Several treatments are available for Dupuytren’s disease. However, surgery may not be indicated immediately upon making the diagnosis. Isolated nodules or knuckle pads may be followed if they do not interfere with hand function. There are currently two non-surgical treatments for Dupuytren’s Disease: needle aponeurotomy and collagenase injection (Xiaflex). Needle aponeurotomy-this is an office procedure where a needle is used to make multiple passes through the abnormal tissue in the palm to weaken it. Then, the Dupuytren’s cord can be ruptured. This procedure does not remove the diseased tissue but can be repeated if needed. It is most appropriate for patients with a small area of disease or those who cannot undergo surgery. Collagenase injection (Xiaflex)-this is a procedure where and enzyme is injected into the diseased tissue. The enzyme breaks up the collagen in the cord, allowing finger extension after 24 hours. The risks of this procedure include bruising, numbness, and allergic reaction. Some patients require more than one injection for complete release. The enzyme is often covered by insurance. The recurrence rate for both needle aponeurotomy and collagenase injection may be higher than surgery, as the diseased tissue is not removed. Surgery is indicated when there is loss of function or progression of the disease. The functional disability usually results from flexion contractures of any or all of the three digital joints, especially the proximal interphalangeal. Patients with mainly cosmetic concerns are discouraged from having surgery.