Dupuytren's Contracture Induces Stenosing Tenosynovitis? Analysis of a National Database Investigating Dupuytren's Impact on the Development of Trigger Finger
Michael B Gehring, MD1, Ryan Constantine, MD1, Elliot Le, MD1, Jon Freedman, MD1, Brandon Wolfe, BS1 and Matthew L. Iorio, MD2, (1)University of Colorado, Denver, CO, (2)University of Colorado, Anschutz Medical Center, Aurora, CO
Background: Large comprehensive data sets can longitudinally identify variances and potential unknown associations in the post-operative phase. One such previously unlinked disease state may be Dupuytren's contracture and stenosing tenosynovitis of the flexor tendons. These are two hand pathologies encountered by the hand surgeon that frequently occur concomitantly. The purpose of this study was to explore any associations with Dupuytren's treatment and the progression of trigger finger.
Methods: PearlDiver, a patient database encompassing a national cohort of private payers encompassing fifty-three million unique patients was utilized. Study cohort included patients diagnosed with either Dupuytren's or trigger finger utilizing both International Classification Codes 9 and 10. Patient demographics included age and gender as well as alcohol and tobacco use. Comorbid conditions included diabetes mellitus, hypothyroidism, rheumatoid arthritis, human immunodeficiency disorder (HIV) and obesity. Current Procedural Terminology codes were used to identify the most common Dupuytren's procedures, as well as trigger finger release. Only patients diagnosed with Dupuytren's who subsequently underwent tendon sheath incision for a trigger finger after their Dupuytren's diagnosis were included. Logistic regression analysis was used to define independent risk factors for developing trigger finger.
Results: Of the 115,127 and 593,606 patients who were identified with Dupuytren's and trigger finger, respectively, 4,959 patients required trigger finger release after receiving treatment for Dupuytren's. From this cohort, 45% were male, 25% were tobacco users and 5% were diagnosed with alcohol abuse. Of the comorbid conditions, diabetes was the most common (58%), followed by obesity (35%) and hypothyroidism (32%). Independent risk factors for the development of trigger finger requiring tendon sheath incision after Dupuytren's diagnosis included age, female gender, diabetes and obesity. Patients who underwent fasciotomy or fasciectomy for Dupuytren's were more likely to be diagnosed with trigger finger requiring surgical release. Patients who received CCH treatment for Dupuytren's or had a history of alcohol abuse were less likely to develop trigger finger. Dupuytren's treatment with PNA was not a statistically significant risk factor for the development of trigger finger, nor was tobacco use, HIV, hypothyroidism or rheumatoid arthritis.
Conclusions: Hand surgeons should consider concurrent tendon sheath incision while performing fasciotomy or fasciectomy for treatment of Dupuytren's, particularly in older, obese, female or diabetic patients. CCH injection may be protective from the development of trigger finger after Dupuytren's diagnosis and therefore, treatment with CCH prior to proceeding with fasciectomy in patients with known risk factors for trigger finger should be considered.
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