once the fibrous tissue is removed, the skin is sewn back together with fine stitches.

In some cases, grafting extra skin is necessary in the area close to the incision to give the finger more flexibility to straighten. Skin grafting is more commonly necessary in severe Dupuytren's contractures that have been present for many years. Over this lengthy time the skin itself also contracts. When the contracture or the cord is released, the skin cannot stretch enough to allow the finger to straighten. Skin is added, or grafted into place to allow the finger to straighten without being held back by the tight skin of the palm.


How should I prepare for surgery?

(Video) Dupuytren's Contracture Injection Recovery Instructions

The decision to proceed with surgery must be made jointly by you and your surgeon. Your Physical Therapist may also provide input regarding failed conservative (non-surgical) treatment, which may lead you to the option of surgical treatment. You need to understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.

Once you decide on surgery, you need to take several steps. Your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.

Surgery for Dupuytren's Disease is commonly performed as an outpatient, meaning that you will probably go home the same day. The surgical procedure may be performed in an operating room in a surgery center or hospital. The needle aponeurotomy may be performed in the office setting. On the day of your surgery, you will arrive at the location chosen by the surgeon and the staff will register and prepare you for the procedure. You shouldn't eat or drink anything after midnight the night before.


What happens during the operation?

Needle Aponeurotomy (Percutaneous Fasciotomy)

The needle aponeurotomy is available when the disease is at an early stage. Under local anesthesia, the surgeon inserts a very thin needle under the skin. The sharp needle cuts a path through the cord, weakening it enough so that when the surgeon straightens the finger the cord will snap or rupture and this allows the finger to straighten. The diseased tissue is not removed. This type of procedure can be done in an office setting.

Dupuytrens Contracture Surgery Patient Guide (4)

Needle aponeurotomy may be used when a patient has a contracture that's due to a palpable cord lying beneath the skin. It does not work for non-Dupuytren's related contractures. The advantage of this procedure is that it can be done on older adults who have other health issues that might make surgery under general anesthesia too risky. The disadvantage is there can be a high recurrence rate because the diseased tissue remains and can continue to contract. There is also the potential for nerve injury, infection, and hematoma (pocket of blood) formation. These complications are similarto the open procedure.

Dupuytrens Contracture Surgery Patient Guide (5)

Palmar Fascia Removal (palmar fasciectomy)

Surgery can last up to 90 minutes. Surgery may be done using a general anesthetic (one that puts you to sleep during surgery), or a local anesthetic (one that only numbs the hand). With a local anesthetic you may be awake during the surgery, but you won't be able to see the surgery.

Once you have anesthesia, your surgeon will make sure the skin of your palm is free of infection by cleaning the skin with a germ-killing solution. An incision will be made in the skin. Several types of incisions can be made, but yours will most likely be made along the natural creases and lines in the hand. This will help make the scar less noticeable once the hand is healed.

Dupuytrens Contracture Surgery Patient Guide (6)

(Video) Frank: Dupuytren's Contracture Surgery

Once the palmar fascia is exposed, it will be carefully separated from nerves, arteries, and tendons. Special care is taken not to damage the nearby nerves and blood vessels.
Next your surgeon will remove enough of the diseased palmar fascia to allow you to straighten your finger(s). If the problem has been ignored for a long time, the joint capsule or the ligaments of the joint may also be stiff or contracted. The surgeon may therefore also need to release these tissues in order to allow the finger to straighten normally. Once the fibrous tissue is removed, the skin is sewn back together with fine stitches.

Dupuytrens Contracture Surgery Patient Guide (7)

A skin graft may be needed if the skin surface has contracted so much that the finger cannot relax as it should and the palm cannot be stretched out flat. Surgeons graft skin from the wrist, elbow, or groin.

Dupuytrens Contracture Surgery Patient Guide (8)


What might go wrong?

As with all major surgical procedures, complications can occur. This document doesn't provide a complete list of the possible complications, but it does highlight some of the most common problems. Some of the most common complications following surgery for Dupuytren's contracture are:

  • anesthesia related issues
  • infection
  • nerve and blood vessel damage


Problems can arise when the anesthesia given during surgery causes a reaction with other drugs the patient is taking. In rare cases, a patient may have problems with the anesthesia itself. In addition, anesthesia can affect lung function because the lungs don’t expand as well while a person is under anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.


Infection of the incision is one possible complication after surgery. Therefore, check your incision every day as instructed by your surgeon. If you think you have a fever, take your temperature, as this is a sign of infection. If you have a fever or other signs of infection or other complications, call your surgeon right away.

Nerve or Blood Vessel Damage

There are many nerves and blood vessels in the hand. It is possible, though uncommon, that these structures can be injured during surgery. If an injury occurs, it can be a serious complication. Injury to nerves can cause numbness or weakness of the hand. Repairing an injury to the blood vessels may require additional surgery.

    After Surgery

    What happens after surgery?

    After a needle aponeurotomy, small adhesive bandages may be applied, or a light gauze wrap. Elevation and ice are recommended for several days following the procedure. Rehabilitation will begin once these bandages are removed.

    (Video) Dupuytren's Contracture - 2021 Update - Noah Raizman, M.D.

    After a partial palmar fasciectomy, your hand will be bandaged with a well-padded dressing and a splint for support. The splint will keep the hand open and the fingers straight during healing. Your surgeon will want to check your hand within five to seven days. Stitches will be removed after 10 to 14 days, though most of your stitches will be absorbed into your body. Due to the many nerves found in the hand, you may have some discomfort after surgery. You will be given pain medicine to control the discomfort.

    You should keep your hand elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

    Rehabilitation will generally begin after your stitches are removed, or as soon as your surgeon feels it is appropriate.


    What should I expect during my recovery?

    Extensive Physical Therapy is not required after a needle aponeurotomy, however a few sessions at Method Wellness and Physical Therapy will start your recovery on the right track. Your Physical Therapist will do some gentle stretching with you and provide you will home exercise regime that you will do independently. You should not be doing any strenuous gripping for one week after your aponeurotomy. After this time you will be able to return to activities as tolerated. Occasionally a splint is prescribed for night use.

    Rehabilitation after a palmar fasciectomy is considerably more extensive. Although the time required for recovery varies, as a guideline, you may expect to attend Physical Therapy sessions for up to six weeks. Our Physical Therapist may apply heat treatments, soft tissue massage, and a program of vigorous stretching. Our Physical Therapist at Method Wellness and Physical Therapy will provide you with a personalized program to speed your recovery.

    Attending the recommended Physical Therapy sessions can make the difference to a successful result after fasciectomy surgery. These sessions are important in limiting the buildup of scar tissue, preventing the return of contractures, and getting the most benefit from surgery.

    Our Physical Therapist may recommend that your wear a splint at night for up to six months after surgery. It is used to keep the joints straight, and prevent new contractures from forming. You will gradually be able to put your hand to use, and should be able to straighten all joints within about four to eight weeks or sometimes slightly longer.

    At Method Wellness and Physical Therapy, our goal for Physical Therapy is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of independently doing your exercises as part of an ongoing home program.

    Generally Physical Therapy at Method Wellness and Physical Therapy occurs without any issues, and full recovery occurs provided our advice is closely followed. If, however, your recovery is not progressing as your Physical Therapist feels it should, we will ask you to return to your surgeon for a follow-up visit to ensure there are no complications, which are impeding your recovery.

    Portions of this document copyright MMG, LLC.

    (Video) Dupuytren's contracture: what is the recommended first line treatment?

    Method Wellness and Physical Therapy provides services for Physical Therapy in San Antonio.


    How long does Dupuytren's surgery take to heal? ›

    Surgery will include making an incision along the palm of your hand and finger with the tight bands and nodules being carefully removed, and if necessary, the skin grafted over the palm. Recovery time is between 4 – 12 weeks, depending on the severity of the finger condition.

    How long after Dupuytren's surgery can you drive? ›

    Activity and Use of your Hand:

    By 2 weeks post surgery you should be able to use your hand for most normal day to day tasks. You are able to drive as soon as pain allows and you are safe to control the vehicle.

    Is Dupuytren's contracture surgery painful? ›

    Surgical incisions will vary based on the extent of your Dupuytren's contracture but may look like a zig-zag on the palmar surface of the finger and hand. Dupuytren's contracture release can be painful. You will receive a prescription for narcotic pain medicine.

    How long does numbness last after Dupuytren's surgery? ›

    You may have some numbness or tingling of fingers due to the local anesthetic injections used to help control post-operative pain (this should wear off within about 24 hours).

    How long will the pain in the hand remain after Dupuytren's surgery? ›

    In the first week or two after surgery, you may have pain, swelling, tingling, or numbness in your palm and fingers. Over-the-counter pain medicines should address the sensitivity. Two or three weeks after your procedure, your hand surgeon will remove any stitches used in your surgery.

    Are you put to sleep for Dupuytren's surgery? ›

    This surgery may be done while you are asleep or while you are awake. If you are awake, you will get medicine to numb your hand and prevent pain. You may also get medicine to help you relax. The doctor will make a cut, called an incision, in the skin of your palm.

    What is the fastest way to recover from hand surgery? ›

    Tips for Hand Surgery Recovery
    1. Keep Your Hand and Arm Elevated. Raising your hand and arm above the level of your heart minimizes swelling and pain after your surgery, especially for the first 3-5 days. ...
    2. Plastic Bags Are Your New Best Friend. ...
    3. Don't Neglect Your Therapy Exercises. ...
    4. Listen To Your Body.
    25 Apr 2019

    How much rest is required after hand surgery? ›

    Healing from a hand surgery will averagely take six weeks. this whole time, you need to regularly visit your physician to ensure that the recovery process goes as planned.

    How long are you off work after hand surgery? ›

    How Long Does It Take to Recover from Hand Surgery? While the obvious answer is “it depends,” there are some general rules and guidelines about recovering from surgery. Generally, it takes 2 to 4 months before the typical patient experiences enough recovery to return to work.

    How do you shower after hand surgery? ›

    After 48 hours, surgical wounds can get wet without increasing the risk of infection. After this time, you can get your stitches wet briefly with a light spray (such as in the shower), but they should not be soaked (for example, in the bath). Make sure you pat the area dry afterwards.

    Are you put to sleep for hand surgery? ›

    Many hand surgery procedures can now be performed under local anesthesia in the clinic setting, without the need for sedation or general anesthesia, using a technique called WALANT, which stands for wide awake local anesthesia no tourniquet.

    Can I drive after hand surgery? ›

    Your hand will be in a splint and immobilized, rendering you unable to drive. Even if your procedure was not outpatient, someone will have to drive you home from the hospital once you are discharged – and most hospitals and clinics now require that the driver be someone you personally know.

    How Long Does your hand hurt after hand surgery? ›

    2. Don't delay in getting treatment. Sure, some minor aches and pains can resolve themselves with home treatment and support. But they shouldn't last for three or four weeks.

    How do I keep my hands after surgery? ›

    Keep your hand elevated above the level of your heart for 3-5 days. While sitting in a chair or lying in bed, place your arm on pillows to keep it elevated. While walking around, keep your hand elevated on your opposite shoulder. You may discontinue elevation when lowering the hand no longer causes it to throb.

    What aggravates Dupuytren's contracture? ›

    Both alcohol and smoking are frequently mentioned as risk factors for Dupuytren's contracture. “The evidence for smoking is stronger than for drinking, and it makes sense because smoking, like diabetes, decreases blood supply to the hand,” Evans says.

    Does Dupuytren's come back? ›

    Dupuytren's disease sometimes comes back after surgery. Talk with your doctor about your risk of the disease returning after surgery. If it comes back, you may need to decide whether to have another surgery. There are other nonsurgical treatments for Dupuytren's.

    What helps pain after hand surgery? ›

    Mild to severe pain may be expected after many types of hand surgeries. Pain medications may be given to help alleviate the discomfort.
    Therapy of the hand may include the following:
    • Exercises for the hand.
    • Heat therapy.
    • Massage therapy.
    • Splinting.
    • Traction.
    • Bandages to help control swelling.
    • Nerve stimulation.

    How effective is Dupuytren's surgery? ›

    In many cases, this surgery successfully eliminates Dupuytren's contracture. Results usually are long-lasting, and the rate of recurrence is low. Recovery after the surgery, however, may take three months or more, and involves extensive physical therapy to regain use of the fingers and hand.

    What should you not do before hand surgery? ›

    Remember not to eat or drink anything after midnight prior to your surgery, or as directed by your anesthesiologist. This includes water, breath mints and even chewing gum. Having food in your stomach can create a risk during surgery.

    How do you sleep after hand surgery? ›

    Your surgeon might teach you the “hand above elbow, elbow above heart” rule. When sleeping, it may help to use a large mound of pillows, either beside you or on your chest, to keep your hand and wrist in this elevated position.

    Is hand surgery complicated? ›

    Tendons are the fibers that join muscle to bone. Tendon repair in the hand is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture.

    When do you start physical therapy after hand surgery? ›

    Surgery is never easy. It is a stressful and sometimes painful process. However, there is one key thing that you can do after surgery to prevent pain and help speed up your recovery, physical therapy (PT). Today, many surgeons recommend starting PT almost immediately after surgery.

    How long after hand surgery can I get my hand wet? ›

    Wound Care

    You may apply a new dressing to the wound on the third day after surgery. Seven days after surgery it is allowable to get your surgical wound wet in the shower. Do not immerse the wound in water.

    What should I watch after hand surgery? ›

    Numbness or tingling in your arm or hand that has not gone away 24 hours after your surgery. A lot of pain that does not get better when you take your pain medication. If you do not have a follow-up appointment, please call your surgeon's office to make one.

    Can you use your hand after hand surgery? ›

    A hand surgery patient should expect a recovery period of several weeks or months, depending on the complexity of the surgery and their body's capacity to heal. During recovery, patients should refrain from using their hands in any manner not approved by their surgeon.

    What should I buy before surgery? ›

    Foods such as low-sodium soup, crackers, bananas, applesauce, protein bars, protein shakes, pudding, yogurt, oatmeal, cottage cheese, Jell-O, frozen dinners, and popsicles will provide the nutrients you need in an easy-to-digest formula.

    What should you not do after surgery? ›

    1. Do Too Much, Too Soon. ...
    2. Stay in Bed. ...
    3. Don't Take Your Meds as Prescribed. ...
    4. Don't Get Enough Food or Drink. ...
    5. Skip Rehab. ...
    6. Go Back to Work Too Soon. ...
    7. Drive Before You're Ready. ...
    8. Quit Your Breathing Exercises.
    27 Apr 2022

    Why do I have to wait 48 hours to shower after surgery? ›

    This is because your wound should not be soaked in water until it's healed. It could cause the skin to soften and reopen the wound. Guidelines published by the National Institute for Health and Care Excellence (NICE) say you can have a shower 48 hours after surgery.

    What happens if you shower too soon after surgery? ›

    Showering too soon after surgery can cause your incision to re-open, inhibit the healing process, cause complications like infection, or worsen your surgical scars.

    Should I wear a sling after hand surgery? ›

    The hand needs to be kept elevated (above the level of the heart) for the first few days following the surgery until the risk of swelling has passed. For this reason, you are likely to have your arm placed in a sling after the operation.

    Do you need to inform car insurance after surgery? ›

    Your insurance company should always be informed about your operation. Some companies will not insure you for up to 4 weeks after an oesophagectomy, so it is important to understand what your policy says.

    How many days should you ice after surgery? ›

    The inflammatory process is most active in the first 24 hours after a surgery, persisting for up to 2 weeks. We recommend that you continue the aforementioned icing routine for the first 2 weeks after your surgery. This is a very effective way to maximize your healing environment.

    Why is my hand throbbing after surgery? ›

    The main reason there is pain after surgery is swelling or inflammation. Usually, the peak time for this is the first 3 days after surgery. The best ways to limit swelling, inflammation, and pain are ice, elevation, ibuprofen (or other NSAID medication), and rest.

    How do you stop Dupuytren's progressing? ›

    The goal of treatment for Dupuytren's is to reduce the symptoms and disability caused by the disease. At this time, however, there is no treatment to stop Dupuytren's contracture from getting worse.

    What vitamins help with Dupuytren's contracture? ›

    It has been claimed that striking success can be gained in the treatment of Dupu'tren's contracture of the palmar fascia by simple oral administration of vitamin E in high dosage. It has been said that, after such treatment, thickening of the fascia disappears anti contracture of the fingers is relieved.

    Is Dupuytren's considered an autoimmune disease? ›

    In terms of the immunological features of DD, evidence has persistently suggested the involvement of both T and B lymphocytes in DD etiology [7, 38]. As such, the disease has frequently been termed a “T-cell-mediated autoimmune disorder” [6].

    How long are you in recovery after hand surgery? ›

    Generally, it takes 2 to 4 months before the typical patient experiences enough recovery to return to work. Ultimately, it can take several months to more than a year to recover 100 percent, but this is not usually necessary before one can return to living a relatively normal life.

    Can Dupuytrens return after surgery? ›

    Recurrence within the first few years after surgery has been reported in the range of 27% to 34% 1564282 1960492. Recurrence rates five years or more after surgery are higher, ranging from 40% to 74% 1564282 1481713, 1564282, 1284017,1284016, 3181828, 3233038 .

    How can I heal faster after hand surgery? ›

    Tips for Hand Surgery Recovery
    1. Keep Your Hand and Arm Elevated. Raising your hand and arm above the level of your heart minimizes swelling and pain after your surgery, especially for the first 3-5 days. ...
    2. Plastic Bags Are Your New Best Friend. ...
    3. Don't Neglect Your Therapy Exercises. ...
    4. Listen To Your Body.
    25 Apr 2019

    How can I sleep comfortably after hand surgery? ›

    The best way to do this comfortably is to lie flat on your back with your hand resting on a few pillows. Elevate your hand for at least three days after surgery.

    How can I speed up my hand recovery? ›

    How to Recover from a Hand Injury
    1. Rest It and Ice It: If you have injured a bone, then make sure that the damaged bone gets optimum rest. ...
    2. Elevate The Damaged Hand: Elevating the hand in the same position for a long period of time is a key to reducing the swelling.
    18 Apr 2016

    What aggravates Dupuytren's? ›

    Both alcohol and smoking are frequently mentioned as risk factors for Dupuytren's contracture. “The evidence for smoking is stronger than for drinking, and it makes sense because smoking, like diabetes, decreases blood supply to the hand,” Evans says.

    What triggers Dupuytren's contracture? ›

    What causes Dupuytren's contracture? Dupuytren's contracture is believed to run in families (be hereditary). The exact cause is not known. It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures.

    Who is prone to Dupuytren's contracture? ›

    Dupuytren contracture occurs most commonly after the age of 50. Sex. Men are much more likely to develop Dupuytren than are women. In men, symptoms may be worse and progress more quickly.

    Can you get disability for Dupuytren's? ›

    This condition causes a limited range of motion in one or both hands. This complication can result in an inability to perform work tasks. If the condition is severe enough to prohibit them from working, individuals suffering from the condition can apply for Social Security disability insurance.

    Is Dupuytren's a form of arthritis? ›

    Dupuytren's contracture: This form of arthritis causes the tissue beneath the hand to develop nodules in the fingers and palms. These lumps can cause the fingers to stick in place.

    How can Dupuytren's be prevented? ›

    Corticosteroid injections are sometimes used to treat painful nodules. The medication is injected directly into the affected area. Radiotherapy has also been used to prevent disease progression for early stage Dupuytren's disease.

    Can Dupuytren's cause nerve damage? ›

    Nerve Injury

    2 Dupuytren's cords can be closely wrapped around nerves in the fingers and sometimes the cord pulls the nerve into an unexpected location. With any invasive treatment, the nerve can be injured. When a nerve injury occurs, the finger can develop tingling or numbness and this can be a permanent problem.

    Is Dupuytren's neurological? ›

    And although the tiny nerve endings in the palm issue may turn out to be something, there's no data to suggest that pinched nerves, peripheral neuropathy or central nervous problems cause Dupuytren disease.

    Can Dupuytren's be caused by trauma? ›

    A specific form of Dupuytren's contracture developing as a result of hand trauma has been observed and discussed previously [6,7,8,9,10,11,12,13,14,15]. The first publications describing this phenomenon introduced repetitive trauma as a possible cause [7].


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