Mr Abhinav Gulihar is a distinguished orathopaedic surgeon providing expert care for patients in London and Kent. As a solo practitioner, he specialises in a comprehensive range of hand and wrist conditions, including the surgical treatment of complex wrist fractures such as distal radius fractures.
What Is Dupuytren’s Disease?
Dupuytren’s disease (also known as Dupuytren’s contracture) is a progressive condition of the hand that causes one or more fingers to bend gradually towards the palm. It is caused by thickening and tightening of the palmar fascia, a layer of tissue beneath the skin.
The condition most commonly affects the ring and little fingers, but any finger can be involved. Dupuytren’s disease usually develops slowly over years and is not caused by overuse or injury.
Common Symptoms
- Lumps or nodules in the palm
- Thick cords under the skin
- Difficulty straightening one or more fingers
- Fingers gradually bending towards the palm
Problems with daily activities such as washing your face, shaking hands, or wearing gloves
When Is Treatment Needed?
Early Dupuytren’s disease does not always require treatment. Surgery or intervention is usually considered when the contracture begins to interfere with hand function.
A common guide is the “table-top test”:
If you are unable to place your hand flat on a table, treatment should be considered.
Treatment Options for Dupuytren’s Disease
The choice of treatment depends on:
- Severity of finger bending
- Joints involved
- Speed of progression
- Your functional needs and preferences
Mr Gulihar will discuss the most appropriate option for your individual case.
Needle Aponeurotomy (Needle Fasciotomy)
This is a minimally invasive procedure performed under local anaesthetic.
- A fine needle is used to divide the tight cords through the skin
- No large incision is required
- Best suited for milder contractures, especially at the knuckle (MCP) joint
Advantages
- Very quick procedure
- Rapid recovery (often days)
- Minimal wound care
Limitations
- High recurrence rate (up to 85% at 5 years)
- Less effective for severe or complex contractures
Limited Fasciectomy (Open Surgery)
This is the most established and durable surgical treatment for Dupuytren’s disease.
- An incision is made in the palm and finger
- The diseased fascia and cords are carefully removed
- Allows the fingers to straighten more fully
Advantages
- Best long-term correction
- Lower recurrence rate (around 20–25% at 5 years)
- Suitable for moderate to severe disease
Limitations
- Longer recovery period
- Requires hand therapy and splinting
What to Expect From Surgery
The aim of treatment is to improve finger straightening and hand function. Surgery does not cure Dupuytren’s disease, and recurrence is always possible over time.
Most patients notice:
- Improved finger position
- Better hand function
- Easier grip and daily activities
The amount of correction depends on how severe the contracture was before treatment.
Recovery After Treatment
After Needle Aponeurotomy
- Light activities within 1–2 days
- Minimal dressing
- Hand therapy usually not required
- Night splint may be advised
After Limited Fasciectomy
- Bulky dressing initially
- Stitches removed at ~2 weeks
- Hand therapy is essential
- Splint worn at night for 6–12 weeks
Full recovery may take 3–6 months
Possible Risks and Complications
All procedures carry some risk. Complications are uncommon but may include:
Common or Temporary
- Swelling and bruising
- Stiffness (improves with therapy)
- Scar sensitivity
Less Common
- Infection
- Delayed wound healing
- Persistent stiffness
Nerve or Blood Vessel Injury
- Small nerves lie close to Dupuytren’s cords
- Temporary numbness is possible
- Permanent nerve injury is rare
Recurrence
- Dupuytren’s disease can return after any treatment
- Recurrence is more common after needle procedures
Rare Complications
- Complex Regional Pain Syndrome (CRPS), causing prolonged pain and stiffness
Mr Gulihar will discuss your individual risk profile and how risks are minimised.
Frequently Asked Questions
Is Dupuytren’s disease painful?
It is usually painless, though nodules can sometimes be tender.
Can Dupuytren’s go away on its own?
No. It is a progressive condition, though progression can be slow.
Which treatment is best for me?
This depends on severity, finger involvement, and your priorities. Mr Gulihar will guide you.
Will I regain full finger straightening?
Most patients achieve meaningful improvement, but severe long-standing contractures may not fully straighten.
Can Dupuytren’s come back after surgery?
Yes. Recurrence is possible after any treatment, but is lowest after fasciectomy.
When can I drive again?
Often within days after needle treatment; several weeks after open surgery.
Will I need hand therapy?
Yes after fasciectomy; usually not after needle treatment.
About Mr Abhinav Gulihar
Mr Abhinav Gulihar is a consultant orthopaedic surgeon with a specialist interest in hand and wrist surgery, providing expert care for patients in London and Kent. He offers personalised assessment and evidence-based treatment for Dupuytren’s disease and other hand conditions.
Further Information & Appointments
If Dupuytren’s disease is affecting your hand function or daily life, a specialist consultation can help determine the most appropriate treatment.
To book an appointment with Mr Abhinav Gulihar in London or Kent, please contact the clinic.