Treatment

Each patient should be assessed individually and the extent of the disability should be noted, especially how it affects normal day to day activity and work.

People who have static Dupuytren's disease with minimal contractures and without significant loss of function will not require treatment and can be managed expectantly. (1) Surgical intervention is considered in patients with significant functional disability. (1)

Joint contractures become irreversible (when the ligaments remodel in the contracted position) in patients with longstanding deformity. This is especially seen in patients with proximal interphalangeal joint contracture and the patient should be referred to a specialist at the first sign of such contracture (1).

Conservative or non-operative management

• there is no current evidence to support the use of stretching to prevent contractures (2)
• the injection of Dupuytren nodules with triamcinolone acetonide monthly for up to 5 months or every 6 weeks for 3 injections has been shown to produce significant regression of the disease, with an average of 3 injections per nodule required for improvement of function. After corticosteroid injection, fewer patients progress to surgery than would be predicted with expectant management alone. (3)
• intralesional injections of gamma-interferon may help in reducing the size of the lesions
• injection of clostridial collagenase into the nodules and cords causing lysis and rupture of digital cords have been shown to be effective (5). However, at the end of 2019 collagenase was withdrawn from the European market, having already been discontinued in Australia and Asia. This was for commercial reasons, and not related to any safety or efficacy concerns.
• needle fasciotomy (6)
  • used in the elderly or frail
  • contractures in the palm or the fingers are divided using a blade or the bevel of a needle
  • aim of procedure is to break the band or partially section it so the finger can be extended causing the fibrous band to snap (7)
  • complications of the procedure include – skin breaks, localized pain, nerve and tendon injuries and infection (7)

Surgical management

• indications for surgical intervention include metacarpophalangeal joint contracture of 30°, any degree of proximal interphalangeal joint contracture or if the deformity is progressive
• there is no evidence that one treatment is superior to others (8)
• surgical option include; (4)
  • limited fasciectomy – most popular technique, only the involved fascia is excised leaving the overlying skin.
  • radical fasciectomy – extensive removal of all palmar fascia
  • dermofasciectomy – the diseased fascia and overlying skin are removed, skin grafts can be used to cover the wound
  • amputation – indicated in severe cases, those with delayed presentation, in recurrence or severe contractures affecting the little finger
    • however, if the contraction is long-standing, there may be secondary changes in the interphalangeal joints preventing finger extension even after excision of the fibrosed tissue.
    • in surgery of Dupuytren’s disease, recurrence rates and prognosis vary depending on the extent of cord resection
    • needle fasciotomy (4)
      • highest recurrence rates 43% at three year follow-up, 85% at five year follow-up
      • most patients recover quickly and are able to return to normal daily activity within 10 days of the procedure
    • fasciectomy
      • recurrence rate of 20.9% at five years
      • most patients returning to work at four to six weeks
    • dermofasciectomy
      • recurrence rate of 8.4% at a mean follow-up of 5.8 years
      • average time of return to work at 8.5 weeks

Restoration of painless hand function is encouraged by postoperative splintage and physiotherapy. However, although a night splint is normally worn for three months following surgery there is now some possible evidence that this practice may adversely affect outcome and further trials are needed. (8)

According to the British society for surgery of the hand recommendations, treatment of Dupuytren’s disease and contracture can be divided according to the severity of the disease; (9)

• mild
  • reassure
  • observe
• moderate
  • needle fasciotomy if appropriately trained; for metacarpophalangeal joint contractures
  • possibly collagenase
  • refer for surgery – limited fasciotomy
• severe
  • refer for surgery
    • limited fasciectomy
    • dermofasciectomy

Reference

1. Townley WA, Baker R, Sheppard N, et al. Dupuytren's contracture unfolded. BMJ. 2006;332:397-400.
2. Harvey LA, Katalinic OM, Herbert RD, et al. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev. 2017;(1):CD007455.
3. Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000 Nov;25(6):1157-62.
4. Boe C, Blazar P, Iannuzzi N. Dupuytren contractures: an update of recent literature. J Hand Surg Am. 2021 Oct;46(10):896-906.
5. Sandler AB, Scanaliato JP, Dennis T, et al; Treatment of Dupuytren's Contracture With Collagenase: A Systematic Review. Hand (N Y). 2022 Sep;17(5):815-824.
6. NICE. Needle fasciotomy for Dupuytren's contracture. Interventional procedures guidance IPG43. Published February 2004
7. Diaz R, Curtin C; Needle aponeurotomy for the treatment of Dupuytren's disease. Hand Clin. 2014 Feb;30(1):33-8.
8. Rodrigues JN, Becker GW, Ball C, et al; Surgery for Dupuytren's contracture of the fingers. Cochrane Database Syst Rev. 2015 Dec 9;(12):CD010143.
9. British Society for Surgery of the Hand (BSSH). BSSH Evidence for Surgical Treatment 1. Dupuytren’s disease. Online. 2025