Dupuytren Decision Guide

Patient decision aid

Make a decision about your Dupuytren's

There is no cure yet for Dupuytren's disease. Treatment can help straighten your fingers and may improve the use of your hand, but it does not get rid of the disease. This tool helps you weigh the risks and benefits of each option so you can talk it through with your healthcare professional.

Palm with a thickened Dupuytren's cord pulling a finger toward the palm

What is Dupuytren's?

Dupuytren's affects the tissue under the skin of your palm or fingers called the fascia. The fascia becomes thicker and less flexible. Over months or years, it can make your fingers bend towards your palm — this bending is called a contracture. It can sometimes be uncomfortable or painful.

How it progresses

1A small hard lump (nodule) appears in the palm.
2Nodules thicken into a cord that restricts finger movement.
3Fingers bend towards the palm. Surgery is usually an option when a finger is bent over 30° and you can't put your hand flat on a table.

People with Dupuytren's you might know

More common than you might think

Up to one in four men of Northern European descent over 60 develops Dupuytren's — which is why it picked up the nickname "the Viking disease". It has nothing to do with how hard you work with your hands: prime ministers, presidents, Olympic rowers and concert pianists have all had it, and most carried on with their careers.

John Elway

NFL Hall of Fame quarterback

Both ring fingers contracted over about 15 years until he could barely grip a football. The first hand specialist he saw presented surgery as the only option — and having already been through countless operations as a player, he wanted no part of another one.

Collagenase (Xiaflex) injections

His contractures were released without an operation. He now speaks publicly about the condition after meeting many people who had the symptoms but no idea what they were.

Margaret Thatcher

Prime Minister of the United Kingdom

Had surgery on her right hand at the age of 60. Dupuytren's is diagnosed far more often in men, so her case made the point that this is not a workplace injury or a male-only condition.

Surgical fasciectomy

The contracture returned after the operation — a reminder that surgery lowers the risk of recurrence but does not remove it.

Bill Nighy

Actor — Love Actually, Living

Both hands are affected; his ring and little fingers curl into his palms. He noticed the first symptoms in his twenties and says he probably should have had surgery then, but didn't — partly out of fear, partly because life got busy.

No procedure

He has kept working at the top of his profession for decades, describing his 'spooky handshake' with dry humour. Younger actors assumed the curled fingers were a deliberate stylistic choice.

Sir Steve Redgrave

Five-time Olympic rowing champion

Won gold at five consecutive Olympic Games from 1984 to 2000 while managing Dupuytren's, along with type 2 diabetes and ulcerative colitis. The condition stops him flattening his hands completely.

No procedure

He adapted rather than operating, and was still taking on physically demanding challenges — including Dancing on Ice — in his sixties.

Misha Dichter

Concert pianist

Had a family history of the disease — his father had it too. He first noticed something was wrong when he could no longer stretch his hand far enough to reach all the keys.

Surgery in 2007, then hand therapy

After surgery and a course of therapy he returned to the piano in top form — the case that shows what a full recovery can look like for a profession that depends entirely on the hands.

Dave Mustaine

Founder and guitarist, Megadeth

Showed interviewers the visible cord forming in his palm and the finger already being pulled down, on top of arthritis in his fingertips. He reasoned that operating from a position of 95% function risked leaving him worse off.

Surgery deferred

He chose to finish a farewell tour first and consider an operation afterwards — a deliberate decision about timing rather than a refusal of treatment.

Every one of them made a different call

Some had surgery, some chose an injection, some did nothing at all and adapted, and one deliberately waited for the right moment. There is no single correct answer — the right choice depends on how much the contracture limits you, how you weigh a longer recovery against a lower chance of coming back, and what you want to get back to doing. That is exactly what the weighting tool above is for.

Also publicly reported

Ronald Reagan · Frank Sinatra · David McCallum · Ally McCoist · Mitt Romney · Bill Murray · Tommy Lee · Max Planck

These names are reported as having Dupuytren's, but there is no reliable public account of how they were treated, so nothing is claimed here about their care.

Where these accounts come from

Is it bad enough to treat?

Answer a few questions to see whether your Dupuytren's is at a stage where treatment is usually considered.

Can you put your hand completely flat on a table?

This is the 'tabletop test'. Place your palm and affected finger(s) flat on a tabletop.

What matters to you

What's important to you?

Answer each question to see a preliminary direction. This doesn't replace advice from your healthcare professional.

Step 1

I struggle with daily activities (difficulty gripping, clumsiness).

I think the benefits of a procedure are worth having treatment.

I would like a procedure even though my contracture could come back.

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Compare the options

Tap any option to see its benefits, recurrence rates, risks, and recovery time — all figures are out of 100 people.

Recurrence: head-to-head comparison

How often the contracture comes back, across the three main procedures.

Systematic review of prospective studies, 1,411 patients, 1,698 joints, mean 3.8-year follow-up (Nocek et al. 2026, J Hand Surg Glob Online — PubMed PMID 41853763).

Limited fasciectomy16.5% recurrence

Collagenase (Xiaflex)32.5% recurrence

Needle aponeurotomy46.4% recurrence

Takeaway: limited fasciectomy (open surgery) has the lowest recurrence, collagenase injection sits in the middle, and needle aponeurotomy has the highest recurrence — but recurrence is only one factor. Recovery time, cost, and your own preferences matter too. PIP (second finger joint) contractures recur more often than MCP (first joint) ones regardless of treatment.

Compare the costs

What each option costs

Direct medical costs in US dollars, per treated finger. These come from published cost analyses and hospital databases — the actual price you're quoted will depend on your insurer, your hospital, and how many fingers are treated.

Cost of the first treatment

Needle fasciotomy$624

Collagenase injection$4,189

Fasciectomy$5,291

Needle fasciotomy costs roughly one-eighth of a fasciectomy, because it is done in the office with no drug and no operating theatre.

Total cost by year 5

Needle fasciotomy$1,540

Fasciectomy$5,507

Collagenase injection$5,952

Once repeat treatments are included, the order changes. Collagenase ends up the most expensive option — its higher recurrence rate means more procedures.

A cheap procedure isn't always the cheaper path. In the largest costed cohort, needle fasciotomy needed repeat treatment in 61 of 100 fingers by 5 years, collagenase in 55, and fasciectomy in just 4. Even so, needle fasciotomy stayed the least expensive option overall.

All six options, and what the price covers

Do nothing

No procedure. Occasional clinic reviews and monitoring only — no charge beyond a normal appointment.

Not applicable.

Needle fasciotomy

$624 – $3,335

An in-office procedure with no drug cost and no operating theatre. Price covers the surgeon's fee and follow-up.

Usually covered as an office procedure, so the patient share is comparatively small.

Collagenase injection

$3,673 – $4,454

The drug itself dominates the bill (historically over $3,000 per vial), plus the injection visit and the follow-up manipulation appointment.

Often covered but frequently requires prior authorization. Patient cost varies widely and is the highest of the three studied options.

Fasciectomy

$3,395 – $5,291

Surgeon's fee, operating theatre time, anaesthesia, dressings and a course of hand therapy afterwards.

Typically covered when the contracture is symptomatic and limits hand function.

Dermofasciectomy

No published estimate

Bundles a fasciectomy with a full-thickness skin graft and longer operating time, so it is billed above a standard fasciectomy.

Covered when clinically indicated, usually for recurrent disease or where skin is involved.

Not included in the published cost comparisons — no comparable figure exists yet.

Radiotherapy

No published US estimate

A course of low-dose radiation, typically around 10 outpatient fractions, with no surgery or anaesthesia.

Rarely covered by US insurance for Dupuytren's, so it is usually paid for out of pocket.

Not included in the published cost comparisons — no comparable figure exists yet.

Why the published numbers disagree so much

• What's counted. Some studies report only the procedure; others include hand therapy, follow-up visits and repeat treatment.
• Price basis. Medicare-standardised costs sit far below what hospitals actually bill, and uninsured patients can be charged more again.
• Country. Studies from Denmark, the Netherlands and Australia report total costs under $2,200 per treatment, well below US figures.
• Drug pricing. Collagenase pricing has changed as generics have entered some markets, so older figures may overstate today's cost.

PubMed sources

Will my insurance cover it?

What each option usually looks like to an insurer, the codes your plan will be checking against, and how to confirm your own benefits.

Your plan — not your diagnosis — decides what is covered. These are the patterns that usually hold for each option, plus the codes your insurer will be looking for. Confirm your own benefits before you book.

No treatment (monitoring)

Usually covered—

No claim to file

There is nothing to authorize. Routine office visits, and any hand therapy you are referred for, are covered the same way as any other visit under Medicare Part B and commercial plans.

Needle fasciotomy

Usually coveredCPT 26040 / 26045

Medicare Part BMost commercial plansMedicaid (state-dependent)

Billed as an in-office procedure rather than surgery, which is why it is the easiest option to insure and the cheapest for your plan. Prior authorization is usually not required; a repeat procedure on the same finger sometimes triggers a review.

Collagenase injection (Xiaflex)

Covered with prior authCPT 20527 + HCPCS J0770

Medicare Part BMost commercial plansTRICARE

Medicare Part B covers the drug as a buy-and-bill medication, and most commercial plans cover it too, but nearly all of them require prior authorization before the first injection. A few plans route the drug through the pharmacy benefit instead of the medical benefit, which changes who supplies it.

Fasciectomy (open surgery)

Covered with prior authCPT 26121 / 26123 / 26125

Medicare Part BMost commercial plansVA / TRICAREMedicaid (state-dependent)

Covered when the record documents a contracture that limits hand function — usually the measured joint angle or a photograph. Many plans ask for that documentation with the prior authorization, and day-surgery vs inpatient changes what you owe.

Dermofasciectomy

Covered with prior authCPT 26123 + skin graft 15240

Medicare Part BMost commercial plansVA / TRICARE

Covered when it is clinically indicated — recurrent disease, aggressive disease, or skin involved in the cord. The skin graft is billed on top of the excision, so the authorization has to cover both codes.

Radiotherapy

Rarely coveredCPT 77261–77799 (course)

Rarely coveredSome Medicare Advantage plans

Most commercial policies classify radiation for Dupuytren's as unproven and deny it; a minority of Medicare Advantage plans and radiotherapy practices do cover low-dose treatment. Assume out of pocket and ask for the price of the full course up front.

Check whether your plan covers it

Look up the procedure in your own plan, then ask the surgeon's billing office to run a predetermination or prior authorization before you are scheduled — that written answer is the one that counts.

Medicare — is it covered?Search any procedure by name or CPT code Aetna membersLog in to see your benefits and prior auth status CignaPrecertification and coverage policies UnitedHealthcareCheck coverage and claims from your member account HumanaCoverage and prior authorization look-ups Blue Cross Blue ShieldFind your local BCBS plan and its coverage rules HealthCare.govCompare marketplace plans and what they cover

Find a surgeon

Once you know which treatment you want, use these free directories and the federal Medicare data to find someone who does it often.

Find a hand surgeon

Not every surgeon performs every option on this page — needle fasciotomy, collagenase injection, fasciectomy and dermofasciectomy are each done by different people at different rates. A hand surgeon (rather than a general orthopaedic or general surgeon) is usually the right person to ask, and both national societies below have free directories.

ASSH — The Hand Society

American Society for Surgery of the Hand

More than 3,000 member hand surgeons across North America. Search by city or ZIP, then open a surgeon's profile for credentials and location.

Find a hand surgeon

AAHS

American Association for Hand Surgery

A second national directory of hand, plastic and orthopaedic surgeons who treat Dupuytren's — handy for cross-checking who is near you.

Search the AAHS directory

Both directories list society members — membership is voluntary, so a surgeon who is not listed may still be excellent. Your primary care doctor, or your insurer's own "find a doctor" tool, can suggest others.

Monitor your condition

Learn to monitor your condition

Dupuytren's usually changes slowly. Monitoring helps you and your clinician decide the right time to act.

Measure the bend

Every few months, try to lay your hand flat on a table. Note which fingers lift off and roughly how much. Your clinician can measure the exact angle at the MCP (first) and PIP (second) joints.

Take photos for comparison

Photograph your hand flat on a table from the same angle every 3–6 months. Side-by-side photos make it much easier to spot slow worsening that's hard to notice week to week.

Track what you struggle with

Jot down daily tasks that have become harder — gripping, washing, putting on gloves, typing, reaching into pockets. This is the clearest sign of whether the disease is starting to impact your life.

Know when to act

Arrange a review when a finger can no longer lie flat on a table (a positive tabletop test) and/or the bend passes about 30°, especially if it's affecting daily activities.

When to seek a review sooner

• A finger is bending more and you can no longer flatten your hand on a table
• The contracture is making everyday tasks difficult or painful
• You notice numbness, tingling, or pins and needles in the finger
• The skin over the cord becomes tight, red, or breaks down

Learn more and get care

This tool is for information only. A hand surgeon can measure your contracture, discuss which options fit your hand, and cover what your insurance will pay.

FeaturedFlagstaff Business News, November 2015

Dr. John H. Flint, M.D.

Wide Awake Hand Surgery

Dr. Flint explains how hand surgery can be done with the patient awake and comfortable. Numbing the hand with lidocaine plus epinephrine stops bleeding without a tourniquet, so there is no need for sedation. Most basic hand procedures can be done this way — no IV line, fewer preoperative tests, none of the grogginess that comes with anaesthesia, and a near-immediate trip home.

“The patient and surgeon truly work as a team to maximize the patient's results.”

Read Dr. Flint's article

Flagstaff Bone & Joint

Fellowship-trained hand, wrist and elbow surgeons in Flagstaff, Kingman and Cottonwood, Arizona — including Dupuytren's contracture surgery, Xiaflex injection and needle fasciotomy.

Visit the practice

What is Dupuytren's contracture?

A plain-language explanation of the condition, why the fibrous tissue thickens, and the treatment options available — from the practice's patient education library.

Read the article

Advancing Hand Surgery: WALANT Procedures

Dr. Derek B. Smith's later Flagstaff Business News column on the same wide-awake technique, including Dupuytren's contracture release.

Read in Flagstaff Business News

This is a decision aid, not medical advice

The figures here come from the NHS England patient decision aid and are meant to help you prepare for a conversation with your healthcare professional. They will consider your age, the severity of your disease, and your personal circumstances before recommending a treatment.