Report into the link between Dupuytren's contracture and trigger finger
Report into the link between Dupuytren's contracture and trigger finger
Dr. Shaffer, President of the IORBC, recently saw a patient he’d previously treated for Dupuytren's disease who now believed they were suffering with “progression" after radiotherapy. In fact, the patient was experiencing symptoms of triggering, and was sent to a surgeon to consider steroid injections. But for Dr. Shaffer, it raised the question, is there a link between the two — Dupuytren’s contracture and trigger finger?
Fortunately, work has already been conducted in this area, with a report on the association between stenosing tenosynovitis and Dupuytren’s contracture in the hand published in 2019. The result — Dupuytren's and trigger finger are associated in a multivariate analysis. While they share some risk factors, such as age, manual labour, and diabetes, the association does not seem to be mediated through those common risk factors (apart from age).
Here’s an overview of the report:
Dupuytren’s contracture ‘consists of pathologic production and deposition of collagen, creating nodules and cords in the palm and digits.’ Stenosing tenosynovitis, or trigger finger, is caused by a ‘size mis-match between the flexor tendon and the sheath/pulley system, most commonly the A1 pulley.’
Dupuytren’s can lead to flexion contracture of joints and severely limit hand function, while stenosing tenosynovitis leads to clicking or catching of the flexor tendon as it glides through the sheath in flexion and extension, potentially causing pain or locking and impairment of hand function, as described by the authors.
Method:
In the report, a retrospective chart review was performed to include all patients seen by a single surgeon between 2014 and 2017 with the diagnosis of either trigger finger or Dupuytren’s contracture in the same hand. Patients’ demographics, medical history, social and surgical histories were recorded. Univariate and multivariate analysis were conducted.
Results:
238 patients were identified — 192 with trigger finger, 89 with Dupytren’s contracture, and 43 with both diagnoses.
In the univariate model, trigger finger, sex, and age were significantly associated with the diagnosis of Dupuytren’s contracture, and Dupuytren’s contracture and sex were significantly associated with the trigger finger diagnosis. Diabetes, manual labor, use of alcohol and tobacco were not associated.
In the multivariate model, age and trigger finger were significantly associated with Dupuytren’s contracture, but not gender.
Conclusion:
The report notes a significant association between stenosing tenosynovitis and Dupuytren’s contracture in the patient cohort. Patients with stenosing tenosynovitis may be at an increased risk of developing Dupuytren’s contracture or vice versa.
A note on the report, from the IORBC:
The text provides an important reminder: for radiation oncologists treating benign conditions, to remain aware of other diseases, even if they do not require treatment with radiotherapy.
Access the full text at the link below:
Citation:
Yang, Kai & Gehring, Michael & Bou Zein Eddine, Savo & Hettinger, Patrick. (2019). Association between Stenosing Tenosynovitis and Dupuytren’s Contracture in the Hand. Plastic and Reconstructive Surgery - Global Open. 7. 1. 10.1097/GOX.0000000000002088.