[Noah930]

Couple other thoughts:

Usually we only recommend intervention once you've got some finger contracture. But if the Dupuytren's disease is painful, that can warrant surgery even without finger contracture, because that's affecting function of the hand.

In the collagenase injection, because we're still leaving behind the majority of the Dupuytren's disease, recurrence can be an issue, as it is with needle aponeurotomy.

You wonder why we don't just cut the stuff out before it starts causing problems of contracture. The literature says that if you one day need a repeat procedure--a revision, because of recurrence of Dupuytren's, then repeat surgery averages a 50% nerve injury rate. That's permanent numbness, effectively, to half of a finger (or two halves of two fingers, depending on which part of the nerve gets accidentally cut). Once surgery gets done and scarring takes place, the locations of the digital nerves may not be where they normally should be. Scar tissue can wrap around the nerves. So repeat surgery is a bit of a minefield, with regards to potential for nerve damage (accidentally cutting a nerve). Why put yourself at higher risk for future nerve damage potential by doing a Dupuytren's surgery if there is no finger contracture yet? So we usually don't cut it out unless there's a contracture necessitating it.