Dupuytren's contracture

Risk Factors

• Age >50, male, family history (AD inheritance)

• North European ancestry

• Alcoholism, cirrhosis, smoking, diabetes

• Repetitive manual labour

• Associations with Peyronie’s disease (penile plaques) and Ledderhose disease (plantar fibromatosis)

• Certain medications (e.g. anticonvulsants) have also been implicated in some cases

Management

Conservative

• Watchful waiting for mild or non-progressive disease

• Padded gloves for labourers, hand-stretching exercises, physiotherapy or hand therapy for maintaining range of motion

• Lifestyle modifications such as reducing alcohol intake and smoking cessation

Medical

• Steroid injection for painful nodules or rapidly progressing cords

• Collagenase (e.g. Xiaflex) injections to weaken and dissolve cords, allowing them to be ruptured through gentle manipulation

Surgical

• Needle fasciotomy (percutaneous aponeurotomy) for early contractures, though recurrence rates can be higher

• Open fasciotomy or partial fasciectomy if there is severe functional impairment or contracture >30° at the MCP or PIP joint

• Night extension splints may be considered post-procedure to maintain correction

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Trigger Finger (stenosing tenosynovitis)

Pathophysiology

• A1 pulley inflammation at the level of the MCP joint leading to impaired tendon gliding

• Commonly linked to diabetes, age >50, female sex, and repetitive gripping tasks

• Frequently affects the ring or middle finger, but any digit can be involved

Presentation

• Clicking or locking sensation, particularly on flexion

• Pain over the A1 pulley, with a palpable nodule that may catch or snap during movement

• Difficulty smoothly extending or flexing the affected finger

Treatment

Conservative

• Splinting the MCP joint to reduce friction and allow the inflamed tendon sheath to settle

• NSAIDs or simple analgesics for pain control

• Avoiding tasks that aggravate repetitive gripping or flexion

Medical

• Steroid injection into the flexor sheath is highly effective in early disease

• Multiple injections (up to two or three) may be considered before surgical intervention

Surgical

• A1 pulley release if symptoms persist or if there is a fixed contracture

• Postoperative hand therapy to restore movement and prevent adhesions

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Key notes

• Dupuytren's contracture: Surgery considered if MCP or PIP contracture exceeds 30° or function is significantly impaired

• Trigger finger: Early corticosteroid injections can prevent permanent deformity and reduce the need for surgery

• Both conditions benefit from identifying and addressing modifiable risk factors (e.g. glycaemic control in diabetes, reducing repetitive strain)

• In Dupuytren’s, recurrence can occur post-surgery or collagenase injection, highlighting the importance of ongoing monitoring and hand therapy