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For further information, see CMDT Part 41-04: Upper Extremity Musculoskeletal Injuries

Key Features

Essentials of Diagnosis

  • Benign fibrosing disorder of the palmar fascia

  • Contracture of one or more fingers can lead to limited hand function

General Considerations

  • Cause is unknown

  • Occurs primarily in white men older than 50 years. The incidence is higher among alcoholics and patients with chronic systemic disorders (especially cirrhosis)

  • Also associated with systemic fibrosing syndrome, which includes

    • Plantar fibromatosis (10% of patients)

    • Peyronie disease (1–2%)

    • Mediastinal and retroperitoneal fibrosis

    • Riedel struma

Clinical Findings

  • Onset may be acute, but slowly progressive chronic disease is more common

  • Nodular or cord-like thickening of one or both hands, with the fourth and fifth fingers most commonly affected

  • Tightness of the involved digits, with inability to satisfactorily extend the fingers; on occasion, there is tenderness

  • The contracture is well tolerated because it exaggerates the normal position of function of the hand, although resulting cosmetic problems may be unappealing


  • Clinical


  • Common treatment options

    • Corticosteroid injections

    • Percutaneous needle aponeurotomy

    • Collagenase Clostridium histolyticum injections

    • Open fasciectomy

  • Injections of triamcinolone or collagenase into a rapidly growing palmar nodule may be of benefit

  • Injection of collagenase C histolyticum lyses collagen, thereby disrupting the contracted cords

  • Surgical options for patients with more severe flexion contractures include

    • Open fasciectomy

    • Partial fasciectomy

    • Percutaneous needle aponeurotomy



  • Splinting after surgery is beneficial

  • Recurrence and more adverse events are more likely to occur after surgery than with nonoperative treatments

  • Overall, treatment success is lower for PIP joints than for MCP joints

  • Fascietomies are more successful for severe conditions involving multiple fingers, while percutaneous needle aponeurotomy is cost-effective and useful for milder cases and for single digit involvement

  • Collagenase Clostridium histolyticum injections are not currently cost effective due to high reintervention rates, regardless of severity

  • Compared to placebo, tamoxifen therapy produced moderate evidence of improvement before or after a fasciectomy

When to Refer

  • Referral can be considered when one or more digits are affected by severe contractures, which interfere with everyday activities and result in functional limitations


Huisstede  BM  et al. Effectiveness of conservative, surgical, and postsurgical interventions for trigger finger, Dupuytren disease, and De Quervain disease: a systematic review. Arch Phys Med Rehabil. 2018 Aug;99(8):1635–49.
[PubMed: 28860097]
Leafblad  ND  et al. Outcomes and direct costs of needle aponeurotomy, collagenase injection, and fasciectomy in the treatment of Dupuytren contracture. J Hand Surg Am. 2019;44:919.
[PubMed: 31537401]  
Sanjuan-Cervero  R. Current role of the collagenase Clostridium histolyticum in Dupuytren's disease treatment. Ir J Med ...

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