When one or more fingers begin curling toward the palm and can no longer straighten fully, it may signal a condition that develops slowly over years, affecting how you grip objects, wear gloves, or shake hands—but there are multiple ways to restore function and ease these challenges.

Understanding Treatment Goals for Hand Function

When someone develops a condition that causes fingers to bend toward the palm and resist straightening, the primary aim of treatment is to restore the ability to use the hand normally in daily life. This condition, known as Dupuytren’s contracture, occurs when tissue beneath the skin of the palm thickens and forms rope-like cords that pull fingers inward. Treatment decisions depend heavily on how much the condition interferes with everyday activities like buttoning shirts, holding a coffee cup, or placing your hand flat on a table.^[1][2]

The approach to managing this hand condition varies based on the stage of the disease and individual patient needs. In early stages, when only small lumps appear under the skin and fingers still move freely, treatment may not be necessary at all. However, as the condition progresses and begins to limit hand function, medical societies recommend a range of interventions—from minimally invasive office procedures to surgical options. Importantly, there is no cure for this condition, but treatments can relieve symptoms, improve hand mobility, and slow down how quickly the contracture worsens.^[5][9]

Beyond standard therapies that have been used for years, researchers are actively exploring new treatment approaches through clinical trials. These investigational therapies aim to address the underlying biological processes that cause the tissue to thicken and contract. The goal is to find treatments that work earlier in the disease process, potentially preventing the severe finger bending that can develop over time. Patients who participate in clinical research may gain access to promising new therapies while contributing to medical knowledge that could benefit others in the future.^[11]

Standard Treatment Approaches

The choice of treatment for Dupuytren’s contracture depends on how much the condition affects hand function. Many people with mild symptoms—just a few lumps or nodules in the palm without significant finger bending—may not need any treatment at all. Healthcare providers often recommend a “wait and watch” approach in these cases, monitoring the condition over time to see if it progresses. A simple home test, called the tabletop test, helps determine if treatment is becoming necessary: if you cannot lay your palm completely flat against a table surface, it may be time to consider intervention.^[4][9]

Non-Surgical Treatment Options

For patients who want to avoid surgery or have moderate disease, several non-surgical treatments can help. Steroid injections into the palm are sometimes used, particularly when nodules are painful or causing local inflammation. These injections contain corticosteroid medications that reduce swelling and may temporarily soften and flatten the thickened tissue, especially in the early stages of the disease. However, the evidence for long-term effectiveness of steroid injections remains limited.^[9][11]

A more established non-surgical option involves injecting an enzyme called collagenase clostridium histolyticum, marketed under the brand name XIAFLEX. This enzyme works by breaking down the collagen protein that makes up the rope-like cord pulling the finger. The treatment involves injecting the enzyme directly into the cord through numbed skin during an office visit. One to three days later, the healthcare provider manipulates the hand to break the weakened cord, allowing the finger to straighten. Patients then wear a splint to maintain the straightened position. This approach requires local anesthetic but not general anesthesia, and patients can typically go home the same day.^[7][9][13]

Another minimally invasive technique is needle fasciotomy, also called needle aponeurotomy. This procedure uses a thin needle inserted through numbed skin to puncture and break apart the cord of thickened tissue. The healthcare provider carefully moves the needle to cut through the cord while avoiding nerves and tendons. Sometimes ultrasound imaging guides the needle placement for added safety. This technique can be performed in the office with local anesthetic, causes minimal scarring, allows quick recovery (usually up to two weeks), and can be done on multiple fingers at once. The main drawback is that contractures tend to come back more frequently compared to surgical removal of the tissue. Also, this technique cannot be used in certain locations in the finger where it might damage important nerves or tendons.^[5][9][12]

Physical therapy and home exercises can complement other treatments. After any intervention, therapists teach stretching exercises to improve the range of motion in the fingers. Some patients find that applying heat to the palm before massage or gentle stretching exercises helps loosen the tissues. While these approaches cannot eliminate established contractures on their own, they play an important role in maintaining hand function after more definitive treatments.^[18]

Surgical Treatment Options

When non-surgical approaches are not suitable or when the contracture is severe, surgery becomes the recommended option. The most common surgical procedure is fasciectomy, which involves making a zigzag incision along the palm and finger to expose the thickened tissue. The surgeon carefully removes the diseased tissue cord while protecting the nearby tendons, nerves, and blood vessels. This procedure can be performed under local anesthetic (with the hand numbed) or general anesthetic (with the patient asleep). Patients usually go home the same day and wear a splint for about two weeks, with full recovery taking 4 to 12 weeks. Fasciectomy has the lowest risk of contracture returning compared to other treatments, though risks include bleeding, numbness, and infection.^[5][12][17]

For more severe or recurrent cases, surgeons may recommend dermofasciectomy. This procedure is similar to fasciectomy but also removes the overlying skin that has become involved with the disease. The surgeon then replaces the removed skin with a skin graft taken from another part of the body, typically the forearm or upper arm. This approach requires two procedures—one to straighten the fingers and remove tissue, and another to place the skin graft. While recovery times are longer than with standard fasciectomy, dermofasciectomy significantly reduces the chance of contracture returning. The procedure carries similar risks to fasciectomy, including bleeding, numbness, and infection.^[5][12]

In rare cases where joints have become permanently stiff from long-standing contracture, surgeons may perform joint fusion, fixing the joint in a functional position. While this permanently limits movement in that joint, it can be preferable to having a finger stuck in a severely bent position. After any surgical procedure, physical therapy is essential to regain strength, flexibility, and full hand function. Patients work with certified hand therapists on specific exercises and may wear splints to maintain the straightened position during healing.^[15][17]

Potential Side Effects and Complications

All treatments for Dupuytren’s contracture carry some risks. With injection treatments, patients may experience pain, swelling, bruising, or small cuts in the skin. More serious but rare complications include damage to tendons or ligaments, which could require surgical repair. Needle fasciotomy risks include tears in the skin that may need stitches, temporary numbness, and the possibility of damaging underlying structures.^[9][13]

Surgical procedures carry standard surgical risks including bleeding, infection, nerve damage causing numbness or tingling, and wound healing problems. Some patients develop complex regional pain syndrome after surgery, causing prolonged pain and stiffness. Regardless of the treatment chosen, there is always a possibility that the contracture will return over time, sometimes requiring additional treatment. Recovery from surgery typically involves several months of hand therapy to optimize the final result.^[5][12]

Emerging Treatments in Clinical Trials

A significant limitation of current treatments is that they only address Dupuytren’s contracture after fingers have already developed significant bending. Researchers have been working to develop treatments that could be used earlier in the disease process, potentially preventing the progression to severe contractures. Understanding what causes the tissue to thicken and contract at the molecular level has been essential to identifying new therapeutic targets.^[11]

Anti-TNF Therapy for Early-Stage Disease

One promising approach that has moved into clinical testing involves targeting a molecule called tumor necrosis factor (TNF), which plays a key role in inflammation and tissue remodeling. Researchers studied the cellular landscape of nodules in early-stage Dupuytren’s disease to understand which molecular signals drive the thickening process. This detailed investigation identified TNF as a potential therapeutic target that could be blocked with existing medications.^[11]

The anti-TNF drug being studied is adalimumab, which is already approved for treating other inflammatory conditions like rheumatoid arthritis. In clinical trials for Dupuytren’s disease, researchers tested this medication in a new way—injecting it directly into the nodules in the palm rather than giving it throughout the body. A Phase 2a clinical trial tested different doses to determine which was most effective and safe for this specific use. The study identified that 40 milligrams of adalimumab in 0.4 milliliters was the optimal dose.^[11]

Following the dose-finding study, researchers conducted a larger Phase 2b trial that was randomized, double-blind, and placebo-controlled—the gold standard for testing whether a treatment truly works. In this trial, patients with early-stage Dupuytren’s disease received either adalimumab injections or placebo injections (inactive substance) directly into their palm nodules. Neither the patients nor the doctors knew who received which treatment during the study. Participants received four injections spaced three months apart, for a total of one year of treatment.^[11]

The results showed that patients who received adalimumab experienced a decrease in nodule hardness and size on ultrasound scanning at 12 months. Importantly, the nodules continued to get smaller and softer even at 18 months—nine months after the final injection—suggesting that the treatment had lasting effects. This approach represents a fundamentally different strategy: rather than waiting until fingers are already bent and then trying to straighten them, the treatment aims to modify the disease process early, potentially preventing contractures from developing in the first place.^[11]

Understanding Clinical Trial Phases

Clinical trials for Dupuytren’s contracture, like those for other conditions, progress through phases that each answer different questions. Phase I trials primarily test safety, determining if a treatment causes unacceptable side effects in humans. They typically involve small numbers of participants. Phase II trials, like the adalimumab study described above, test whether the treatment actually works (efficacy) and continues to monitor safety. These trials involve more participants and often compare different doses. Phase III trials are large studies that compare the new treatment directly to current standard treatments to confirm effectiveness, monitor side effects in larger populations, and collect information that allows the treatment to be used safely. Successful Phase III trials can lead to regulatory approval, making the treatment available to all patients who might benefit.^[11]

The Evidence-Based Approach to New Treatments

The development of anti-TNF therapy for Dupuytren’s contracture illustrates an important principle in medical research: treatments should have a clear biological basis and evidence from robust scientific studies before being recommended to patients. This contrasts with some other approaches that have been tried for early-stage Dupuytren’s disease, such as radiotherapy, which has been used despite lacking strong evidence from well-designed, placebo-controlled trials and not having a clear biological rationale for how it would work.^[11]

The rigorous approach of conducting randomized, double-blind, placebo-controlled trials provides clinicians with a reliable evidence base for advising their patients. It helps distinguish between treatments that truly work and those that seem to work due to placebo effects or the natural variability of the disease. This is particularly important for Dupuytren’s contracture because the condition progresses very slowly and unpredictably—some people’s nodules never progress to contractures, while others develop severe finger bending over time.^[11]

Ongoing Research Directions

Beyond anti-TNF therapy, researchers continue to investigate the underlying mechanisms that cause Dupuytren’s contracture. Since the condition is genetic and runs in families, understanding which genes are involved and how they lead to tissue thickening could reveal additional therapeutic targets. Scientists are studying the specific cell types present in diseased tissue and the molecular signals that cause normal palm tissue to transform into thick, contracting cords.^[2][11]

Clinical trials for Dupuytren’s contracture are conducted in various locations including the United States, Europe, and other regions. Patient eligibility for trials depends on factors like disease stage (early nodules versus established contractures), which fingers are affected, whether the patient has had previous treatments, and overall health status. Many patients desire access to treatments before they develop significant contractures, which drives interest in early-intervention trials. As research progresses, the hope is to develop therapies that can prevent or significantly delay the progression from early nodules to disabling finger contractures.^[11]

Most Common Treatment Methods

• Enzyme Injection Therapy
  • Collagenase clostridium histolyticum (XIAFLEX) injected into the cord
  • Breaks down collagen in thickened tissue
  • Performed in office with local anesthetic
  • Followed by manipulation to straighten finger
  • May require insurance approval
• Minimally Invasive Needle Procedures
  • Needle fasciotomy (needle aponeurotomy) to cut through cord
  • Uses thin needle through numbed skin
  • Office procedure with quick recovery
  • Can treat multiple fingers at once
  • Higher recurrence rate than surgery
• Surgical Removal of Diseased Tissue
  • Fasciectomy—removal of thickened tissue cord
  • Dermofasciectomy—removal of tissue and overlying skin with skin graft
  • Lowest risk of contracture returning
  • Recovery takes 4 to 12 weeks with physical therapy
  • Performed under local or general anesthetic
• Steroid Injections
  • Corticosteroid medications injected into nodules
  • May help soften and flatten thickened tissue
  • Particularly for painful nodules in early stages
  • Limited evidence for long-term effectiveness
• Physical Therapy and Home Care
  • Stretching exercises to improve finger range of motion
  • Heat application before massage or stretching
  • Splinting to maintain straightened position
  • Essential after any treatment intervention
  • Helps prevent recurrence and optimize function