Can Dupuytren's contracture be treated without surgery?
- Jun 2
- 5 min read
If you have been diagnosed with Dupuytren's contracture, surgery is often the first treatment mentioned. For moderate to severe cases, it is the most reliable way to straighten the fingers and restore function. But not everyone with Dupuytren's needs surgery, and some patients with early or mild disease have other options available to them.
This guide explains when non-surgical approaches are appropriate, what they involve, and how to decide which option is right for you.
Does Dupuytren's always need to be treated?
Not necessarily. In the early stages, Dupuytren's often requires no treatment at all. If you have a firm nodule in the palm but your fingers can still be straightened fully, the most appropriate course of action is usually to monitor the condition and review it periodically.
A simple test called the tabletop test can give you a useful guide: if you can place your hand flat on a table, treatment is unlikely to be needed urgently. When the condition has progressed to the point where one or more fingers are bent and cannot be fully straightened, treatment becomes more relevant.
Dupuytren's contracture without surgery: the options
Needle fasciotomy (needle aponeurotomy)
Needle fasciotomy is a minimally invasive procedure in which a needle is used to divide and break up the thickened Dupuytren's cord. It is performed under local anaesthetic and takes around 20 to 30 minutes. There is no incision and no stitches are required. Recovery is quick: most patients can use the hand for light activities within a day or two.
The main limitation of needle fasciotomy is that it is less suitable for severe contractures or for cords that are very close to the digital nerves. It also has a higher recurrence rate than surgical removal of the cord. Studies suggest that a significant proportion of patients need a repeat procedure within five years. It is most appropriate for early to moderate contractures in selected patients.
Collagenase injection (Xiapex)
Collagenase clostridium histolyticum, sold under the brand name Xiapex, is an enzyme that can be injected directly into the Dupuytren's cord. The enzyme weakens the collagen in the cord, making it easier to break. The day after the injection, the surgeon manipulates the finger to rupture the cord, straightening the finger.
Collagenase injection is a non-surgical option that can be effective for single cord contractures, particularly those affecting the metacarpophalangeal joint (the knuckle joint at the base of the finger). It is less effective for proximal interphalangeal joint (middle joint) contractures. Side effects include swelling, bruising and pain at the injection site, and in a small number of cases the tendon itself can be affected.
It is worth noting that the availability of collagenase injection has varied in the UK, and it may not be available at all centres. Your surgeon will advise whether it is a suitable option for you.
Splinting
Splinting alone does not treat Dupuytren's contracture and will not straighten a bent finger caused by this condition. However, splints are sometimes used after surgical or non-surgical treatment to help maintain the position of the straightened finger during the recovery period. Night splinting is particularly useful in the early post-treatment phase.
Physiotherapy and exercises
Stretching exercises and physiotherapy will not reverse Dupuytren's contracture. The condition is caused by changes in the connective tissue of the palm, which cannot be corrected by exercise. However, physiotherapy plays an important role after treatment, helping to restore movement, strength and function to the hand.
When is surgery the right choice?
Surgery, specifically a fasciectomy in which the thickened cords and affected tissue are removed from the palm, remains the most effective treatment for moderate to severe Dupuytren's contracture (also known as Viking disease). It provides the most complete correction and has better long-term durability than non-surgical options.
Surgery is generally recommended when the finger contracture is significant enough to affect daily activities such as gripping, shaking hands or laying the hand flat. Your surgeon will consider the degree of contracture, which joints are involved, your age and general health, your occupation and hobbies, and your preferences before recommending a course of action.
Which option is right for you?
There is no single answer that applies to everyone. The right approach depends on how advanced your Dupuytren's is, how much it is affecting your day-to-day life, and your personal priorities. It is also often be confused with Trigger Finger. Some patients prefer the quicker recovery of needle fasciotomy even knowing it carries a higher recurrence rate. Others prefer the more definitive result offered by surgery.
A consultation with a specialist hand surgeon is the best way to understand your options and make an informed decision on whether you can recover from Dupuytren's contracture without surgery - or if surgery is the best course of action. Mr Rikki Mistry sees patients across East Grinstead, Chatham and Tunbridge Wells and will take the time to explain all available options in the context of your specific situation.
FAQ
Can Dupuytren's contracture go away on its own?
Dupuytren's contracture does not resolve on its own. It is a progressive condition, which means it tends to worsen over time, though the rate of progression varies greatly between individuals. Some people experience only slow progression over many years, while others see more rapid worsening. Early-stage disease may remain stable for some time, but it will not reverse without treatment.
How long does needle fasciotomy take and what is recovery like?
The procedure typically takes 20 to 30 minutes and is performed under local anaesthetic. Most patients experience minimal downtime and can use the hand for light activities within a day or two. There may be some bruising and soreness for a few days. The finger should be noticeably straighter immediately after the procedure.
How often does Dupuytren's come back after needle fasciotomy?
Recurrence rates following needle fasciotomy are higher than those following full surgical fasciectomy. Studies suggest that a significant proportion of patients will need a repeat procedure within five years. This does not mean needle fasciotomy is the wrong choice: for patients with early disease who prefer a quicker recovery, it can be very appropriate. Your surgeon will help you weigh the trade-offs.
Is collagenase injection available on the NHS?
Collagenase injection has had variable availability on the NHS and may not be funded in all areas. It is available as a private treatment option. Your surgeon can advise on current availability and whether you are a suitable candidate for the procedure.
What happens if Dupuytren's contracture is left untreated?
If left untreated, Dupuytren's contracture will typically progress. The fingers may become increasingly bent and less functional over time. Very advanced contracture can be more difficult to treat surgically, which is one reason why seeking an assessment earlier rather than later is advisable if your fingers are starting to curl.
Mr Rikki Mistry is a Consultant Plastic Surgeon specialising in Dupuytren's contracture surgery at clinics in East Grinstead, Chatham and Tunbridge Wells. To arrange a private consultation, call 0330 1331 464 or visit rikkimistry.com/contact.
