Severity of Contracture and Self-Reported Disability in Patients with Dupuytren’s Contracture Referred for Surgery

Study Design: prospective observational study: Dupuytren’s disease (DD) is a fibroproliferative disorder of the palmar fascia and may lead to functional deficits requiring surgical intervention. Outcomes are usually reported using digital range of motion although recent studies have also included patient-rated outcome measures with the extensively validated Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire commonly used. Purpose of the study: To explore the relationship between pre-operative flexion contracture and self-reported disability in patients undergoing surgical release by fasciectomy or dermofasciectomy. Methods: One hundred fifty-four patients consecutively enrolled in a prospective randomised trial were assessed prior to surgery for active range of movement using goniometry and self-reported functioning using DASH questionnaire. Results: The small finger was affected in 69% of patients with a mean flexion contracture of 77.8° (SD = 43.5°). The mean DASH score was 16 points (range 0–62). The correlation between severity of flexion contracture in all four fingers and DASH was weak (r = 0.264, p = 0.001). At individual digital level, the correlation between flexion contracture and DASH was weak in the index (r = 0.26), middle (r = 0.28) and ring (r = 0.21) fingers but almost absent in the small finger (r = 0.07). Conclusions: These results show that the relationship between severity of flexion contracture and functional disability measured by the DASH questionnaire appears to be very weak or even absent. Level of evidence: Level III prospective cohort study