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Contractures and Deformities

Dupuytren’s, trigger finger, and fixed flexion deformities: etiology, staging, and surgical/non-surgical management options.

Overview

Contracture management spans diverse etiologies, requiring distinct approaches based on patient age and pathology. In infants under three years with camptodactyly, passive stretching offers a straightforward, complication-free method to improve flexion contractures [1]. For pediatric elbow flexion contractures (≤21 years), anterior approach release yields satisfactory results with low complication rates [10]. Conversely, posttraumatic elbow releases necessitate counseling regarding recurrence and the potential need for multiple procedures to achieve functional motion [2]. In the pediatric spastic upper extremity, appropriate intervention and expectation management optimize function while avoiding sequelae [13].

Dupuytren's contracture surgery aims to correct deformity rather than cure the disease [4], with outcomes showing success but high rates of recurrence within years and common surgical complications [3]. Collagenase treatment is effective, with most successfully treated joints remaining below surgical thresholds three years post-treatment [20]; however, older age and greater correction magnitude increase skin tearing risk [8]. For severe Dupuytren's PIPJ contractures, a staged procedure using a central slip facilitation device provides reliable, reproducible correction [9].

Initial nonsurgical management is warranted for stiff digits but may yield poorer results in severe or chronic cases [6]. Surgery is indicated when limited improvement occurs after 3 to 6 months of conservative care [6]. Surgical release for posttraumatic proximal interphalangeal joint flexion contractures typically improves flexion contracture by 25° to 30°, shifting the arc into a more functional range [42].

Anatomy & Pathophysiology

Early intervention is critical for arthrogrypotic hand deformities, where bony and soft-tissue interventions yield superior outcomes when performed during the early years of life [17]. Contemporary classification and management of congenital hand and upper extremity disorders, refined since the 1970s, prioritize optimal function through deformity recognition, surgical option identification, and expectation management [22]. Accurate diagnosis of hand and carpal fractures and dislocations relies on thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility [45]. Suboptimal treatment of intra-articular fractures or fracture dislocations of the proximal interphalangeal joint typically results in functional impairment [61].

Classification Systems: A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis detects advanced deformity earlier and correlates more strongly with hand function [24]. Surgical Goals: Reconstruction for thumb deformity in cerebral palsy aims to create a stable thumb capable of satisfactory grasp and release by decreasing deformity, balancing muscle forces, and stabilizing joints [48]. The goal of surgery for camptodactyly is to achieve a more extended resting position to allow improved grasp, not to obtain a normal digit [58].

Thumb Deformity Management: The value of the thumb depends largely on web mobility [56]. Radial transposition of the extensor pollicis longus (EPL) tendon enhances thumb extension regardless of whether the tendon is routed through or superficial to the first extensor compartment [46]. There are no significant differences in thumb motion range after EPL rerouting techniques or insertion sites for thumb-in-palm deformity in cerebral palsy [52]. The key to consistent release of spastic thumb-in-palm deformity and establishing functional lateral pinch is the accurate determination of deforming forces and identification of joint instability [62].

Congenital and Neuromuscular Conditions: Limited surgical procedures improved finger, thumb, and wrist positions at 2-year follow-up in children with upper limb congenital muscular hypertrophy and aberrant muscle syndrome [50]. The hand surgeon must address all patho-anatomic features to achieve the best possible result, though a normal functioning interphalangeal joint cannot be provided if the abnormality is marked [51]. The Partial Excision Greenstick (PEG) Osteotomy is a simple and effective method for correcting malalignment in the small bones of children's hands [63].

Rehabilitation and Outcomes: Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery for severe camptodactyly [59]. Insights from exercise relative motion orthoses may inform future biomechanical and clinical research on proximal interphalangeal joint motion [54]. Variation in outcome measurement methods for thumb function suggests current consistency and efficacy are less than ideal; applying a standard global assessment of thumb function to all congenital conditions affecting the thumb may be appropriate [57].

Classification

Congenital Hand Deformities: Congenital contracture of the ulnar digits is a distinct flexion deformity involving the middle, ring, and small fingers, differentiated from ischemic contracture by a bony prominence on the proximal ulna [14]. Classification and understanding of congenital hand and upper extremity disorders have improved significantly since the 1970s, focusing on recognizing deformities, identifying surgical options, and managing patient expectations to achieve optimal function [22].

Dupuytren's Disease: Surgery for Dupuytren's contracture is performed to correct contractures rather than to cure the underlying disease [4]. A revised severity staging system incorporating total flexion deformity and additional clinical risk factors provides a more objective and precise method for assessing disease severity and may predict surgical outcomes [38]. Patient-rated measures should be used alongside contracture severity to assess outcomes in patients referred for surgery [18]. A simple staged procedure using a central slip facilitation device is a valid alternative for managing severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes [9].

Rheumatoid Arthritis: A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis could detect advanced deformity earlier and was more strongly correlated with hand function [24].

Obstetric Brachial Plexus Injury: Severe supination contracture of the forearm in obstetric brachial plexus injury usually presents before the age of 10 years [5]. Flexion contracture in this population is not primarily related to bony changes of the elbow [28].

Other Considerations: Passive stretching is a straightforward, complication-free method for improving flexion contracture in camptodactyly of different severities in infants younger than three years of age [1]. Patients must be counseled that elbow contracture may reoccur after open surgical release, and some may require multiple procedures to achieve functional motion [2]. Surgical correction of elbow flexion contractures in pediatric patients (21 years or younger) through an anterior approach leads to a satisfactory result in the majority of cases with a low incidence of complications [10]. Nonoperative treatment of Boutonniere deformity can achieve one to two grades of ROM improvement, although the deformity can persist even after dedicated conservative management [15]. Contractures can occur in muscles subjected to frequent injections and may develop in adult life as well as in childhood [7]. A contracture model was successfully established in rats [40].

Clinical Presentation

The clinical evaluation of contractures begins with a thorough history to identify etiology and timing. Congenital etiologies include camptodactyly in infants under three years [1], congenital contracture of the ulnar digits affecting the middle, ring, and small fingers [14], and deformities secondary to amniotic constriction bands [19]. Obstetric brachial plexus injury typically presents with severe supination contracture before age 10 [5]. Acquired causes encompass trauma, spasticity, and ischemia leading to intrinsic hand contracture [32], frequent muscle injections causing contractures in both childhood and adult life [7], and Dupuytren's disease, which is distinct from atypical non-Dupuytren disease in presentation, etiology, treatment, and prognosis [29].

Inspection and palpation focus on distinguishing specific deformities and risk factors. Congenital contracture of the ulnar digits is distinguished from ischemic contracture by a bony prominence on the proximal ulna [14]. In Dupuytren's contracture, risk factors for skin tearing during collagenase treatment include older age and increased contracture correction [8]. Predictive factors for recurrence in Dupuytren's contracture are early age, Dupuytren diathesis, multifocal disease, PIP joint disease, and small finger contracture [36]. Correct diagnosis of the etiology is imperative for successful treatment of Swan Neck Deformity in cerebral palsy [12].

Range-of-motion assessment guides management decisions and prognostication. Passive stretching is a straightforward, complication-free method for improving flexion contracture in camptodactyly of varying severities in infants under three years [1]. Initial nonsurgical treatment for stiff digits may yield poorer results in patients with severe or chronic contractures [6]. The presence of a proximal interphalangeal joint contracture is associated with a reduced clinical response to corticosteroid injection in trigger fingers [34]. For stiff digits, surgery should be considered if limited improvement occurs after 3 to 6 months of conservative management [6].

Stability, special tests, and outcome assessment rely on patient-reported measures and specific functional goals. Patient-rated measures should be used alongside contracture severity to assess outcomes in patients with Dupuytren's contracture referred for surgery [18]. Surgical correction of elbow flexion contractures in pediatric patients (21 years or younger) via an anterior approach yields satisfactory results with low complication incidence [10]. A simple staged procedure using a central slip facilitation device is a valid alternative for severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction [9].

Red-flag patterns and management expectations must be clearly communicated. Patients must be counseled that contractures may recur after open surgical elbow release, with some requiring multiple procedures for functional motion [2]. Surgical complications are common following fasciectomy and fasciotomy for Dupuytren's contracture, with recurrence likely within a few years [3]. Surgery for Dupuytren's contracture is performed to correct contractures, not to cure the disease [4]. Recurrence of the contracture is always a possibility in Dupuytren contracture [36]. Currently, limited evidence guides the management of patients with Dupuytren's contracture [21]. Appropriate interventions and management of expectations optimize limb appearance and function while avoiding unexpected sequelae in the spastic upper extremity in children [13].

Investigations

Plain radiography: Radiography is recommended to exclude a bony prominence on the proximal ulna in patients with congenital flexion deformity and an aberrant origin of the flexor digitorum profundus [27]. This bony prominence distinguishes congenital contracture of the ulnar digits from ischemic contracture [14]. In obstetric brachial plexus injury, flexion contracture is not primarily related to bony changes of the elbow [28].

Computed tomography: Computed tomography of the forearm is recommended to exclude a bony prominence on the proximal part of the ulna in patients with congenital flexion deformity with an aberrant origin of the flexor digitorum profundus [27].

Other Considerations: Correct diagnosis of the etiology of deformity is imperative for successful treatment of Swan Neck Deformity in cerebral palsy [12]. One technique does not treat all finger deformities uniformly, highlighting the need to determine the true etiology before surgical intervention [67]. Severe supination contracture of the forearm usually presents before the age of 10 years in patients with obstetric brachial plexus injury [5]. Contractures can occur in muscles subjected to frequent injections and may develop in adult life as well as in childhood [7]. Many hand and upper extremity deformities secondary to amniotic constriction bands are encountered [19]. Most arthrogrypotic hand deformity surgeries result in better outcomes if performed during the early years of life using bony and/or soft-tissue interventions [17].

Prognostic Factors: Passive stretching is a straightforward, complication-free method of improving flexion contracture in camptodactyly of different severities in infants younger than three years of age [1]. Patients undergoing open surgical elbow contracture release after trauma must be counseled that contracture may reoccur and some may require multiple procedures to achieve functional motion [2]. Postoperative outcomes for fasciectomy and fasciotomy for Dupuytren's contracture in European patients were successful, but surgical complications were common and recurrence of a contracture was likely within a few years [3]. Surgery for Dupuytren's contracture is performed to correct contractures, not to cure the disease [4]. Older age and increased contracture correction are risk factors for skin tearing in collagenase treatment of Dupuytren contractures [8]. Long-term recurrence rates for collagenase injection suggest disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures [11]. Recurrence of Dupuytren's contracture after collagenase injection was generally less severe than the initial contracture in the MCP group [11]. Preoperative deformity is a significant predictor of complete intraoperative correction and complete correction at follow-up for Dupuytren's disease [68]. Improved, but not normal, elbow motion can be expected in many but not all cases following operative treatment of elbow contracture in patients twenty-one years of age or younger [66]. One to two grades of ROM improvement can be achieved with nonoperative treatment of Boutonniere deformity, although deformity can persist even after dedicated conservative management [15]. Swan neck deformity can progress significantly with time because of increasing DIPJ flexion contracture [16]. Appropriate interventions and management of expectations will optimize limb appearance and function while avoiding unexpected sequelae in the spastic upper extremity in children [13].

Treatment

Non-Operative

Initial nonsurgical treatment is warranted for stiff digits but may yield poorer results in patients with more severe or chronic contractures, with surgery considered for limited improvement after 3 to 6 months of conservative management [6]. Passive stretching serves as a straightforward, complication-free method for improving flexion contracture in camptodactyly of varying severities in infants younger than three years of age [1]. In the management of Boutonniere deformity, nonoperative treatment can achieve one to two grades of range of motion improvement, although the deformity may persist even after dedicated conservative management [15]. Regarding Dupuytren's disease, it may remain non-progressive without developing contracture, as demonstrated by case reports of individuals with palm thickening but no functional impairment over 20 to 30 years [55].

Operative

Indications: Surgery for Dupuytren's contracture is performed to correct contractures, not to cure the disease [4]. Current evidence suggests that while initial nonsurgical treatment is warranted for stiff digits, surgery should be considered for limited improvement after 3 to 6 months of conservative management [6]. For patients with contractures less than 20°, the safety of Xiaflex is questioned because no published prospective trials included such patients, despite the drug's indication covering any degree of contracture [53]. Surgical correction of elbow flexion contractures in pediatric patients (21 years or younger) through an anterior approach leads to a satisfactory result in the majority of cases [10].

Surgical Approach / Technique: Patients undergoing open surgical elbow contracture release after trauma must be counseled that contracture may reoccur and some may require multiple procedures to achieve functional motion [2]. Postoperative outcomes for fasciectomy and fasciotomy in Dupuytren's contracture are successful, but surgical complications are common and recurrence of a contracture is likely within a few years [3]. A simple staged procedure using a central slip facilitation device is a valid alternative for managing severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes [9]. Surgery is effective in correcting deformity in Rubinstein–Taybi Syndrome via osteotomy of the thumb delta phalanx, but there is a risk of incomplete correction or recurrence [35]. Immediate postoperative active mobilization is safe and has similar outcomes of deformity correction compared to immobilization following tendon transfer for claw deformity correction in the hand [30].

Adjuncts: Older age and increased contracture correction are risk factors for skin tearing in patients undergoing collagenase treatment of Dupuytren contractures [8]. Long-term recurrence rates for collagenase injection suggest disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures [11]. In patients treated with collagenase for Dupuytren's disease, recurrence was generally less severe than the initial contracture in the MCP group [11]. Most successfully treated joints with collagenase clostridium histolyticum had a contracture well below the threshold for surgical intervention 3 years after treatment [20]. Correction of joint contracture and range of motion with collagenase clostridium histolyticum in clinical practice was similar to findings from clinical trials despite a lower injection rate [33].

Other Considerations: Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture [21]. There is a low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [43]. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care [37].

Complications

Stiffness / Arthrofibrosis: Recurrence of contracture is a primary concern across multiple etiologies. Patients undergoing open surgical elbow contracture release after trauma must be counseled that contracture may reoccur, and some may require multiple procedures to achieve functional motion [2]. In Dupuytren's disease, recurrence is common in prospectively collected cohorts with a mean 3.8 years of follow-up [25]. Long-term recurrence rates suggest disease recurrence or progression in 67% of MCP joint contractures and 100% of PIP joint contractures [26]. Recurrence after collagenase injection is generally less severe than the initial contracture in the MCP group, with disease recurrence or progression occurring in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures [11]. Similarly, recurrence after Dupuytren's disease treatment is generally less severe than the initial contracture [26]. Recurrences after needle aponeurotomy were frequent in younger patients and for PIP contractures [41]. Initial nonsurgical treatment for stiff digits may have poorer results in patients with more severe or chronic contractures, necessitating consideration of surgery for limited improvement after 3 to 6 months of conservative management [6]. Severe supination contracture of the forearm in obstetric brachial plexus injury usually presents before the age of 10 years [5]. The swan neck deformity can progress significantly with time because of increasing DIPJ flexion contracture [16]. Sustained hip flexion contracture frequently occurs after femoral lengthening in patients with achondroplasia [44].

Wound complications: Skin tearing is a common complication of collagenase treatment for Dupuytren contractures [8]. Older age and increased contracture correction are risk factors for skin tearing in this setting [8]. Surgical complications for fasciectomy and fasciotomy in Dupuytren's contracture are common [3].

Other Considerations: Passive stretching for simple camptodactyly in children younger than three years of age is a straightforward, complication-free method of improving flexion contracture [1]. Surgery for Dupuytren's contracture is performed to correct contractures, not to cure the disease [4]. Recurrent contracture in joints previously successfully treated with collagenase clostridium histolyticum may be effectively retreated with up to 3 injections of CCH at a short-term follow-up of 1 year [23]. Correct diagnosis of the etiology of deformity is imperative for successful treatment of Swan Neck Deformity in cerebral palsy [12]. Contractures can occur in muscles subjected to frequent intramuscular injections and may develop in adult life as well as in childhood [7]. Radiography or computed tomography of the forearm is recommended to exclude a bony prominence on the proximal part of the ulna in patients with congenital flexion deformity with an aberrant origin of the flexor digitorum profundus [27].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the provided evidence; however, initial nonsurgical treatment is warranted for the stiff digit, with surgery considered only after 3 to 6 months of conservative management if limited improvement is observed [6]. For infants younger than three years with camptodactyly, passive stretching serves as a straightforward, complication-free method to improve flexion contracture [1].

Full activity (months): Evidence does not provide specific month ranges for full activity return. Patients undergoing open surgical elbow contracture release after trauma must be counseled that contracture may reoccur and that some may require multiple procedures to achieve functional motion [2]. Similarly, postoperative outcomes for fasciectomy and fasciotomy in Dupuytren's contracture are successful, though surgical complications are common and recurrence of a contracture is likely within a few years [3].

Complete recovery / outcome plateau (months): Long-term recurrence rates for Dupuytren's disease suggest recurrence in 67% of MCP joint contractures and 100% of PIP joint contractures, with recurrence generally being less severe than the initial contracture [26]. In prospectively collected cohorts with a mean 3.8 years of follow-up, recurrence after Dupuytren contracture treatment is common [25]. Recurrence of contracture (not disease recurrence) for Dupuytren disease could be predicted as early as 6 months after surgery [49]. For collagenase injection, long-term recurrence rates suggest disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures, though recurrence is generally less severe than the initial contracture in the MCP group [11]. Recurrent contracture in joints previously successfully treated with collagenase clostridium histolyticum may be effectively retreated with up to 3 injections of CCH at a short-term follow-up of 1 year [23].

Rehabilitation protocol: The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution for the stiff proximal interphalangeal joint [47]. Most arthrogrypotic hand deformity surgeries result in better outcomes if performed during the early years of life using bony and/or soft-tissue interventions [17]. The choice of surgical approach, timing, and technique for malunited fractures in the hand is determined by the deformity location, soft tissue compliance, tendon balance, and presence of joint contracture [64].

Functional milestones: Functional outcomes vary by etiology; severe supination contracture of the forearm in obstetric brachial plexus injury usually presents before the age of 10 years [5]. The swan neck deformity progressed significantly with time due to increasing distal interphalangeal joint flexion contracture [16]. Forty-seven (96 per cent) of 49 shoulders had a good clinical result after distal release of deltoid muscle contracture [65].

Other Considerations: Contractures can occur in muscles subjected to frequent injections and may develop in adult life as well as in childhood [7]. Initial nonsurgical treatment for the stiff digit is warranted but may yield poorer results in patients with more severe or chronic contractures [6].

Key Evidence

  • [L4] It is a straightforward, complication-free method of improving flexion contracture in camptodactyly of different severities in infants. (10.1016/j.jhsa.2010.07.032)
  • [L4] Patients must be counseled that contracture may reoccur, and some may require multiple procedures to achieve functional motion. (10.1016/j.jse.2017.10.023)
  • [L2] Postoperative outcomes were successful, but surgical complications were common and recurrence of a contracture was likely within a few years. (10.1177/1753193410397971)
  • [L3] Severe supination contracture of the forearm usually presents before the age of 10 years. (10.1177/17531934221121912)
  • [L5] Initial nonsurgical treatment is warranted but may have poorer results in patients with more severe or chronic contractures; surgery should be considered for limited improvement after 3 to 6 months of conservative management. (10.5435/jaaos-d-18-00310)
  • [L4] Contractures can occur in muscles subjected to frequent injections and may develop in adult life as well as in childhood. (10.2106/00004623-197456040-00019)
  • [L2] Patients can be counseled before CCH treatment that older age and increased contracture correction are risk factors for this common complication. (10.1016/j.jhsa.2019.06.010)
  • [L4] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. (10.1177/1753193412439673)
  • [L4] Surgical correction of elbow flexion contractures in pediatric patients through an anterior approach leads to a satisfactory result in the majority of cases, with a low incidence of complications. (10.1016/j.jse.2020.01.081)
  • [L4] Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. (10.1016/j.jhsa.2010.01.003)
  • [L4] Correct diagnosis of the etiology of deformity is imperative for successful treatment. (10.1016/j.jhsa.2014.01.039)
  • [L5] Appropriate interventions and management of expectations will optimize limb appearance and function while avoiding unexpected sequelae. (10.5435/jaaos-d-20-00719)
  • [L4] Congenital contracture of the ulnar digits is a new congenital flexion deformity involving the middle, ring, and small fingers, distinguished from ischemic contracture by a bony prominence on the proximal ulna. (10.1016/j.jhsa.2021.06.008)
  • [L3] One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management. (10.1016/j.jht.2025.02.013)
  • [L5] The swan neck deformity in this individual progressed significantly with time because of increasing DIPJ flexion contracture. (10.1016/j.jht.2009.11.005)
  • [L5] Most arthrogrypotic hand deformity surgeries result in better outcomes if performed during the early years of life using bony and/or soft-tissue interventions. (10.1016/j.jhsa.2021.10.027)
  • [L3] These results suggest that patient-rated measures should be used alongside contracture severity to assess outcomes. (10.1016/j.jht.2010.07.006)
  • [L4] Many hand and upper extremity deformities secondary to ACB are encountered. (10.1177/1558944717750917)
  • [L4] Most successfully treated joints had a contracture well below the threshold for surgical intervention 3 years after treatment. (10.1016/j.jhsa.2012.09.028)
  • [L2] Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. (10.1302/0301-620x.100b9.bjj-2017-1194.r2)
  • [L4] At a short-term follow-up of 1 year, recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH. (10.1016/j.jhsa.2017.02.010)
  • [L3] The modified classification could detect advanced deformity earlier and was more strongly correlated with hand function. (10.1177/1753193419886719)
  • [L2] In prospectively collected cohorts with a mean 3.8 years of follow-up, recurrence after Dupuytren contracture treatment was common. (10.1016/j.jhsg.2026.100979)
  • [L4] Long-term recurrence rates suggest recurrence in 67% of MCP joint contractures and 100% of PIP joint contractures, though recurrence was generally less severe than the initial contracture. (10.1016/s0363-5023(09)60096-4)
  • [L4] They recommend performing radiography or computed tomography of the forearm to exclude a bony prominence on the proximal part of the ulna in patients with this deformity. (10.1016/j.jhsa.2015.07.012)
  • [L4] This indicates that flexion contracture is not primarily related to bony changes of the elbow. (10.5435/jaaos-d-17-00110)
  • [L2] Immediate postoperative active mobilization is safe and has similar outcomes of deformity correction compared to immobilization. (10.1016/j.jhsa.2007.10.012)
  • [L5] Intrinsic contracture of the hand results from various etiologies including trauma, spasticity, and ischemia, causing significant disability. (10.5435/jaaos-21-10-581)
  • [L3] Despite a lower injection rate, correction of joint contracture and range of motion was similar to findings from clinical trials. (10.1016/j.jhsa.2013.08.114)
  • [L4] The presence of a proximal interphalangeal joint contracture was associated with a reduced clinical response to corticosteroid injection. (10.1177/1753193415596497)
  • [L4] Surgery is effective in correcting the deformity, but there is a risk of incomplete correction or recurrence. (10.1177/1753193409354523)
  • [L4] Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. (10.1177/1558944719834654)
  • [L4] The revised severity staging system, which incorporates total flexion deformity and additional clinical risk factors, provides a more objective and precise method for assessing Dupuytren's disease severity and may predict surgical outcomes. (10.1007/s11552-007-9071-1)
  • [L5] A contracture model was successfully established. (10.1016/j.jse.2010.02.004)
  • [L4] The complication rate was low, but recurrences were frequent in younger patients and for PIP contractures. (10.1016/j.jhsa.2012.01.029)
  • [L4] Most clinical series of patients who have undergone surgical release document improvement in flexion contracture between 25° to 30° and a shift of the flexion/extension arc into a more functional range. (10.5435/00124635-200609000-00002)
  • [L1] There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture. (10.1177/1558944721994220)
  • [L3] Sustained hip flexion contracture frequently occurs after femoral lengthening in achondroplasia patients. (10.1186/s12891-018-2344-8)
  • [L5] This biomechanical model demonstrates that radial transposition of the EPL tendon enhances extension of the thumb regardless of whether the tendon is routed through, or superficial to, the first extensor compartment. (10.1016/j.jhsa.2018.01.015)
  • [L2] The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution. (10.1016/j.jht.2011.09.006)
  • [L5] Surgical reconstruction aims to create a stable thumb capable of satisfactory grasp and release by decreasing deformity, balancing muscle forces, and stabilising joints. (10.1177/1753193407087891)
  • [L3] Recurrence of contracture (not disease recurrence) could be predicted as early as 6 months after surgery for Dupuytren disease. (10.1016/j.jhsa.2013.05.038)
  • [L4] Limited surgical procedures improved finger, thumb, and wrist positions at 2-year follow-up. (10.1177/1753193418774459)
  • [Commentary] The hand surgeon should address all patho-anatomic features to achieve the best possible result, though a normal functioning interphalangeal joint cannot be provided if the abnormality is marked. (10.1177/1753193414538149)
  • [L5] We were unable to find significant differences in the motion range of the thumb after these rerouting techniques or sites of insertion. (10.1177/1753193419857067)
  • [L5] The author questions the safety of Xiaflex for patients with contractures less than 20° because no published prospective trials included such patients, despite the drug's indication covering any degree of contracture. (10.1007/s11552-012-9424-2)
  • [L4] These insights may inform future biomechanical and clinical research on this underexplored topic. (10.1016/j.jht.2022.12.002)
  • [L4] Dupuytren's disease may remain non-progressive without developing contracture, as demonstrated by two case reports of individuals with palm thickening but no functional impairment over 20 to 30 years. (10.1177/1753193416632644)
  • [L4] The value of the thumb is dependent in large part upon the mobility of its web. (10.2106/00004623-195032020-00004)
  • [L5] Variation in methods of outcome measurement of thumb function suggests that consistency and efficacy of current methods are less than ideal; it may be appropriate to consider applying a standard global assessment of thumb function to all congenital conditions affecting the thumb. (10.1177/1753193415625146)
  • [L4] The goal of surgery is to achieve a more extended resting position to allow improved grasp, not to obtain a normal digit. (10.1016/j.jhsa.2018.03.023)
  • [L4] Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery. (10.1016/j.jht.2014.12.004)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. (10.1177/1753193414559464)
  • [L4] The key to achieving consistent release of the spastic thumb-in-palm deformity and to establishing functional lateral pinch is the accurate determination of the deforming forces and the identification of joint instability. (10.1054/jhsb.2001.0601)
  • [L4] This approach is a simple and effective way of correcting malalignment in the small bones of children's hands. (10.1177/1753193409103246)
  • [L5] The choice of surgical approach, timing, and technique is determined by the deformity location, soft tissue compliance, tendon balance, and presence of joint contracture. (10.1016/j.jhsa.2013.07.014)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [L4] Improved, but not normal, elbow motion can be expected in many but not all cases. (10.2106/00004623-200203000-00008)
  • [L5] It emphasizes that one technique does not treat all deformities uniformly and highlights the need to determine the true etiology before surgical intervention. (10.1016/j.jhsa.2022.07.008)
  • [L2] Preoperative deformity is a significant predictor of complete intraoperative correction and complete correction at follow-up. (10.1177/1753193409353849)

See Also

References

[1] Effect of Passive Stretching on Simple Camptodactyly in Children Younger Than Three Years of Age. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.07.032

[2] Open surgical elbow contracture release after trauma: results and recommendations. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.023

[3] The efficacy and safety of fasciectomy and fasciotomy for Dupuytren’s contracture in European patients: a structured review of published studies. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410397971

[4] 32. No Higher Self-Reported Recurrence in Segmental Fasciectomy. n.d..

[5] Natural history of elbow flexion and forearm rotation contractures in obstetric brachial plexus injury. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221121912

[6] Etiology, Evaluation, and Management Options for the Stiff Digit. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00310

[7] Contracture of the Deltoid Muscle in the Adult after Intramuscular Injections. The Journal of Bone & Joint Surgery. 1974. DOI: 10.2106/00004623-197456040-00019

[8] Risk Factors for Skin Tearing in Collagenase Treatment of Dupuytren Contractures. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.06.010

[9] Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412439673

[10] Anterior elbow release for post-traumatic flexion contractures in patients 21 years or younger. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.081

[11] Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.01.003

[12] Treatment of Swan Neck Deformity in Cerebral Palsy. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.039

[13] The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00719

[14] Congenital Contracture of the Ulnar Digits and Its Differentiation From Ischemic Contracture. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.06.008

[15] Nonoperative treatment of the Boutonniere deformity: Is there a difference in outcomes?. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.013

[16] Swan Neck Deformity after Distal Interphalangeal Joint Flexion Contractures: A Biomechanical Analysis. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2009.11.005

[17] The Hand in Distal Arthrogryposis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.10.027

[18] Severity of Contracture and Self-reported Disability in Patients with Dupuytren’s Contracture Referred for Surgery. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2010.07.006

[19] Amniotic Constriction Bands: Secondary Deformities and Their Treatments. HAND. 2018. DOI: 10.1177/1558944717750917

[20] Dupuytren Contracture Recurrence Following Treatment with Collagenase Clostridium Histolyticum (CORDLESS Study): 3-Year Data. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.09.028

[21] Treatment of Dupuytren’s contracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b9.bjj-2017-1194.r2

[22] Chapter 55 Pediatric Upper Extremity Disorders. 2020.

[23] Treatment of Recurrent Dupuytren Contracture in Joints Previously Effectively Treated With Collagenase Clostridium histolyticum. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.02.010

[24] A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis: a cross-sectional analysis. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886719

[25] Likelihood of Dupuytren Contracture Recurrence After Limited Fasciectomy, Needle Aponeurotomy or Collagenase Clostridium histolyticum: Systematic Review of Prospective Data With 2- to 7-Year Follow-up. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100979

[26] Dupuytren's Disease and Fibroblast Contractility. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60096-4

[27] Congenital Flexion Deformity With an Aberrant Origin of the Flexor Digitorum Profundus: A Potentially Ignored Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.012

[28] Natural History of the Elbow Bony Architecture in Patients With Obstetric Brachial Plexus Injury and the Association With Flexion Contractures. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00110

[29] 1. Dupuytren’s Disease: Anatomy, Pathology, and Presentation. n.d..

[30] Immediate Postoperative Active Mobilization Versus Immobilization Following Tendon Transfer for Claw Deformity Correction in the Hand. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.012

[32] Intrinsic Contracture of the Hand: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-10-581

[33] Collagenase Clostridium Histolyticum for Dupuytren Contracture: Patterns of Use and Effectiveness in Clinical Practice. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.114

[34] Comparative study on the effectiveness of corticosteroid injections between trigger fingers with and without proximal interphalangeal joint flexion contracture. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415596497

[35] Long-term results following osteotomy of the thumb delta phalanx in Rubinstein–Taybi Syndrome. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409354523

[36] Chapter 32 Dupuytren Contracture. 2019.

[37] Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review. HAND. 2019. DOI: 10.1177/1558944719834654

[38] Revised Tubiana's Staging System for Assessment of Disease Severity in Dupuytren's Disease—Preliminary Clinical Findings. HAND. 2007. DOI: 10.1007/s11552-007-9071-1

[40] Development of a Shoulder Contracture Model in Rats. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.02.004

[41] Results of Needle Aponeurotomy for Dupuytren Contracture in Over 1,000 Fingers. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.029

[42] Posttraumatic Proximal Interphalangeal Joint Flexion Contractures. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200609000-00002

[43] Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis. HAND. 2021. DOI: 10.1177/1558944721994220

[44] Sustained hip flexion contracture after femoral lengthening in patients with achondroplasia. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2344-8

[45] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[46] Intracompartmental Versus Extracompartmental Transposition of the Extensor Pollicis Longus for Treating Thumb-in-Palm Deformity: A Biomechanical Comparison. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.01.015

[47] The Long-term Relationship between Duration of Treatment and Contracture Resolution Using Dynamic Orthotic Devices for the Stiff Proximal Interphalangeal Joint: A Prospective Cohort Study. Journal of Hand Therapy. 2012. DOI: 10.1016/j.jht.2011.09.006

[48] THE SRGICAL MANAGEMENT OF THUMB DEFORMITY IN CEREBRAL PALSY. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087891

[49] Patterns of Recontracture After Surgical Correction of Dupuytren Disease. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.038

[50] Upper limb congenital muscular hypertrophy and aberrant muscle syndrome in children. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418774459

[51] Commentary on Patel, AUC. Tonkin, MA, Smith, BJ, Alshehri, AH, and Lawson. RD. Factors affecting surgical results of Wassel type IV duplications. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414538149

[52] Extensor pollicis longus rerouting for thumb-in-palm deformity in cerebral palsy: a biomechanical analysis. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419857067

[53] What were the adverse events for Dupuytren’s patients treated with Xiaflex who had contractures less than 20°?. HAND. 2012. DOI: 10.1007/s11552-012-9424-2

[54] The use of exercise relative motion orthoses to improve proximal interphalangeal joint motion: A survey of Australian hand therapy practice. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.002

[55] Non-progressive Duypytren’s disease. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416632644

[56] CONTRACTURE OF THE THUMB WEB. The Journal of Bone & Joint Surgery. 1950. DOI: 10.2106/00004623-195032020-00004

[57] Assessment of surgery for the underdeveloped thumb. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415625146

[58] Camptodactyly Treatment for the Lesser Digits. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.03.023

[59] Severe camptodactyly: A systematic surgeon and therapist collaboration. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.12.004

[61] Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414559464

[62] Surgery for Cerebral Palsy Part 3: Classification and Operative Procedures for Thumb Deformity. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2001.0601

[63] The Partial Excision Greenstick (PEG) Osteotomy: A Novel Approach to the Correction of Clinodactyly in Children’s Fingers. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409103246

[64] Malunited Fractures in the Hand. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.07.014

[65] Contracture of the Deltoid Muscle. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00010

[66] OPERATIVE TREATMENT OF ELBOW CONTRACTURE IN PATIENTS TWENTY-ONE YEARS OF AGE OR YOUNGER. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200203000-00008

[67] Clarification of Extensor Tenotomy for Finger Deformities. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.07.008

[68] The association between intraoperative correction of Dupuytren’s disease and residual postoperative contracture. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409353849

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