Dynamism in Dupuytren’s contractures

Abstract

Dynamism of Dupuytren’s contractures may occur if a contracture crosses over both the metacarpophalangeal (MCPJ) and proximal interphalangeal (PIPJ) joints of one finger. In this situation the extension deficit at one joint can be influenced by the position of the other. This may affect clinical measurements and introduce errors and bias into research using angular deformity as an endpoint. This study reports the dynamism encountered when measuring passive joint extension deficits in pre-operative contractures. Eighty-five digits with a contracture affecting the PIPJ or MCPJ and PIPJ on 72 hands from 70 patients were studied. Seventy-six digits showed dynamism at either the MCPJ or PIPJ (89%). Seventy-four showed dynamism at the PIPJ (87%). The mean dynamism observed was 6° at the MCPJ and 14° at the PIPJ. Previous Dupuytren’s surgery to the finger did not influence the amount of dynamism seen. Dynamism is common and may be a source of error or bias in trials of Dupuytren’s disease treatment.

Level of evidence: III

Keywords

Dynamism Dupuytren’s contracture Dupuytren’s disease goniometry finger joint

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References

Ball

Pratt

Nanchahal

. Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord. 2013, 14: 131.

Becker

Davis

. The outcome of surgical treatments for primary Dupuytren’s disease—a systematic review. J Hand Surg Eur Vol. 2010, 35: 623–6.

Darzi

. High quality care for all: NHS Next Stage Review final report. London: TSO, 2008. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 (12 March 2014).

Ellis

Bruton

. A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand. Clin Rehabil. 2002, 16: 562–70.

Hurst

. Dupuytren’s contracture. In: Wolfe

Hotchkiss

Pederson

Kozin

(Eds.) Green’s Operative Hand Surgery, 6th ed. Philadelphia, Elsevier Churchill-Livingstone, 2010.

Hurst

Badalamente

Hentz

. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med. 2009, 361: 968–79.

Jerosch-Herold

Shepstone

Chojnowski

Larson

. Severity of contracture and self-reported disability in patients with Dupuytren’s contracture referred for surgery. J Hand Ther. 2011, 24: 6–10.

Mokkink

Terwee

Knol

. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol. 2010, 10: 22.

van Rijssen

Gerbrandy

Ter Linden

Klip

Werker

. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren’s disease: a 6-week follow-up study. J Hand Surg Am. 2006, 31: 717–25.

10.

van Rijssen

ter Linden

Werker

PMN

. Five-year results of a randomized clinical trial on treatment in Dupuytren’s disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012, 129: 469–77.

11.

Werker

PMN

Pess

van Rijssen

Denkler

. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am. 2012, 37: 2095–105.e7.

12.

Witthaut

Bushmakin

Gerber

Cappelleri

Le Graverand-Gastineau

. Determining clinically important changes in range of motion in patients with Dupuytren’s contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin Drug Investig. 2011, 31: 791–8.