Table 1 Clinical staging and grading systems for Dupuytren’s disease

Grade or Stage

0: Small nodules, hand function not affected

1: Hands with a nodule in the palmar fascia not yet involving the skin and causing no contracture of the fingers

1: Fibrosis of palmar fascia without contractures

Proliferative stage: nodules in the palm and fingers

0: Palmar nodules

Early disease: nodules in the palmar fascia without digital contracture

N: Palmar nodule without presence of contracture

As Tubiana

As Tubiana

1: Nodules and cords in the palm and early contracture of MCPJ

2: Nodule in the fascia involving the skin but not causing finger flexion deformity

2: Contractures up to 135° toward the palm

Involutional stage: development of finger flexion contractures

1 point: total digital deformity of ≤60°

Active disease: nodular thickening with associated digital contracture

1: Total flexion deformity (TFD) between 0° and 45°

N/1: TFD 1–5

N/1: TFD 1–10

2: MCPJ contracture up to 30° and early PIPJ contracture

3: Nodule in the palm invading skin plus flexion contracture of one or more fingers

3: Contractures up to 90° toward the palm

Residual stage: cord development and finger contractures with joint changes

2 points: 61 to 120°

Advanced disease: Progressive joint contracture for more than 3 years with diffuse palmar fibrotic thickening

2: TFD between 45° and 90°

1: TFD 6–45

1: TFD 11–45

3: Contracture of IPJs more than 30°

4: Includes all stage 3 cases in which the secondary changes have occurred in the tendons or joints of one or more fingers.

4: Fibrosis of palmar fascia, with flexion deformities of the fingers beyond 90° toward the palm.

3 points: >120

3: TFD between 90° and 135°

As Tubiana

As Tubiana

4: Extreme digital flexion contracture. Sensory and circulatory disturbance

4: TFD greater than 135°

As Tubiana

As Tubiana