New York State Medical Treatment Guidelines for Dupuytren’s Disease in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for managing Dupuytren’s Disease. These directives aim to assist healthcare professionals in identifying appropriate therapeutic approaches within the context of a comprehensive assessment.

Healthcare professionals with expertise in treating Dupuytren’s Disease can depend on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable therapeutic methods for their patients.

It is crucial to emphasize that these guidelines are not meant to substitute clinical judgment or professional expertise. The ultimate decision regarding the management of Dupuytren’s Disease should involve collaboration between the patient and their healthcare provider.

Dupuytren’s Disease Overview

  • Definition: Dupuytren’s disease is a condition affecting the hand characterized by the formation of scar tissue in the palm and fingers, leading to contractures.
  • Factors: It exhibits strong age and hereditary patterns. Associated risks include alcohol consumption, smoking, diabetes mellitus, and epilepsy, along with heavy or manual work.
  • Inclusion: To enhance patient care, this guideline incorporates Dupuytren’s disease as an appendix to the Hand, Wrist, and Forearm Disorders Guideline.

Injection Therapy

Collagenase Injections

  • Recommended Use: Collagenase injections are recommended for select patients with Dupuytren’s disease.
  • Indications: Suitable for Dupuytren’s contractures causing impairment.
  • Frequency/Dose: Administer Clostridial collagenase 10,000 U injection, with repeat injections at 4 to 6 week intervals, up to 3 injections.
  • Discontinuation: Cease injections upon contracture resolution or due to adverse effects.



  • First-Line Medications: Ibuprofen, naproxen, or other older generation NSAIDs are recommended for most patients. Acetaminophen is a potential alternative, although NSAIDs are generally more effective.
  • Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Post-operative Swelling: Recommended for managing post-operative swelling after Dupuytren’s disease surgery.
  • NSAIDs for Pain Management: NSAIDs are recommended for acute, subacute, or chronic pain associated with Dupuytren’s disease.
  • NSAIDs for High-Risk Patients: Patients at high risk of gastrointestinal bleeding should consider concomitant use of cytoprotective medications alongside NSAIDs.
  • NSAIDs for Cardiovascular Risk: Patients with cardiovascular disease or risk factors should discuss the risks and benefits of NSAID therapy. Acetaminophen or aspirin are safer first-line therapies in this context.
  • Acetaminophen for Pain Management: Recommended for pain management in Dupuytren’s disease, especially for patients with NSAID contraindications.


  • Limited Use: Opioids are recommended for limited use (up to seven days) as adjunctive therapy for postoperative pain management, particularly for nocturnal use.
  • Indications: Primarily for postoperative pain management, opioids can complement more effective treatments like NSAIDs and acetaminophen.
  • Frequency/Duration: Prescribed as needed throughout the day, tapering off gradually, with a primary focus on nocturnal use for postoperative sleep improvement.


  • Not Recommended: Radiotherapy is not recommended for preventing the progression of Dupuytren’s disease.
  • Evidence: There is insufficient evidence supporting the use of radiotherapy for preventing the progression of Dupuytren’s disease.


  • Rehabilitation following a work-related injury should focus on restoring functional ability to meet daily and work activities, aiming to return the injured worker to their pre-injury status as much as possible.
  • Active vs. Passive Therapy: Active therapy requires patient effort to complete exercises, while passive therapy relies on modalities delivered by a therapist. Active interventions should be prioritized over passive ones, with passive interventions used to support active therapy.
  • At-Home Therapy: Patients should continue both active and passive therapies at home to maintain improvement levels achieved during supervised therapy sessions. Assistive devices may be used to aid in functional gains.

Active Therapy

  • Therapeutic Exercise for Post-operative Dupuytren’s Disease: Recommended for post-operative Dupuytren’s disease crush injuries.
  • Frequency/Dose/Duration: The number of therapy visits may vary based on the severity of functional deficits, ranging from two to three visits for mild deficits to 12 to 15 visits for more severe deficits. A home exercise program should be developed and followed in conjunction wit therapy.



  • Surgery for Treatment of Dupuytren’s Contracture: Regional or selective fasciectomy is recommended for treating contractures due to Dupuytren’s disease.
  • Percutaneous Needle Fasciotomy: Recommended for patients with Dupuytren’s contractures, although there is a higher recurrence rate compared to fasciectomy.
  • “Firebreak” Full-thickness Skin Graft: Not recommended for routine Dupuytren’s contracture surgery but may be considered in select severe recurrent cases.
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