Investigating Techniques to Reduce Flexor Tendon Rupture Risk During Manipulation for Dupuytren Contracture.

Purpose: The purpose of this study was to explore the strength required to extend the small finger using these techniques. Methods: Healthy adult participants without current hand injury or pathology were tested for small finger manipulation strength using a calibrated scale as the flexed small finger proximal interphalangeal joint was brought into extension with resistance. Both wrist flexion and quadriga effect were tested first, then quadriga effect alone, then wrist flexion, then without restrictions. This was to prevent fatigue as a confounding factor (weakest to strongest). Measurements were obtained for bilateral small fingers. The means of each of the categories were then compared using analysis of variance. Results: A total of eight participants (16 hands), seven right-handed and one left-handed, were included. Five women and three men were included, with an average age of 28. The force required to fully extend the small finger using both wrist flexion and quadriga effect was 2.5 kg. The force to extend the small finger with quadriga alone was 2.8 kg, wrist flexion alone was 3.0 kg, and baseline without any restrictions was 3.2 kg. The combined intervention required significantly less force to fully extend the small finger compared to other methods ( Conclusions: Collagenase clostridium histolyticum injection and manipulation for treatment of Dupuytren contracture has a small risk of flexor tendon rupture. While wrist flexion is described in the technique guide, using the quadriga effect to lessen the force needed to extend the small finger has not been explored. This study found that combining wrist flexion and remaining finger extension during manipulation decreases the force required to extend the small finger, suggesting a decrease in stress seen by the flexor tendons during manipulation. Type of study/level of evidence: Therapeutic IV.