Discovering Connections Between Trigger Finger and Dupuytren’s

Discovering Connections Between Trigger Finger and Dupuytren’s

By: Tayer Roost

Reference: Yang, Gehring, M., Bou Zein Eddine, S., & Hettinger, P. (2019). Association between stenosing tenosynovitis and dupuytren’s contracture in the hand. Plastic and reconstructive surgery. Global open, 7(1), e2088–e2088. https://doi.org/10.1097/GOX.0000000000002088

The Skinny: This retrospective chart review discussed the possibility of a correlation between stenosing tenosynovitis (trigger finger) and Dupuytren’s contracture in the same hand. 

Dupuytren’s contracture in the same digit where a previous A1 pulley release was completed for trigger finger. Reference: Plastic and Reconstructive Surgery – Global Open7(1):e2088, January 2019.

In the weeds: Patients who were seen by the same surgeon between the years of 2014 and 2017 who had a dual diagnosis of trigger finger and Dupuytren’s contracture were chart reviewed. Patients who had been diagnosed with both trigger finger and Dupuytren’s were included if the same or neighboring digits were involved with both diagnoses. For patients with only a Dupuytren’s diagnosis, the following criteria were gathered: 

• Decreased ROM in affected digits w presence of palpable nodules and cords
• Positive Hueston’s tabletop test to identify MCP and PIP contractures 
• Interventions used to treat Dupuytren’s: injections of collagenase and surgical release

For patients with a trigger finger diagnosis: 

• Pain at A1 pulley 
• Catching or locking of affected digits w/movement 
• Interventions used to treat trigger finger: 2 steroid injections or surgical release 
• Alcohol and history of injections with steroids or collagenase clostridium histolyticum were recorded; however, alcohol was only included if consumption occurred during clinical visits. 

Exclusion criteria: 

• Systemic inflammatory diseases as the underlying pathology
• Patients with both diagnoses but in separate hands 

The data was then entered into the standard statistical software package, SAS 9, for both univariate and multivariate analyses.

Bringing it home: 238 patients were diagnosed with either Dupuytren’s contracture or stenosing tenosynovitis by the same hand surgeon. 43 out of 238 patients were diagnosed with both Dupuytren’s contracture and trigger finger in the same or adjacent digits in the same hand. In the univariate analysis completed by SAS 9, trigger finger was significantly associated with the development of Duypuytren’s contracture (Yang, et al., 2019). Both Dupuytren’s contracture and trigger finger carry common risk factors such as age, manual labor, and diabetes, however the only significant factor between the two diagnoses in this study was age. This study states that there is a possibility that trigger finger could bring forth or exacerbate Dupuytren’s contracture due to the process of inflammation in neighboring tissues from postoperative healing and/or general trigger finger pathology (Yang, et al., 2019). Overall, it is beneficial to explore and look for early onset of Dupuytren’s contracture in a patient who presents with a stenosing tenosynovitis diagnosis and vice versa. Education on preoperative and concurrent A1 pulley releases can be offered to patients as a preventative measure. 

Rating: 3/5 

It is important to understand that there is a significant association between the two diagnoses, however, more research needs to be completed to determine if there is a direct correlation. Since this was a retrospective study completed on chart data, there are multiple limiting factors in the ability to record the amount of alcohol consumed, manual labor performed, and accurate chart recording by medical personnel. Lack of power due to the necessity for a larger sample size presents as a limitation as well. However, there are significant associations between the two diagnoses; therefore, it is beneficial to be attentive when treating either diagnosis.