Dupuytren’s disease: achieving a balance between treatment, overtreatment and non-treatment

INTRODUCTION: Dupuytren's disease is characterized by a highly variable presentation and progression. Notably, minimal manifestations such as nodules do not invariably evolve into contractures with significant functional impairment. These unrecognized variability raises important concerns regarding patient anxiety and the risk of overtreatment.Current staging systems:Staging systems that focus primarily on angular deformity demonstrate limited correlation with functional impairment. They fail to reliably predict treatment necessity, clinical impact, therapeutic outcomes or risk of recurrence. This discrepancy highlights the limitations of relying solely on extension deficit as a clinical decision-making criterion. Moreover, patient-reported assessments, while valuable, have not consistently enhanced prognostic accuracy. Similarly, alternative staging approaches, such as histologic classification, have not demonstrated consistent predictive value for disease progression or treatment outcomes.Achieving balance in classifications and treatment:The heterogeneity of Dupuytren's disease progression is critically evaluated to highlight the shortcomings of existing staging frameworks. We emphasize the importance of moving beyond rigid classification systems toward more nuanced, individualized treatment strategies. CONCLUSIONS: Achieving an appropriate balance between no treatment and treatment, whilst avoiding and over-treatment is essential, ensuring that interventions are reserved for cases where they are truly warranted, while avoiding unnecessary procedures that may not improve, and could even potentially compromise patient outcomes as well as waste scarce healthcare resources. Recognizing the complex interplay between anatomical findings and functional impact is key to optimizing patient-centred care and supporting informed, judicious clinical decisions in the management of Dupuytren's disease. LEVEL OF EVIDENCE: V.