Dupuytren's contracture#Notable sufferers

File:Dupuytren's2010.JPG

Typically, Dupuytren's contracture first presents as a thickening or nodule in the palm, which initially can be with or without pain.{{cite web|url=http://www.nhs.uk/Conditions/Dupuytrens-contracture/Pages/Symptoms.aspx|title=Dupuytren's contracture – Symptoms|website=National Health Service (England)|url-status=live|archive-url=https://web.archive.org/web/20160408033727/http://www.nhs.uk/Conditions/Dupuytrens-contracture/Pages/Symptoms.aspx|archive-date=2016-04-08|date=2017-10-19}} Page last reviewed: 29/05/2015 Later in the disease process, which can be years later,{{cite book|url=https://books.google.com/books?id=Ay5mDwAAQBAJ&q=dupuytren%27s+plantar+fibromatosis&pg=PA132 |author=Giorgio Pajardi |author2=Marie A. Badalamente |author3=Lawrence C. Hurst |title=Collagenase in Dupuytren Disease |publisher=Springer|date=2018 |access-date=2020-01-16|isbn=978-3-319-65822-3}} there is increasing loss of range of motion of the affected finger(s). The earliest sign of a contracture is a triangular "puckering" of the skin of the palm as it passes over the flexor tendon just before the flexor crease of the finger, at the metacarpophalangeal (MCP) joint.{{citation needed|date=September 2021}}

File:Late_Stage_Dupuytren's_Contracture.webm

Dupuytren disease is generally considered painless, but can be painful if nerve tissue is involved, although this is not usually discussed in the literature.{{cite journal | last1=von Campe | first1=A. | last2=Mende | first2=K. | last3=Omaren | first3=H. | last4=Meuli-Simmen | first4=C. | title=Painful Nodules and Cords in Dupuytren Disease | journal=The Journal of Hand Surgery | volume=37 | issue=7 | date=2012 | doi=10.1016/j.jhsa.2012.03.014 | pages=1313–1318| pmid=22560560 }} The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected.{{cite journal |doi=10.1097/prs.0b013e3182958a33 |pmid=23897337 |title=Prevalence of Dupuytren Disease in the Netherlands |journal=Plastic and Reconstructive Surgery |volume=132 |issue=2 |pages=394–403 |year=2013 |last1=Lanting |first1=Rosanne |last2=Van Den Heuvel |first2=Edwin R. |last3=Westerink |first3=Bram |last4=Werker |first4=Paul M. N. |s2cid=46900744 |url=https://pure.rug.nl/ws/files/195692688/Prevalence_of_Dupuytren_Disease_in_The_Netherlands.26.pdf }}

The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal (MCP) joints affected before the proximal interphalangeal (PIP) joints.{{cite journal |doi=10.1142/S0218810414300058 |pmid=25288296 |title=Dupuytren's Contracture: Emerging Insight into a Viking Disease |journal=Hand Surgery |volume=19 |issue=3 |pages=481–90 |year=2014 |last1=Nunn |first1=Adam C. |last2=Schreuder |first2=Fred B. }}

The MCP joints at the base of the finger responds much better to treatment and are usually able to fully extend after treatment. Due to anatomic differences in the ligaments and extensor tendons at the PIP joints, they may have some residual flexion. Proper patient education is necessary to set realistic treatment expectation.

In Dupuytren's contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl and can impair finger function. The main function of the palmar fascia is to increase grip strength; thus, over time, Dupuytren's contracture decreases a person's ability to hold objects and use the hand in many different activities. Dupuytren's contracture can also be experienced as embarrassing in social situations and can affect quality of life.{{Cite journal|last1=Turesson|first1=Christina|last2=Kvist|first2=Joanna|last3=Krevers|first3=Barbro|date=2020|title=Experiences of men living with Dupuytren's disease—Consequences of the disease for hand function and daily activities|journal=Journal of Hand Therapy|volume=33|issue=3|pages=386–393|doi=10.1016/j.jht.2019.04.004|pmid=31477329|s2cid=201804901|issn=0894-1130|url=http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-167465 }} People may report pain, aching, and itching with the contractions. Normally, the palmar fascia consists of collagen type I, but in Dupuytren patients, the collagen changes to collagen type III, which is significantly thicker than collagen type I.{{Cite journal |last=Al-Qattan |first=Mohammad |date=November 1, 2006 |title=Factors in the Pathogenesis of Dupuytren's Contracture |url=https://www.jhandsurg.org/article/S0363-5023(06)00968-3/fulltext |journal=The Journal of Hand Surgery |volume=31 |issue=9 |pages=1527–1534 |doi=10.1016/j.jhsa.2006.08.012 |pmid=17095386 |via=Elsevier|url-access=subscription }}

People with severe involvement often show lumps on the back of their finger joints (called "Garrod's pads", "knuckle pads", or "dorsal Dupuytren nodules"), and lumps in the arch of the feet (plantar fibromatosis or Ledderhose disease). In severe cases, the area where the palm meets the wrist may develop lumps. It is thought the condition Peyronie's disease is related to Dupuytren's contracture.{{Cite journal|last1=Carrieri|first1=MP|last2=Serraino|first2=D|last3=Palmiotto|first3=F|last4=Nucci|first4=G|last5=Sasso|first5=F|year=1998|title=A case-control study on risk factors for Peyronie's disease|journal=Journal of Clinical Epidemiology|volume=51|issue=6|pages=511–5|doi=10.1016/S0895-4356(98)00015-8|pmid=9636000}}

In one study those with stage 2 of the disease were found to have a slightly increased risk of mortality, especially from cancer.{{cite journal |doi=10.1016/S0895-4356(01)00413-9 |pmid=11781116 |title=Increased total mortality and cancer mortality in men with Dupuytren's disease |journal=Journal of Clinical Epidemiology |volume=55 |issue=1 |pages=5–10 |year=2002 |last1=Gudmundsson |first1=Kristján G. |last2=Arngrímsson |first2=Reynir |last3=Sigfússon |first3=Nikulás |last4=Jónsson |first4=Thorbjörn }}

Many risk factors have been suggested or identified:

• Scandinavian or Northern European ancestry;{{cite web |url=http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=140&topcategory |title=Your Orthopaedic Connection: Dupuytren's Contracture |archive-url=https://web.archive.org/web/20070313223951/http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=140&topcategory |archive-date=2007-03-13 }} Dupuytren's has been called the "Viking disease", though it is also widespread in some Mediterranean countries, e.g., Spain{{cite journal |doi=10.1016/S0753-9053(88)80013-9 |pmid=3056294 |title=Quelques aspects épidémiologiques de la maladie de Dupuytren |trans-title=Various epidemiologic aspects of Dupuytren's disease |language=es |journal=Annales de Chirurgie de la Main |volume=7 |issue=3 |pages=256–62 |year=1988 |last1=Guitian |first1=A. Quintana }} and Bosnia.{{cite book |doi=10.1007/978-3-642-22697-7_16 |chapter=The Epidemiology of Dupuytren's Disease in Bosnia |title=Dupuytren's Disease and Related Hyperproliferative Disorders |pages=123–7 |year=2012 |last1=Zerajic |first1=Dragan |last2=Finsen |first2=Vilhjalmur |isbn=978-3-642-22696-0 }}{{cite web |url=http://www.dupuytren-online.info/dupuytren_age_distribution.html |title=Age and geographic distribution of Dupuytren's disease (Dupuytren's contracture) |publisher=Dupuytren-online.info |date=2012-11-21 |access-date=2013-02-27 |url-status=live |archive-url=https://web.archive.org/web/20130316191926/http://www.dupuytren-online.info/dupuytren_age_distribution.html |archive-date=2013-03-16 }} Dupuytren's is uncommon among groups including Chinese and Africans.{{cite journal |doi=10.1016/s0895-4356(99)00145-6 |pmid=10760640 |title=Epidemiology of Dupuytren's disease |journal=Journal of Clinical Epidemiology |volume=53 |issue=3 |pages=291–6 |year=2000 |last1=Gudmundsson |first1=Kristján G. |last2=Arngrímsson |first2=Reynir |last3=Sigfússon |first3=Nikulás |last4=Björnsson |first4=Árni |last5=Jónsson |first5=Thorbjörn }}{{clarify|reason=This contradicts the statement in the introduction to the article, which says that scientists no longer believe this.|date=November 2022}}
• In June 2023 a study found that gene variants that were inherited from Neanderthals dramatically increased the odds of developing the condition {{Cite web |last=Agren, Patil, Zhou, Salholm, Paabo and Zeberg |date=14 June 2023 |title=Major Genetic Risk Factors for Dupuytren's Disease Are Inherited From Neandertals. |url=https://academic.oup.com/mbe/article/40/6/msad130/7197475?searchresult=1&login=false}}
• Male sex; men are 80% more likely to develop the condition{{cite book|url=https://books.google.com/books?id=gZWRDwAAQBAJ&q=%22Dupuytren%27s%22&pg=PA344 |title=Essential Orthopaedics E-Book |author=Mark D. Miller |author2=Jennifer Hart |author3=John M. MacKnight |publisher=Elsevier Health Sciences |date=2019 |isbn=978-0-323-56704-6 |access-date=2020-01-17}}
• Age of 50 or over (5% to 15% of men in that group in the US); the likelihood of getting Dupuytren's disease increases with age
• A family history (60% to 70% of those affected have a genetic predisposition to Dupuytren's contracture){{cite web |url=http://orthoinfo.aaos.org/topic.cfm?topic=A00008 |title=Dupuytren's Contracture |url-status=live |archive-url=https://web.archive.org/web/20160616085600/http://orthoinfo.aaos.org/topic.cfm?topic=a00008 |archive-date=2016-06-16 }}

• Smoking, especially 25-plus cigarettes per day{{cite journal |doi=10.1302/0301-620x.79b2.6990 |pmid=9119843 |title=Smoking, Alcohol and the Risk of Dupuytren's Contracture |journal=The Journal of Bone and Joint Surgery |volume=79 |issue=2 |pages=206–10 |year=1997 |last1=Burge |first1=Peter |last2=Hoy |first2=Greg |last3=Regan |first3=Padraic |last4=Milne |first4=Ruairidh |doi-access=free }}
• Lower-than-average body mass index (thinness).
• Alcohol consumption
• Manual work:{{cite journal |last1=van den Berge |first1=Bente A. |last2=Wiberg |first2=Akira |last3=Werker |first3=Paul M. N. |last4=Broekstra |first4=Dieuwke C. |last5=Furniss |first5=Dominic |title=Dupuytren's disease is a work-related disorder: results of a population-based cohort study |journal=Occupational and Environmental Medicine |date=March 2023 |volume=80 |issue=3 |pages=137–145 |doi=10.1136/oemed-2022-108670|doi-access=free|pmid=36635095 |pmc=9985760 }} a 2023 paper by researchers at the University of Groningen Medical Centre and Oxford University, "Dupuytren's disease is a work-related disorder: results of a population-based cohort study", found that people whose jobs involved significant manual work were 1.29 times more likely to develop Dupuytren's disease than others, with a linear dose–response relationship with cumulative manual labour over 30 years.

• Previous hand injury
• Ledderhose disease (plantar fibromatosis)
• Epilepsy (possibly due to anti-convulsive medication)[http://www.gms-books.de/book/living-textbook-hand-surgery/chapter/etiology-dupuytrens-disease "Etiology of Dupuytren's Disease"] {{webarchive|url=https://web.archive.org/web/20161012145731/http://www.gms-books.de/book/living-textbook-hand-surgery/chapter/etiology-dupuytrens-disease|date=2016-10-12}} Living Textbook of Hand Surgery.
• Higher-than-average fasting blood glucose level
• Diabetes mellitus
• HIV
• Macrophallism
• Previous myocardial infarction

There may be three types of Dupuytren's disease:{{Cite web|url=https://dupuytrens.org/three-types-of-dupuytren-disease/|archive-url=https://web.archive.org/web/20160613041902/http://dupuytrens.org/three-types-of-dupuytren-disease/|title=Three types of Dupuytren disease?|archive-date=June 13, 2016|website=Dupuytren Research Group}}

• Type 1: An aggressive form of the disease found in only 3% of people with Dupuytren's, which can affect men under 50 with a family history of Dupuytren's. It is often associated with other symptoms such as knuckle pads and Ledderhose disease. This type is sometimes known as Dupuytren's diathesis.
• Type 2: The more normal type of Dupuytren's disease, usually found in the palm only, and which generally begins above the age of 50. This type may be made more severe by other factors such as diabetes or heavy manual labor.
• Type 3: A mild form of Dupuytren's which is common among diabetics or which may also be caused by certain medications, such as the anti-convulsants taken by people with epilepsy. This type does not lead to full contracture of the fingers, and is probably not inherited.

Treatment is indicated when the so-called table-top test is positive. With this test, the person places their hand on a table. If the hand lies completely flat on the table, the test is considered negative. If the hand cannot be placed completely flat on the table, leaving a space between the table and a part of the hand as big as the diameter of a ballpoint pen, the test is considered positive and surgery or other treatment may be indicated. Additionally, finger joints may become fixed and rigid. There are several types of treatment, with some hands needing repeated treatment.{{citation needed|date=September 2021}}

The main categories listed by the International Dupuytren Society in order of stage of disease are radiation therapy, needle aponeurotomy (NA), collagenase injection, and hand surgery. {{As of|2016}} the evidence on the efficacy of radiation therapy was considered inadequate in quantity and quality, and difficult to interpret because of uncertainty about the natural history of Dupuytren's disease.

Needle aponeurotomy is most effective for Stages I and II, covering 6–90 degrees of deformation of the finger. However, it is also used at other stages.

Collagenase injection is likewise most effective for Stages I and II. However, it is also used at other stages.{{citation needed|date=September 2021}}

Hand surgery is effective at stage I to stage IV.{{cite web |url=http://www.dupuytren-online.info/dupuytren_stages_therapies.html |title=Progression of Dupuytren's disease |publisher=Dupuytren-online.info |date=2012-08-18 |access-date=2013-02-27 |url-status=live |archive-url=https://web.archive.org/web/20130322045650/http://www.dupuytren-online.info/dupuytren_stages_therapies.html |archive-date=2013-03-22 }}

Use of a splint to keep treated fingers straight following various forms of treatment, typically at all times for some days, then at nighttime for some weeks, is usual. However, a 2015 Cochrane review concluded: "low-quality evidence suggests that postoperative splinting may not improve outcomes and may impair outcomes by reducing active flexion. Further trials on this topic are urgently required".

On 12 June 1831, Dupuytren performed a surgical procedure on a person with contracture of the fourth and fifth digits who had been previously told by other surgeons that the only remedy was cutting the flexor tendons. He described the condition and the operation in The Lancet in 1834{{cite journal |doi=10.1016/S0140-6736(02)77708-8 |title=Clinical Lectures on Surgery |journal=The Lancet |volume=22 |issue=558 |pages=222–5 |year=1834 |hdl=2027/uc1.$b426113 |url=https://zenodo.org/record/2088201 |pmc=5165315 }} after presenting it in 1833, and posthumously in 1836 in a French publication by Hôtel-Dieu de Paris.{{cite journal|last=Dupuytren|first=Guillaume|date=1836|journal=Leçons Orales de Clinique Chirurgicale, Faites a l'Hotel-Dieu de Paris|volume=1|pages=[https://archive.org/details/leonsoralesdec01dupu/page/n12 1]–12|title=Rétraction Permanente des Doigts|url=https://archive.org/details/leonsoralesdec01dupu}} The procedure he described was a minimally invasive needle procedure.

Because of high recurrence rates,{{citation needed|date=April 2017}} new surgical techniques were introduced, such as fasciectomy and then dermofasciectomy. Most of the diseased tissue is removed with these procedures.{{clarify span|Recurrence rates are low.|date=April 2017}} For some individuals, the partial insertion of "K-wires" into either the DIP or PIP joint of the affected digit for a period of a least 21 days to fuse the joint is the only way to halt the disease's progress. After removal of the wires, the joint is fixed into flexion, which is considered preferable to fusion at extension.

Research using large datasets in the UK has shown surgery to be safe and effective. When surgery needs to be repeated, however, the research suggests there are higher risks of serious complications such as finger amputation.{{Cite journal |last=Beeston |first=Amelia |date=2021-06-01 |title=Dupuytrens-surgery-safe-but-repeat-operations-carry-risks-NIHR-Evidence |url=https://evidence.nihr.ac.uk/alert/dupuytrens-surgery-effective-but-repeat-operations-higher-risks/ |access-date=2024-05-31 |website=NIHR Evidence |doi=10.3310/alert_46320 |language=en-GB|url-access=subscription }}{{Cite journal |last1=Alser |first1=Osaid |last2=Craig |first2=Richard S. |last3=Lane |first3=Jennifer C. E. |last4=Prats-Uribe |first4=Albert |last5=Robinson |first5=Danielle E. |last6=Rees |first6=Jonathan L. |last7=Prieto-Alhambra |first7=Daniel |last8=Furniss |first8=Dominic |date=2020-10-05 |title=Serious complications and risk of re-operation after Dupuytren's disease surgery: a population-based cohort study of 121,488 patients in England |journal=Scientific Reports |language=en |volume=10 |issue=1 |pages=16520 |doi=10.1038/s41598-020-73595-y |pmid=33020582 |issn=2045-2322|pmc=7536429 }} Amputation of fingers may be needed for severe or recurrent cases or after surgical complications.{{cite journal |doi=10.1136/bmj.332.7538.397 |pmid=16484265 |pmc=1370973 |title=Dupuytren's contracture unfolded |journal=BMJ |volume=332 |issue=7538 |pages=397–400 |year=2006 |last1=Townley |first1=W. A. |last2=Baker |first2=R. |last3=Sheppard |first3=N. |last4=Grobbelaar |first4=A. O. }}

File:Hand Post Dupuytren-Op with Stiches and healed.jpg

Limited/selective fasciectomy removes the pathological tissue, and is a common approach.{{cite journal |pmid=14758215 |year=2004 |last1=Skoff |first1=H. D. |s2cid=41351257 |title=The surgical treatment of Dupuytren's contracture: A synthesis of techniques |journal=Plastic and Reconstructive Surgery |volume=113 |issue=2 |pages=540–4 |doi=10.1097/01.PRS.0000101054.80392.88 }}{{cite journal |doi= 10.2174/1874325001105010283 |doi-access=free|pmid=21886694 |pmc=3149852 |title=Dupuytren's Disease: Review of the Current Literature |journal=The Open Orthopaedics Journal |volume=5 |pages=283–8 |year=2011 |last1=Khashan |first1=Morsi |last2=Smitham |first2=P. J. |last3=Khan |first3=W. S. |last4=Goddard |first4=N. J. }}Living Textbook of Hand Surgery https://books.publisso.de/en/publisso_gold/publishing/books/overview/49/71 A 2015 Cochrane review reported that low-quality evidence suggested that fasciectomy may be more effective for people with advanced Dupuytren's contractures.{{Cite journal|last1=Rodrigues|first1=Jeremy N.|last2=Becker|first2=Giles W.|last3=Ball|first3=Cathy|last4=Zhang|first4=Weiya|last5=Giele|first5=Henk|last6=Hobby|first6=Jonathan|last7=Pratt|first7=Anna L.|last8=Davis|first8=Tim|date=2015-12-09|title=Surgery for Dupuytren's contracture of the fingers|journal=Cochrane Database of Systematic Reviews|volume=2015|issue=12|pages=CD010143|doi=10.1002/14651858.cd010143.pub2|pmid=26648251|pmc=6464957|issn=1465-1858|url=http://bura.brunel.ac.uk/bitstream/2438/12149/1/Fulltext.pdf}}

During the procedure, the person is under regional or general anesthesia. A surgical tourniquet prevents blood flow to the limb.{{cite journal |doi=10.1016/j.jhsa.2006.02.021 |pmid=16713831 |title=A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren's Disease: A 6-Week Follow-Up Study |journal=The Journal of Hand Surgery |volume=31 |issue=5 |pages=717–25 |year=2006 |last1=Van Rijssen |first1=Annet L. |last2=Gerbrandy |first2=Feike S. J. |last3=Linden |first3=Hein Ter |last4=Klip |first4=Helen |last5=Werker |first5=Paul M.N. }} The skin is often opened with a zig-zag incision but straight incisions with or without Z-plasty are also described and may reduce damage to neurovascular bundles.{{cite journal |pmid=7271195 |pmc=2493820 |year=1981 |last1=Robbins |first1=T. H. |title=Dupuytren's contracture: The deferred Z-plasty |journal=Annals of the Royal College of Surgeons of England |volume=63 |issue=5 |pages=357–8 }} All diseased cords and fascia are excised. The excision has to be very precise to spare the neurovascular bundles. Because not all the diseased tissue is visible macroscopically, complete excision is uncertain.

A 20-year review of surgical complications associated with fasciectomy showed that major complications occurred in 15.7% of cases, including digital nerve injury (3.4%), digital artery injury (2%), infection (2.4%), hematoma (2.1%), and complex regional pain syndrome (5.5%), in addition to minor complications including painful flare reactions in 9.9% of cases and wound healing complications in 22.9% of cases.{{cite journal |pmid=20204055 |pmc=2828055 |year=2010 |last1=Denkler |first1=K |title=Surgical complications associated with fasciectomy for Dupuytren's disease: A 20-year review of the English literature |journal=ePlasty |volume=10 |pages=e15 }} After the tissue is removed the incision is closed. In the case of a shortage of skin, the transverse part of the zig-zag incision is left open. Stitches are removed 10 days after surgery.

After surgery, the hand is wrapped in a light compressive bandage for one week. Flexion and extension of the fingers can start as soon as the anaesthesia has resolved. It is common to experience tingling within the first week after surgery. Hand therapy is often recommended. Approximately six weeks after surgery the patient is able completely to use the hand.{{cite journal |pmid=19857298 |year=2009 |last1=Van Rijssen |first1=A. L. |title=Treatment of Dupuytren's contracture; an overview of options |journal=Nederlands Tijdschrift voor Geneeskunde |volume=153 |pages=A129 |last2=Werker |first2=P. M. }}

The average recurrence rate is 39% after a fasciectomy after a median interval of about four years.{{cite journal |doi=10.1177/1753193410397971 |pmid=21382860 |title=The efficacy and safety of fasciectomy and fasciotomy for Dupuytren's contracture in European patients: A structured review of published studies |journal=Journal of Hand Surgery |volume=36 |issue=5 |pages=396–407 |year=2011 |last1=Crean |first1=S. M. |last2=Gerber |first2=R. A. |last3=Le Graverand |first3=M. P. H. |last4=Boyd |first4=D. M. |last5=Cappelleri |first5=J. C. |s2cid=6244809 }}

Limited/selective fasciectomy under local anesthesia (LA) with epinephrine but no tourniquet is possible. In 2005, Denkler described the technique.{{cite journal |pmid=15731682 |year=2005 |last1=Denkler |first1=K |title=Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet |journal=Plastic and Reconstructive Surgery |volume=115 |issue=3 |pages=802–10 |doi=10.1097/01.prs.0000152420.64842.b6|s2cid=40168308 }}{{cite journal |doi=10.1258/shorts.2012.012050 |pmid=22908029 |pmc=3422854 |title=The development of one-stop wide-awake Dupuytren's fasciectomy service: A retrospective review |journal=JRSM Short Reports |volume=3 |issue=7 |page=48 |year=2012 |last1=Bismil |first1=Q. |last2=Bismil |first2=M. |last3=Bismil |first3=A. |last4=Neathey |first4=J. |last5=Gadd |first5=J. |last6=Roberts |first6=S. |last7=Brewster |first7=J. }}

Dermofasciectomy is a surgical procedure that may be used when:

• The skin is clinically involved (pits, tethering, deficiency, etc.)
• The risk of recurrence is high and the skin appears uninvolved (subclinical skin involvement occurs in ~50% of cases{{cite journal |last1=Wade |first1=Ryckie |last2=Igali |first2=Laszlo |last3=Figus |first3=Andrea |title=Skin involvement in Dupuytren's disease |journal=Journal of Hand Surgery (European Volume) |date=9 September 2015 |volume=41 |issue=6 |pages=600–608 |doi=10.1177/1753193415601353|pmid=26353945 |s2cid=44308422 |url=http://eprints.whiterose.ac.uk/105541/2/14%20607%20final%20-%20additional%20reference%20%20numbers%20altered%2026th%20July.pdf }})
• Recurrent disease. Similar to a limited fasciectomy, the dermofasciectomy removes diseased cords, fascia, and the overlying skin.{{cite journal |pmid=10697321 |year=2000 |last1=Armstrong |first1=J. R. |title=Dermofasciectomy in the management of Dupuytren's disease |journal=The Journal of Bone and Joint Surgery. British Volume |volume=82 |issue=1 |pages=90–4 |last2=Hurren |first2=J. S. |last3=Logan |first3=A. M. |doi=10.1302/0301-620x.82b1.9808|url=https://dupuytrens.org/wp-content/uploads/2023/05/2000_Armstrong.pdf}}

Typically, the excised skin is replaced with a skin graft, usually full thickness, consisting of the epidermis and the entire dermis. In most cases the graft is taken from the antecubital fossa (the crease of skin at the elbow joint) or the inner side of the upper arm.{{cite journal |doi=10.1302/0301-620X.91B3.21054 |pmid=19258615 |title=Does a 'firebreak' full-thickness skin graft prevent recurrence after surgery for Dupuytren's contracture?: a prospective, randomised trial |journal=Journal of Bone and Joint Surgery. British Volume |volume=91-B |issue=3 |pages=374–8 |year=2009 |last1=Ullah |first1=A. S. |last2=Dias |first2=J. J. |last3=Bhowal |first3=B. |s2cid=45221140 }} This place is chosen because the skin color best matches the palm's skin color. The skin on the inner side of the upper arm is thin and has enough skin to supply a full-thickness graft. The donor site can be closed with a direct suture.

The graft is sutured to the skin surrounding the wound. For one week the hand is protected with a dressing. The hand and arm are elevated with a sling. The dressing is then removed and careful mobilization can be started, gradually increasing in intensity. After this procedure the risk of recurrence is minimised, but Dupuytren's can recur in the skin graft{{cite journal |last1=Wade |first1=Ryckie George |last2=Igali |first2=Laszlo |last3=Figus |first3=Andrea |title=Dupuytren Disease Infiltrating a Full-Thickness Skin Graft |journal=The Journal of Hand Surgery |date=August 2016 |volume=41 |issue=8 |pages=e235–e238 |doi=10.1016/j.jhsa.2016.04.011|pmid=27282210 |url=http://eprints.whiterose.ac.uk/105540/2/Dupuytren%27s%20in%20a%20skin%20graft%20-inc.%20%20EIC%20edits%2015-01152R1%20-%20v4%20accept%20changes.pdf }} and complications from surgery may occur.{{vague|date=July 2017}}{{cite journal |doi=10.1007/s12570-012-0092-z |pmid=22611457 |pmc=3338000 |title=Current trends in the surgical management of Dupuytren's disease in Europe: An analysis of patient charts |journal=European Orthopaedics and Traumatology |volume=3 |issue=1 |pages=31–41 |year=2012 |last1=Bainbridge |first1=Christopher |last2=Dahlin |first2=Lars B. |last3=Szczypa |first3=Piotr P. |last4=Cappelleri |first4=Joseph C. |last5=Guérin |first5=Daniel |last6=Gerber |first6=Robert A. }}

Segmental fasciectomy involves excising part(s) of the contracted cord so that it disappears or no longer contracts the finger. It is less invasive than the limited fasciectomy, because not all the diseased tissue is excised and the skin incisions are smaller.{{cite journal |doi=10.1016/0266-7681(91)90047-R |pmid=1960487 |title=Segmental aponeurectomy in Dupuytren's disease |journal=The Journal of Hand Surgery|volume=16 |issue=3 |pages=243–54 |year=1991 |last1=Moermans |first1=J |citeseerx=10.1.1.1028.1469 |s2cid=45886218 }}

The person is placed under regional anesthesia and a surgical tourniquet is used. The skin is opened with small curved incisions over the diseased tissue. If necessary, incisions are made in the fingers. Pieces of cord and fascia of approximately one centimeter are excised. The cords are placed under maximum tension while they are cut. A scalpel is used to separate the tissues. The surgeon keeps removing small parts until the finger can fully extend.{{cite journal |doi=10.3109/2000656X.2011.558725 |pmid=21682613 |title=Improved postoperative outcome of segmental fasciectomy in Dupuytren disease by insertion of an absorbable cellulose implant |journal=Journal of Plastic Surgery and Hand Surgery |volume=45 |issue=3 |pages=157–64 |year=2011 |last1=Degreef |first1=Ilse |last2=Tejpar |first2=Sabine |last3=De Smet |first3=Luc |s2cid=26305500 }} The patient is encouraged to start moving their hand the day after surgery. After surgery people wear a light pressure dressing for four days, followed by an extension splint, typically continuously for a few weeks, then every night for eight weeks.

The same procedure is used in the segmental fasciectomy with cellulose implant. After the excision and a careful hemostasis, the cellulose implant is placed in a single layer in between the remaining parts of the cord.

Studies have been conducted for percutaneous release, extensive percutaneous aponeurotomy with lipografting and collagenase. These treatments show promise.{{cite journal |doi=10.1097/PRS.0b013e31821741ba |pmid=21701337 |title=Extensive Percutaneous Aponeurotomy and Lipografting: A New Treatment for Dupuytren Disease |journal=Plastic and Reconstructive Surgery |volume=128 |issue=1 |pages=221–8 |year=2011 |last1=Hovius |first1=Steven E. R. |last2=Kan |first2=Hester J. |last3=Smit |first3=Xander |last4=Selles |first4=Ruud W. |last5=Cardoso |first5=Eufimiano |last6=Khouri |first6=Roger K. |s2cid=19339536 }}{{cite journal |doi=10.2147/TCRM.S8591 |pmid=21127696 |pmc=2988615 |title=The emerging role of Clostridium histolyticum collagenase in the treatment of Dupuytren disease |journal=Therapeutics and Clinical Risk Management |volume=6 |pages=557–72 |year=2010 |last1=Bayat |first1=Ardeshir |last2=Thomas |doi-access=free }}{{cite journal |doi=10.1056/NEJMoa0810866 |pmid=19726771 |title=Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture |journal=New England Journal of Medicine |volume=361 |issue=10 |pages=968–79 |year=2009 |last1=Hurst |first1=Lawrence C. |last2=Badalamente |first2=Marie A. |last3=Hentz |first3=Vincent R. |last4=Hotchkiss |first4=Robert N. |last5=Kaplan |first5=F. Thomas D. |last6=Meals |first6=Roy A. |last7=Smith |first7=Theodore M. |last8=Rodzvilla |first8=John |s2cid=23771087 |doi-access=free }}

Needle aponeurotomy is a minimally-invasive technique where the cords are weakened through the insertion and manipulation of a small needle. It is applicable only if the contracture is clearly visible. The hand is first numbed by injection with local anaesthetic.{{Citation|url=https://www.england.nhs.uk/wp-content/uploads/2022/07/Making-a-decision-about-Dupuytrens-contracture.pdf|title=Making a decision about: Dupuytren's contracture|publisher=Winton Centre for Risk and Evidence Communication and NHS England|date=July 2022|version=1.1|chapter=2: Treatment Options}} The cord is then sectioned at as many levels as possible in the palm and fingers, depending on the location and extent of the disease, using perhaps a 25-gauge needle mounted on a 10 ml syringe.{{cite journal |doi=10.1016/j.jhsa.2012.05.022 |pmid=22763055 |title=Percutaneous Needle Fasciotomy for Recurrent Dupuytren Disease |journal=The Journal of Hand Surgery |volume=37 |issue=9 |pages=1820–3 |year=2012 |last1=Van Rijssen |first1=Annet L. |last2=Werker |first2=Paul M.N. }} Once weakened, the offending cords can be snapped by putting tension on the finger(s) and pulling the finger(s) straight. After the treatment a small dressing is applied for 24 hours, after which people are able to use their hands normally. No splints or physiotherapy are given.

The advantage of needle aponeurotomy is the minimal intervention without incision (done in the office under local anesthesia) and the very rapid return to normal activities without need for rehabilitation, but the nodules may resume growing.{{cite journal |doi=10.1016/j.lpm.2008.07.012 |pmid=18922672 |title=Maladie de Dupuytren: La chirurgie n'est plus obligatoire |trans-title=Dupuytren's contracture: surgery is no longer necessary |language=fr |journal=La Presse Médicale |volume=37 |issue=12 |pages=1779–81 |year=2008 |last1=Lellouche |first1=Henri }} A study reported postoperative gain is greater at the MCP joint level than at the level of the IP-joint and found a reoperation rate of 24%; complications are scarce.{{cite journal |doi=10.1016/S0266-7681(03)00013-5 |pmid=12954251 |title=Percutaneous needle aponeurotomy: Complications and results |journal=The Journal of Hand Surgery|volume=28 |issue=5 |pages=427–31 |year=2003 |last1 = FOUCHER | first1 = G.| last2 = MEDINA | first2 = J.| last3 = NAVARRO | first3 = R.|s2cid=11181513 }} Needle aponeurotomy may be performed on fingers that are severely bent (stage IV), and not just in early stages. A 2003 study showed 85% recurrence rate after five years.{{cite journal |doi=10.1097/PRS.0b013e31823aea95 |pmid=21987045 |title=Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytrenʼs Disease |journal=Plastic and Reconstructive Surgery |volume=129 |issue=2 |pages=469–77 |year=2012 |last1=Van Rijssen |first1=Annet L. |last2=Ter Linden |first2=Hein |last3=Werker |first3=Paul M. N. |s2cid=24454361 |url=https://research.rug.nl/en/publications/fiveyear-results-of-a-randomized-clinical-trial-on-treatment-in-dupuytrens-disease(8f1b4ff4-1119-409f-90da-76eac017a26d).html }}

A comprehensive review of the results of needle aponeurotomy in 1,013 fingers was performed by Gary M. Pess, MD, Rebecca Pess, DPT, and Rachel Pess, PsyD, and published in the Journal of Hand Surgery April 2012. Minimal follow-up was three years. Metacarpophalangeal joint (MP) contractures were corrected at an average of 99% and proximal interphalangeal joint (PIP) contractures at an average of 89% immediately post procedure. At final follow-up, 72% of the correction was maintained for MP joints and 31% for PIP joints. The difference between the final corrections for MP versus PIP joints was statistically significant. When comparing people aged below and above 55 years of age there was a statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group.{{citation needed|date=September 2021}}

Gender differences were not statistically significant. Needle aponeurotomy provided successful correction to 5° or less contracture immediately post procedure in 98% (791) of MP joints and 67% (350) of PIP joints. There was recurrence of 20° or less over the original post-procedure corrected level in 80% (646) of MP joints and 35% (183) of PIP joints. Complications were rare except for skin tears, which occurred in 3.4% (34) of digits. This study showed that NA is a safe procedure that can be performed in an outpatient setting. The complication rate was low, but recurrences were frequent in younger people and for PIP contractures.{{cite journal |doi=10.1016/j.jhsa.2012.01.029 |pmid=22464232 |title=Results of Needle Aponeurotomy for Dupuytren Contracture in over 1,000 Fingers |journal=The Journal of Hand Surgery |volume=37 |issue=4 |pages=651–6 |year=2012 |last1=Pess |first1=Gary M. |last2=Pess |first2=Rebecca M. |last3=Pess |first3=Rachel A. }}

A technique introduced in 2011 is extensive percutaneous aponeurotomy with lipografting. This procedure also uses a needle to cut the cords. The difference with the percutaneous needle fasciotomy is that the cord is cut at many places. The cord is also separated from the skin to make place for the lipograft that is taken from the abdomen or ipsilateral flank. This technique shortens the recovery time. The fat graft results in supple skin.

Before the aponeurotomy, a liposuction is done to the abdomen and ipsilateral flank to collect the lipograft. The treatment can be performed under regional or general anesthesia. The digits are placed under maximal extension tension using a firm lead hand retractor. The surgeon makes multiple palmar puncture wounds with small nicks. The tension on the cords is crucial, because tight constricting bands are most susceptible to be cut and torn by the small nicks, whereas the relatively loose neurovascular structures are spared. After the cord is completely cut and separated from the skin the lipograft is injected under the skin. A total of about 5 to 10 ml is injected per ray.

After the treatment the person wears an extension splint for 5 to 7 days. Thereafter the person returns to normal activities and is advised to use a night splint for up to 20 weeks.

{{main|Collagenase clostridium histolyticum}}

File:Xiaflex (Collagenase) for Dupuytrens.jpg

The cords are weakened through the injection of small amounts of the enzyme collagenase, which breaks peptide bonds in collagen.{{cite journal |doi=10.1016/j.jhsa.2007.04.002 |pmid=17606053 |title=Efficacy and Safety of Injectable Mixed Collagenase Subtypes in the Treatment of Dupuytren's Contracture |journal=The Journal of Hand Surgery |volume=32 |issue=6 |pages=767–74 |year=2007 |last1=Badalamente |first1=Marie A. |last2=Hurst |first2=Lawrence C. }}{{cite journal |doi=10.1053/jhsu.2000.6918 |pmid=10913202 |title=Enzyme injection as nonsurgical treatment of Dupuytren's disease |journal=The Journal of Hand Surgery |volume=25 |issue=4 |pages=629–36 |year=2000 |last1=Badalamente |first1=Marie A. |last2=Hurst |first2=Lawrence C. |s2cid=24029657 }}{{cite journal |doi=10.1053/jhsu.2002.35299 |pmid=12239666 |title=Collagen as a clinical target: Nonoperative treatment of Dupuytren's disease |journal=The Journal of Hand Surgery |volume=27 |issue=5 |pages=788–98 |year=2002 |last1=Badalamente |first1=Marie A. |last2=Hurst |first2=Lawrence C. |last3=Hentz |first3=Vincent R. }}{{excessive citations inline|date=September 2020}}

Clostridial collagenase injections have been found to be more effective than placebo.

In February 2010 the US Food and Drug Administration (FDA) approved injectable collagenase extracted from Clostridium histolyticum for the treatment of Dupuytren's contracture in adults with a palpable Dupuytren's cord. (Three years later, it was approved as well for the treatment of the sometimes related Peyronie's disease.){{cite web |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199736.htm |title=FDA Approves Xiaflex for Debilitating Hand Condition |publisher=Fda.gov |date=2010-02-02 |access-date=2013-02-27 |url-status=dead |archive-url=https://web.archive.org/web/20121126231018/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199736.htm |archive-date=2012-11-26 }} In 2011 its use for the treatment of Dupuytren's contracture was approved as well by the European Medicines Agency, and it received similar approval in Australia in 2013. However, the Swedish manufacturer withdrew distribution of this drug in Europe{{cite web |url=https://www.ema.europa.eu/en/medicines/human/EPAR/xiapex |title = Xiapex |publisher= European Medicines Agency| date=17 September 2018 }} including the UK, Australia, and Asia in March 2020.{{cite web | title=Collagenase for Dupuytren | publisher=The British Dupuytren's Society| url=https://dupuytrens-society.org.uk/treatment-2/dupuytrens-disease/collagenase-clostridium-histolyticum/ | access-date=6 January 2025}} (It is also used in the US as a dermatological treatment for cellulite aka "cottage cheese thighs").{{Cite web|url=https://medlineplus.gov/druginfo/meds/a612029.html|title=Collagenase Clostridium Histolyticum Injection|publisher=MedlinePlus Drug Information}}

The treatment with collagenase is different for the MCP joint and the PIP joint. In a MCP joint contracture the needle must be placed at the point of maximum bowstringing of the palpable cord. The needle is placed vertically on the bowstring. The collagenase is distributed across three injection points. For the PIP joint the needle must be placed not more than 4 mm distal to palmar digital crease at 2–3 mm depth. The injection for PIP consists of one injection filled with 0.58 mg CCH 0.20 ml. The needle must be placed horizontal to the cord and also uses a three-point distribution. After the injection the person's hand is wrapped in bulky gauze dressing and must be elevated for the rest of the day. After 24 hours the person returns for passive digital extension to rupture the cord. Moderate pressure for 10–20 seconds ruptures the cord. After the treatment with collagenase the person should use a night splint and perform digital flexion/extension exercises several times per day for 4 months.

File:DupuytrensRadiotherapyHamburg.jpg]]

Radiation therapy has been used mostly for early-stage disease, but is unproven. Evidence to support its use {{As of|2017|lc=y}}, however, was scarce—efforts to gather evidence are complicated due to a poor understanding of how the condition develops over time.{{cite web|title=Radiation therapy for early Dupuytren's disease: Guidance and guidelines|url=https://www.nice.org.uk/guidance/ipg573/chapter/1-Recommendations|publisher=NICE|date=December 2016|url-status=live|archive-url=https://web.archive.org/web/20170628124914/https://www.nice.org.uk/guidance/IPG573/chapter/1-Recommendations|archive-date=2017-06-28}} It has been studied in early disease. The Royal College of Radiologists concluded that radiotherapy is effective in early stage disease which has progressed within the last 6 to 12 months.{{Cite web|url=https://www.bmj.com/content/373/bmj.n1308/rr|title=Re: Dupuytren's disease|date=7 August 2021|pages=n1308}}

Several alternate therapies such as vitamin E treatment have been studied, though without control groups. Most doctors do not value those treatments.[http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21598 Proposed Natural Treatments for Dupuytren's Contracture, EBSCO Complementary and Alternative Medicine Review Board, 2 February 2011] {{webarchive|url=https://web.archive.org/web/20110723134133/http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21598 |date=23 July 2011 }}. Date February 2011. None of these treatments stops or cures the condition permanently. A 1949 study of vitamin E therapy found that "In twelve of the thirteen patients there was no evidence whatever of any alteration. ... The treatment has been abandoned."{{Cite journal|url=http://dupuytrens.org/DupPDFs/1949_King.pdf|title=Vitamin E therapy in Dupuytren's contracture - Examination of the Claim that Vitamin Therapy is Successful|last=King|first=Raymond A|journal=The Bone & Joint Journal|volume=31B|issue=3|date=August 1949|page=443}}[http://www.dupuytren-online.info/dupuytren_anecdotal.html Therapies for Dupuytren's contracture and Ledderhose disease with possibly less benefit, International Dupuytren Society, 19 January 2011] {{Webarchive|url=https://web.archive.org/web/20110314135156/http://www.dupuytren-online.info/dupuytren_anecdotal.html |date=14 March 2011 }}.

Laser treatment (using red and infrared at low power) was informally discussed in 2013 at an International Dupuytren Society forum,{{Cite web|url=http://www.dupuytren-online.info/Forum_English/board/other-therapies/cold-laser-treatment-2_35_3.html|title=Cold Laser Treatment|date=28 March 2009 – 22 May 2013|url-status=live|archive-url=https://web.archive.org/web/20131109052623/http://www.dupuytren-online.info/Forum_English/board/other-therapies/cold-laser-treatment-2_35_3.html|archive-date=9 November 2013|website=International Dupuytren Society online forum}} as of which time little or no formal evaluation of the techniques had been completed. In 2021 improvement of Dupuytren's disease in a single patient by treatment with a fractionated CO₂ laser was reported.{{cite journal | last=Rivers | first=Jason K. | last2=Zarbafian | first2=Misha | title=Improvement of Dupuytren Disease After Treatment With a Fractionated CO₂ Laser | journal=Dermatologic Surgery | volume=47 | issue=1 | date=2021 | issn=1076-0512 | doi=10.1097/DSS.0000000000002159 | pages=153–154}}

Postoperative care involves hand therapy and splinting. Hand therapy is prescribed to optimize post-surgical function and to prevent joint stiffness. The extent of hand therapy is depending on the patient and the corrective procedure.{{Cite journal|last=Turesson|first=Christina|date=2018-08-01|title=The Role of Hand Therapy in Dupuytren Disease|url=https://www.sciencedirect.com/science/article/pii/S0749071218300362|journal=Hand Clinics|language=en|volume=34|issue=3|pages=395–401|doi=10.1016/j.hcl.2018.03.008|pmid=30012299|s2cid=51651115|issn=0749-0712}}

Besides hand therapy, many surgeons advise the use of static or dynamic splints after surgery to maintain finger mobility. The splint is used to provide prolonged stretch to the healing tissues and prevent flexion contractures. Although splinting is a widely used post-operative intervention, evidence of its effectiveness is limited,{{cite journal |doi=10.1186/1471-2474-9-62 |pmid=18447898 |pmc=2386788 |title=Splinting after contracture release for Dupuytren's contracture (SCoRD): Protocol of a pragmatic, multi-centre, randomized controlled trial |journal=BMC Musculoskeletal Disorders |volume=9 |page=62 |year=2008 |last1=Jerosch-Herold |first1=Christina |last2=Shepstone |first2=Lee |last3=Chojnowski |first3=Adrian J. |last4=Larson |first4=Debbie |doi-access=free }} leading to variation in splinting approaches. Most surgeons use clinical experience to decide whether to splint.{{cite journal |doi=10.1186/1471-2474-9-104 |pmid=18644117 |pmc=2518149 |title=Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: A systematic review |journal=BMC Musculoskeletal Disorders |volume=9 |page=104 |year=2008 |last1=Larson |first1=Debbie |last2=Jerosch-Herold |first2=Christina |doi-access=free }} Cited advantages include maintenance of finger extension and prevention of new flexion contractures. Cited disadvantages include joint stiffness, prolonged pain, discomfort, subsequently reduced function and edema.

A third approach emphasizes early self-exercise and stretching.

Dupuytren's disease has a high recurrence rate, especially when a person has so-called Dupuytren's diathesis. The term diathesis relates to certain features of Dupuytren's disease, and indicates an aggressive course of disease.{{cite journal |doi=10.1016/j.jhsa.2006.09.006 |pmid=17145383 |title=Dupuytren's Diathesis Revisited: Evaluation of Prognostic Indicators for Risk of Disease Recurrence |journal=The Journal of Hand Surgery |volume=31 |issue=10 |pages=1626–34 |year=2006 |last1=Hindocha |first1=Sandip |last2=Stanley |first2=John K. |last3=Watson |first3=Stewart |last4=Bayat |first4=Ardeshir |s2cid=21211060 }}

The presence of all new Dupuytren's diathesis factors increases the risk of recurrent Dupuytren's disease by 71%, compared with a baseline risk of 23% in people lacking the factors. In another study the prognostic value of diathesis was evaluated. It was concluded that presence of diathesis can predict recurrence and extension.{{cite journal |doi=10.1016/j.jhsb.2004.06.004 |pmid=15336743 |title=An objective method to evaluate the risk of recurrence and extension of Dupuytren's disease |journal=The Journal of Hand Surgery|volume=29 |issue=5 |pages=427–30 |year=2004 |last1=Abe |first1=Y. |s2cid=27542382 }} A scoring system was made to evaluate the risk of recurrence and extension, based on the following values: bilateral hand involvement, little-finger surgery, early onset of disease, plantar fibrosis, knuckle pads, and radial side involvement.

Minimally invasive therapies may precede higher recurrence rates. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.{{citation needed|date=January 2017}}

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• Chelsea Handler (born 1975), American comedian, actress and writerDana Leigh Smith: [https://www.womenshealthmag.com/health/a19948887/hand-trouble-it-might-be-this/ Hand Trouble? It Might Be THIS], womenshealthmag.com, May 8, 2013
• Tim Herron (born 1970), American golfer{{cite web|url=https://www.pgatour.com/beyond-the-ropes/2018/11/06/tim-herron-dupuytrens-contracture.html|title=Herron dealing with early stages of Dupuytren's contracture| author= Helen Ross|website=PGATour| date= November 6, 2018}}
• Prince Joachim of Denmark (born 1969){{cite news | url=http://www.herognu.com/nyheder/nyheder/Joachim-opereret-for-krumme-fingre/ | work=HER&NU | title=Joachim opereret for krumme fingre | date=March 17, 2013 | archive-url=https://web.archive.org/web/20131029191647/http://www.herognu.com/nyheder/nyheder/Joachim-opereret-for-krumme-fingre/ | archive-date=October 29, 2013 }}
• Joanne Harris (born 1964), British author[http://www.springgroup.org/medical-professionals/articles/new-treatment-straightens-bent-fingers-without-surgery New Treatment Straightens Bent Fingers without Surgery] {{Webarchive|url=https://web.archive.org/web/20220814122700/http://www.springgroup.org/medical-professionals/articles/new-treatment-straightens-bent-fingers-without-surgery |date=2022-08-14 }}, springgroup.org
• Jonathan Agnew (born 1960), English cricketerJonathan Agnew: [https://www.telegraph.co.uk/health-fitness/body/viking-ancestry-nearly-cost-hands/ How my Viking ancestry nearly cost me my hands], telegraph.co.uk, 27 July 2017
• John Elway (born 1960), American football player{{cite web|url=https://www.sportingnews.com/us/nfl/news/broncos-john-elway-opens-up-about-15-year-battle-with-debilitating-hand-condition/d3e1vlhsfn7m1gs3kxzuef8yq|title=Broncos' John Elway opens up about 15-year battle with debilitating hand condition|work=Sporting News|date=August 22, 2019|author=Chelsea Howard|access-date=August 23, 2019|archive-date=August 23, 2019|archive-url=https://web.archive.org/web/20190823000120/https://www.sportingnews.com/us/nfl/news/broncos-john-elway-opens-up-about-15-year-battle-with-debilitating-hand-condition/d3e1vlhsfn7m1gs3kxzuef8yq}}
• Nanci Griffith (1953–2021), American singer, guitarist, and songwriter{{cite news | url=https://www.nytimes.com/2012/03/01/arts/01iht-griffith01.html| work=The New York Times | title=Politics Sung With a Texas Kick | first=David | last=Belcher | date=February 29, 2012 | url-status=live | archive-url=https://web.archive.org/web/20210815203433/https://www.nytimes.com/2012/03/01/arts/01iht-griffith01.html | archive-date=August 15, 2021 }}{{cite news | url=https://www.theguardian.com/music/2021/aug/15/nanci-griffith-obituary| work=The Guardian | title=Nanci Griffith obituary | first=Adam | last=Sweeting | date=August 15, 2021 | url-status=live | archive-url=https://web.archive.org/web/20210816005614/https://www.theguardian.com/music/2021/aug/15/nanci-griffith-obituary | archive-date=August 16, 2021 }}
• Bill Murray (born 1950), American actor and comedian[https://dupuytrens.org/homepage/ Dupuytren Disease and the Dupuytren Research Group] {{Webarchive|url=https://web.archive.org/web/20220619205143/https://dupuytrens.org/homepage/ |date=2022-06-19 }}, dupuytrens.org
• Bill Nighy (born 1949), British actor{{cite web | url=https://www.theguardian.com/film/2015/feb/08/bill-nighy-interview-second-best-exotic-marigold-hotel | work=The Guardian | title=Bill Nighy: 'I'm greedy for beauty' | first=Nigel | last=Farndale | date=February 8, 2015 | access-date=March 23, 2017 | url-status=live | archive-url=https://web.archive.org/web/20170323083844/https://www.theguardian.com/film/2015/feb/08/bill-nighy-interview-second-best-exotic-marigold-hotel | archive-date=March 23, 2017 }}
• Mitt Romney (born 1947), American politician
• Misha Dichter (born 1945), American pianist{{cite news | url=https://www.nytimes.com/2010/03/16/business/16hand.html | work=The New York Times | title=Triumph for Drug to Straighten Clenched Fingers | first=Andrew | last=Pollack | date=March 15, 2010 | url-status=live | archive-url=https://web.archive.org/web/20100318044902/http://www.nytimes.com//2010//03//16//business//16hand.html | archive-date=March 18, 2010 }}
• José Feliciano (born 1945), Puerto Rican musician, singer and composerJoe Bosso: [https://www.guitarplayer.com/players/jose-feliciano-on-the-enduring-ecstasies-of-guitar-playing José Feliciano on the Enduring Ecstasies of Guitar Playing], guitarplayer.com, May 8, 2020
• Bill Frindall (1939–2009), English cricket player and statistician, who had a finger amputatedJonathan Agnew, Aggers' Ashes (London, 2011), page 103
• David McCallum (1933–2023), Scottish/British actor and musician[https://www.imdb.com/name/nm0564724/bio David McCallum], imdb.com
• Paul Newman (1925–2008), American actor and film director[https://www.sun-sentinel.com/sfl-mtblog-2014-07-local_md_will_speak_on_crippli-story.html "Local MD Will Speak on Crippling Hand Disease Which Affects Many Seniors,"] Sun-Sentinel, July 15, 2014
• Margaret Thatcher (1925–2013), Prime Minister of the United Kingdom
• Ronald Reagan (1911–2004), American President and actor[https://www.chicagotribune.com/2010/03/17/drug-approved-to-treat-hand-crippling-syndrome/ Drug Approved to Treat Hand-Crippling Syndrome], Delthia Ricks, Chicago Tribune, March 17, 2010.
• Andrew Wyeth (1917–2009), American visual artist
• Frank Sinatra (1915–1998), American singer, actor, and producer{{cite book|url=https://books.google.com/books?id=BBm6CgAAQBAJ&q=%22Frank+Sinatra%22+%22Dupuytren%27s%22&pg=PT414 |title=Frank Sinatra: An Extraordinary Life |last=Leigh |first=Spencer |publisher=McNidder and Grace Limited |date=2015 |isbn=978-0-85716-088-1 |access-date=2020-01-18}}
• Samuel Beckett (1906–1989), Irish novelist, poet and playwright
• Max Planck (1858–1947), German theoretical physicist and Nobel Prize laureate
• Tommy Lee (Born 1962), American drummer{{Cite web|url=https://people.com/tommy-lee-twirls-drumsticks-again-after-hand-surgery-have-my-life-back-8584641|title=Tommy Lee Reveals He Can Twirl Drumsticks Again in Update After Hand Surgery: 'I Have My Life Back'|website=Peoplemag}}
• Ally McCoist (Born 1962), Scottish footballer{{Cite web|url=https://www.bbc.co.uk/news/articles/cn42rpy4n1zo|title=Ally McCoist reveals incurable hand condition|website=BBC}}

{{colend}}

{{reflist}}

{{Medical resources

| DiseasesDB = 4011

| ICD10 = {{ICD10|M|72|0|m|70}}

| ICD9 = {{ICD9|728.6}}

| ICDO =

| OMIM = 126900

| MedlinePlus = 001233

| eMedicineSubj = med

| eMedicineTopic = 592

| eMedicine_mult = {{eMedicine2|orthoped|81}} {{eMedicine2|plastic|299}} {{eMedicine2|pmr|42}} {{eMedicine2|derm|774}}

| MeshID = D004387

}}

{{Soft tissue disorders}}

{{Educational assignment}}

{{Authority control}}

Category:Disorders of fascia

Category:Rare diseases

Category:Wikipedia emergency medicine articles ready to translate

Category:Soft tissue disorders

Category:Wikipedia medicine articles ready to translate