Dupuytren's Contracture

Dupuytren's contracture is a hand surgeon's domain. The American Society for Surgery of the Hand (assh.org) has a Find a Hand Surgeon tool.

Treatment eligibility for Xiaflex depends on having ≥30 degrees of contracture. Get your finger measured and documented at baseline.

Many patients aren't offered Xiaflex because not all hand surgeons perform it. Ask specifically: 'Am I a candidate for Xiaflex?' It's FDA-approved, covered by insurance, done in-office, and avoids surgery.

Dupuytren's is easier to treat before it becomes Stage III/IV. If you notice progression, schedule evaluation sooner rather than later.

The exact cause is unknown, but Dupuytren's is strongly genetic — first-degree relatives of affected patients have a 44–68% lifetime risk. Risk factors include: Northern European ancestry, male sex, age over 50, diabetes (2–3× higher risk), smoking, alcohol use, and manual vibration exposure. It is NOT caused by trauma or overuse.

Early Dupuytren's presents as a small, firm nodule in the palm — often near the base of the ring or little finger. Over months to years, the nodule becomes a fibrous cord that pulls the finger into a bent position you cannot straighten. The table-top test is a simple self-check: if you cannot place your hand flat on a table, you likely have meaningful contracture.

Xiaflex (collagenase injection) is a non-surgical option done in-office — an enzyme dissolves the cord, then the doctor manipulates the finger to break it. Recovery takes days. Surgery (fasciectomy) removes the cord entirely — more effective for severe disease but requires operating room anesthesia and weeks of hand therapy. Recurrence rates at 5 years are comparable for mild-moderate disease.

Yes — Xiaflex is covered by most major commercial insurers and Medicare when contracture is ≥30 degrees at the MCP joint. Prior authorization is typically required. Endo's patient assistance program provides co-pay assistance for eligible commercially insured patients.