GPAtlas🧭 When to suspect
Dupuytren's disease is a benign, slowly progressive fibroproliferative disorder of the palmar and digital fascia. Thickened tissue forms nodules and then cords that can draw one or more fingers into fixed flexion – most often the ring and little fingers.
It is common:
• Affecting around 4% of the UK population and a much higher proportion of older men
• Strongly associated with Northern European ancestry
• Up to six times more common in men than women
Most disease is painless and never needs intervention – only about one in three affected people progress to a cord and contracture.
In the surgery:
• Recognise it clinically
• Decide who needs referral, driven by contracture and hand function, not by the mere presence of a nodule
• Do not mislabel an atypical hand lump as Dupuytren's
Suspect Dupuytren's when there is:
• Thickening, pitting or puckering of the palmar skin
• A firm palmar nodule
• A cord with early bending of a finger
Raise your index of suspicion with:
• A family history
• Increasing age
• Smoking
• Excess alcohol
• Diabetes
| Clinical picture | Primary-care action |
|---|---|
| Palmar nodule(s) only, no contracture | • Reassure, observe and safety-net • Tender nodules usually settle with time |
| Cord with mild contracture, hand still lies flat, function preserved | • Observe and address risk factors • Refer if progressing or affecting function |
| Cannot lay the palm flat (positive Hueston tabletop test), or metacarpophalangeal (MCP) ≥ 30° or proximal interphalangeal (PIP) ≥ 20° | Refer to hand surgery. |
| Significant functional impairment (any angle) | Refer to hand surgery. |
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