Understanding the Condition
The Cords That
Bend the Fingers Down
Dupuytren's contracture is a fibroproliferative disorder of the palmar fascia — the connective tissue layer that lies just beneath the skin of the palm. Over months and years, this tissue abnormally thickens, forming nodules that can be felt as firm bumps in the palm, and cords that extend from the palm into the fingers. As the cords tighten, they pull one or more fingers into a progressively flexed position that cannot be voluntarily straightened.
The ring and small fingers are most commonly affected, though any finger can develop contracture. The thumb and index finger are less frequently involved. The condition is nearly always painless — it is the mechanical limitation, not pain, that brings most patients to treatment. When the finger cannot be fully extended, shaking hands becomes awkward, flat surfaces become impossible, gloves don't fit, and a range of daily activities from washing the face to putting a hand in a pocket become problematic.
Dupuytren's is a genetic condition with a strong hereditary component, far more common in men of Northern European descent. It is associated with diabetes, epilepsy, alcohol use, and certain manual occupations — but the disease progresses on its own biological timeline regardless of activity. There is no conservative treatment that reverses or stops the cords. Once contracture develops, the only effective treatment is to divide or remove the cord.
Cords — not the flexor tendons beneath them — are responsible for finger flexion in Dupuytren's. This distinction matters: dividing or removing the cord releases the contracture without damaging the underlying tendons or neurovascular structures (when performed carefully).
The ring and small fingers are most commonly affected. Contracture at the MCP joint (knuckle) responds well to treatment. Contracture at the PIP joint (middle knuckle) is more resistant and may not fully correct — especially in longstanding cases.
Disease Progression
From Nodule to Contracture
Dupuytren's progresses at its own pace — months in some patients, decades in others. The stage at presentation guides which treatment is most appropriate.
Firm Lump in the Palm
A tender nodule appears in the palm — most commonly at the base of the ring or small finger. No contracture yet. The finger extends fully.
Many patients notice the nodule but have not yet developed cord or deformity.
Palpable Cord, Minimal Contracture
A cord develops extending from the nodule into the finger. Less than 30° of contracture at the MCP joint. Finger function still largely preserved.
The tabletop test may be borderline positive.
30–60° Contracture at MCP
Meaningful functional limitation. Hand cannot be laid flat on a table (positive tabletop test). Handshaking, gloving, and daily tasks increasingly impacted.
PIP joint may also be developing contracture.
>60° or PIP Involvement
Significant deformity. PIP joint contracture is present and may be resistant to full correction. Digital neurovascular anatomy may be displaced.
Fasciectomy typically preferred for more complete release.
Treatment Options
Fast Recovery or Lower Recurrence — Your Choice
Dr. Graham offers both procedures and presents the honest trade-offs at every consultation. The decision belongs to you.
Fasciotomy divides the Dupuytren's cord through small skin punctures — no formal incision, no stitches. The cord is weakened at multiple points until the finger straightens. It is performed in the office under local anesthesia. Most patients return to light activities within days.
The trade-off is recurrence. Because the diseased tissue is divided but not removed, Dupuytren's can regrow along the same cord over months or years. When it does, the procedure can be repeated — or at that point, the patient may choose open fasciectomy.
Partial fasciectomy removes the diseased cord through a formal incision in the palm — typically a zigzag incision that allows thorough exposure and preserves the skin over the cord. The Dupuytren's tissue is carefully excised under magnification, releasing the contracture while protecting the digital nerves and vessels that run alongside the cord.
Because the diseased tissue is removed rather than just divided, recurrence is significantly less likely — though not impossible. Recovery involves wound care, suture removal at 10–14 days, and hand therapy. The incision must be kept dry until healed.
Procedure Details
What Each Procedure Involves
Select a procedure to see exactly what happens — from arrival to recovery.
Percutaneous
Palmar Fasciotomy
Percutaneous fasciotomy is Dr. Graham's preferred in-office Dupuytren's procedure for eligible patients. A precise distinction from the generic description you may have read elsewhere: Dr. Graham performs this with a 15-blade scalpel, not a hypodermic needle. The blade allows more controlled, precise division of the cord at multiple points along its length — the result is a cleaner, more complete release than a needle technique.
John Tierney, PA-C administers the local anesthetic at the base of the finger and in the palm. Once the area is numb, Dr. Graham works along the cord with the blade, weakening it at multiple points under the skin. When the cord has been sufficiently divided, the finger is straightened — usually immediately and completely for MCP contractures. The skin puncture sites are small enough that no stitches are required.
The entire procedure takes 15–20 minutes per cord. Multiple cords on different fingers can be addressed at the same visit. Patients leave the office with the finger extended and a simple dressing. Hand therapy with a custom-made extension orthosis (night splint) begins promptly to maintain correction.
PIP joint contracture corrects less predictably than MCP contracture with fasciotomy — particularly in longstanding cases. Dr. Graham addresses this candidly at consultation when the PIP joint is involved.
Open Partial
Palmar Fasciectomy
Open partial fasciectomy removes the Dupuytren's cord through a formal incision in the palm. A zigzag (Brunner) incision design is typically used — it provides excellent exposure, avoids placing a straight scar across the flexion creases of the palm and fingers, and allows the skin flaps to be reflected to expose the cord in its full extent.
The cord is dissected free from the overlying skin and — most importantly — from the digital nerves and vessels that run intimately alongside it. In Dupuytren's disease, the neurovascular structures can be displaced or encased by the cord, particularly in severe or recurrent cases. This is where the subspecialty training and surgical experience of a fellowship-trained hand surgeon matters most. The cord is removed as completely as possible while protecting these structures.
The procedure is performed at Baptist Beaches Hospital or an affiliated surgery center under local or regional anesthesia with sedation, or general anesthesia depending on the extent of involvement and patient preference. It is outpatient — patients go home the same day.
Because the diseased fascia is removed rather than merely divided, recurrence is significantly less likely — though Dupuytren's disease is biological and can produce new cords elsewhere in the palm over time.
A Note on Spiral Cords
Spiral cords — a specific Dupuytren's cord pattern that displaces the digital neurovascular bundle toward the midline as it spirals around the finger — require particular surgical caution. In these cases, the nerves and vessels are no longer in their expected anatomical position and can be at higher risk of inadvertent injury during cord division. Dr. Graham identifies spiral cord anatomy preoperatively and at consultation. Percutaneous fasciotomy is generally avoided when a spiral cord is identified — open fasciectomy with direct visualization of the neurovascular structures is the safer approach for this pattern.
Why Dr. Graham Doesn't Offer Xiaflex (Collagenase)
Collagenase clostridium histolyticum — marketed as Xiaflex — is an enzyme injection that enzymatically dissolves the Dupuytren's cord, allowing the finger to be straightened at a follow-up visit. It is FDA-approved and used by some hand surgeons as an alternative to surgical procedures.
Dr. Graham does not routinely offer Xiaflex for a straightforward reason: the outcomes are equivalent to percutaneous fasciotomy, and the cost is significantly higher. Multiple studies comparing Xiaflex to percutaneous fasciotomy with a 15-blade show similar correction rates, similar recurrence rates, and similar patient satisfaction — with Xiaflex carrying a substantially higher price tag due to the medication cost. When two approaches produce the same result and one costs considerably more, the less expensive option is the more patient-centered choice.
If a patient comes in specifically requesting collagenase and has a compelling reason for it, that conversation can always happen. But Dr. Graham's default recommendation is the procedure that achieves equivalent results at a fraction of the cost — percutaneous fasciotomy in the office.
Recovery
What Recovery Looks Like — by Procedure
The two procedures have meaningfully different recovery courses. Both use a custom night splint to maintain the correction achieved at surgery.
"Dr. Graham has a great sense of humor. I really appreciate his positive outlook and his ability to put patients at ease. His bedside humor and surgical skills are just what I needed."
Tammy Davis · Dupuytren's Treatment · Verified Google Review ★ 5/5
Common Questions
Frequently Asked Questions
Next Steps
Your Fingers
Don't Have to Stay Bent.
Dupuytren's contracture is a progressive condition — the cords do not resolve on their own. But the treatment options are straightforward, and the decision about which one is right for you is genuinely yours to make after an honest conversation about the trade-offs. A consultation with Dr. Graham starts there.
Jacksonville Beach, FL 32250
Surgery days: Mon · Thu
Dupuytren's can be evaluated and a treatment plan made at the first visit. Walk-in access through JOI Now on clinic days.