Dupuytren’s Disease of the Thumb and First Web

First web space and thumb contracture represents a unique entity in the spectrum of Dupuytren’s disease. Radial-sided disease, while less common than more ulnar-based contractures (Tubiana et al., Clin Orthop Relat Res 168:222–229, 1982; Mikkelsen, Hand 8:265–271, 1976; Figus et al., J Hand Surg Eur Vol 33:272–279, 2008), can cause thumb deformity in a three-dimensional plane. Two predominant pathologic cords, a radial cord and commissural cord, combine to result in a deformity that concomitantly affects thumb abduction, opposition, and flexion/extension movements. Similar to ulnar-sided contractures, collagenase can effectively be used to enzymatically lyse pathologic cords about the thumb to improve overall hand function by releasing contractures in multiple planes. Technical aspects of injection, manipulation, and post-procedure care for the thumb are described. Appropriate consideration to the details of these differences can help hand surgeons, therapists, and patients optimize outcomes when using collagenase to treat Dupuytren’s disease in the thumb.