Tell me about reatments for Dupuytren's contracture

The short version: no treatment here is proven to cure Dupuytren's, and the best evidence says the cheap needle technique works about as well as the expensive enzyme injection.

For a bent finger, the real question is which procedure buys the most straightening for the least risk and the fewest repeat visits. A randomized trial found needle fasciotomy (a needle poked through the skin to break the cord) and collagenase injection (an enzyme that dissolves the cord) gave no significant difference in outcomes over two years [1]. A systematic review of randomized trials found no clearly superior treatment, with needle work giving higher short-term satisfaction but more recurrence, and the enzyme giving early improvement with more short-lived side effects [2]. A Dutch observational study found similar short-term straightening but better patient-reported hand function and far fewer mild complications with the needle versus open surgery [3].

The enzyme trials were placebo-controlled and industry-shaped, and the review itself notes the trials were too heterogeneous to crown a winner [2]. Long-term recurrence after the needle is the real cost, and open surgery is the durable option at the price of more complications [2][3]. My call: for a first, moderate contracture, needle fasciotomy is a reasonable low-risk start, with surgery reserved for severe or recurrent disease. Confidence: moderate.