Correlation between Stenosing Tenosynovitis and Dupuytren's Contracture in the Hand

Background:

Stenosing tenosynovitis and Dupuytren's contracture are common pathology encountered in hand surgery. In stenosing tenosynovitis (i.e trigger finger), inflammation leads to trapping of the flexor tendon, while in Dupuytren’s contracture pathologic proliferation and thickening of the palmar fascia leads to soft tissue contractures. Most commonly each diagnosis exists as a single form of pathology. However, in a subset of patients, there is a spectrum of disease with each diagnosis contributing to hand dysfunction. The purpose of this study is to examine the association between these two common pathologies in the hand.

Methods:

A retrospective chart review was performed to include all patients seen by a single surgeon between 2014 to 2017 with the diagnosis of either trigger finger or Dupuytren’s contracture. Patients with systemic inflammatory diseases such as rheumatoid arthritis, lupus, etc. were excluded. Patients’ demographics, medical history, social and surgical histories was recorded. A univariate and multivariant analysis was then conducted.

Results:

A cohort of 238 patients was identified. 192 patients were diagnosed with trigger finger. 89 patients were diagnosed with Dupuytren’s contracture. 43 patients carried both diagnoses. Median age was 63.9 (56.0 – 72.0). 50.4% were male. 66.8% had a history of alcohol intake. 52.9% were former or current smokers. 23.9% had diabetes. 31.1% had occupations requiring manual labor. Trigger finger (p<0.0001), gender (p=0.001) and age (p=0.001) were significantly associated with the development of Dupuytren’s contracture in the univariant analysis. Dupuytren’s contracture (p<0.0001) and gender (p=0.001) were significantly associated with the development of trigger finger in the univariant analysis. Diabetes, manual labor, use of alcohol and tobacco were not found to be significant. In the multivariant model, age was significantly associated with Dupuytren’s contracture [OR 1.047, (95% CI: 1.016, 1.079)].

Conclusion:

Dupuytren’s contracture and stenosing flexor tenosynovitis remain common diagnoses in the upper extremity. Historically, clear predisposing factors have been identified yet little has been written regarding the coexistence of each condition. Based on this study, there is a significant association between stenosing tenosynovitis and Dupuytren’s contracture identified in our patient cohort. While there is a common association, it remains unclear whether one diagnosis predisposes to the other. In our experience, there is a spectrum of disease with a subset of trigger finger patients who develop thickening of their overlying palmar fascia. The treating physician should have a high index of suspicion, as this cohort may be predisposed to progression of Dupuytren’s contracture following A1 pulley release. While a clear association is identified in this study, more data is required before further conclusions can be drawn regarding a correlation between these disease processes.