What non-surgical management options are available for patients with Dupuytren's contracture, and how effective are they?

Non-surgical management options for Dupuytren's contracture include:

• Observation and reassurance: For people with Dupuytren's disease who do not have contracture or significant loss of function, no treatment is necessary. Patients should be informed about the progressive nature of the condition and advised to return for review if contracture develops, as referral for surgical management is then recommended.
• Corticosteroid injections: These may be considered for people with painful nodules without contracture or loss of function. Corticosteroid injections can soften or flatten nodules and may reduce progression to surgery in the short term. However, about 50% of patients experience recurrence within 3 years after the last injection, and there is a lack of high-quality evidence supporting their routine use. Such treatment decisions should be made after evaluation by a hand specialist rather than in primary care.
• Radiation therapy: This is only recommended under special arrangements for clinical governance, consent, audit, or research due to limited evidence and expert opinion supporting its use.

Effectiveness: Observation is appropriate when no contracture or functional loss is present. Corticosteroid injections may provide short-term improvement in nodules and delay progression but have a high recurrence rate and lack robust evidence. Radiation therapy is not routinely recommended outside research settings. Overall, non-surgical options have limited evidence of long-term effectiveness, and early referral to a specialist is advised when contracture or functional impairment develops.

Therefore, non-surgical management mainly involves monitoring and symptomatic treatment of nodules with corticosteroids in selected cases, with surgical referral recommended once contracture or functional loss occurs.

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