Dupuytren’s Contracture Treatment Options in Arizona: From Needle Aponeurotomy to Surgery

If you’ve noticed thick cords or nodules developing in your palm, or if one or more fingers are gradually curling toward your palm and you can’t straighten them, you may have Dupuytren’s contracture. This progressive condition of the hand fascia can significantly impact your ability to grip objects, shake hands, put on gloves, or lay your hand flat on a table.

As a hand surgeon serving the Phoenix metropolitan area, I treat Dupuytren’s contracture regularly and offer multiple treatment approaches tailored to each patient’s specific situation.

What Is Dupuytren’s Contracture?

Dupuytren’s contracture (also called Dupuytren’s disease) is a condition in which the fascia—a layer of connective tissue beneath the skin of the palm—thickens and tightens over time. This abnormal tissue forms nodules (lumps) and cords (thick bands) that gradually pull one or more fingers into a bent position. The ring finger and small finger are most commonly affected, though any finger can be involved.

The condition is not caused by overuse or injury. It is a fibroproliferative disorder with a strong genetic component.

Who Gets Dupuytren’s Disease?

• Northern European ancestry (Scandinavian, British, Irish)—sometimes called the "Viking disease"

• Men are affected more often than women, typically beginning after age 50

• Family history is the strongest risk factor

• Diabetes, smoking, and heavy alcohol use increase risk
  

The condition tends to progress more aggressively in patients with a strong family history, early onset, or involvement of both hands

Stages and Symptoms

Dupuytren’s typically progresses through stages:

• Early: Painless nodules (lumps) in the palm, often near the base of the ring or small finger

• Intermediate: Cords develop extending from the palm into the fingers, mild difficulty straightening the fingers

• Advanced: Significant contracture—fingers are pulled into a bent position and cannot be fully straightened, interfering with daily activities

The hallmark test is the "tabletop test"—if you cannot lay your hand flat on a table, it’s time to see a hand surgeon.

When Is Treatment Needed?

Not all Dupuytren’s disease requires treatment. If you only have nodules without any finger contracture, observation is typically recommended. Treatment is indicated when:

• You cannot lay your hand flat on a table (positive tabletop test)

• Finger contracture of 20–30 degrees or more at the metacarpophalangeal (MCP) joint

• Any contracture at the proximal interphalangeal (PIP) joint (these are harder to correct if allowed to progress)

• The contracture interferes with work, hobbies, or daily function
  

Treatment Options

Needle Aponeurotomy (Percutaneous Fasciotomy)

This is a minimally invasive office procedure. Using a needle, I perforate the Dupuytren’s cord at multiple points, weakening it enough that the finger can be straightened manually. There is no incision and no sutures—just small needle punctures. Recovery is rapid, with most patients returning to full activity within days. The tradeoff is a higher recurrence rate compared to surgery, typically 50–65% over five years. However, the procedure can be repeated if needed.

Open Fasciectomy

This is the surgical standard of care for more significant contractures. Through one or more incisions, I directly remove the diseased fascia (Dupuytren’s tissue). This provides the most thorough correction and has the lowest recurrence rate of the treatment options—approximately 10–30% over five years depending on disease severity. Recovery takes 4–6 weeks, and hand therapy is often recommended.

Which Treatment Is Right for You?

The choice depends on the severity and location of your contracture, your age and overall health, your activity level and functional demands, and your preference for a quicker recovery versus a more durable result. I discuss all options with each patient and make a recommendation based on their individual situation.

Frequently Asked Questions About Dupuytren’s

Is Dupuytren’s contracture painful?

In early stages, nodules can be tender. Once cords and contracture develop, pain is usually not the primary complaint—functional limitation is the main concern.

Can Dupuytren’s be cured?

There is currently no cure for the underlying disease. All treatments address the existing contracture, but the disease can recur or progress in other areas of the hand. However, recurrence after treatment can be re-treated.

Does stretching or physical therapy help?

Unfortunately, stretching exercises alone will not prevent or reverse Dupuytren’s contracture. The disease is driven by abnormal tissue biology, not muscle tightness.

Expert Dupuytren's Care in Phoenix Metro

If you’ve noticed lumps in your palm or your fingers are starting to curl, early evaluation gives you the most treatment options and the best outcomes. I see patients from across the Valley—Phoenix, Scottsdale, Mesa, Chandler, Gilbert, Fountain Hills, Peoria, Goodyear, and Buckeye—for Dupuytren’s evaluation and treatment.

☎ Schedule Your Consultation

Call (602) 258-4788 or visit toddrichardsmd.com to book an appointment with Dr. Todd Richards. Most insurance plans accepted. Same-week appointments often available.