What causes one-sided finger contracture?

Causes of One-Sided Finger Contracture

The most common cause of one-sided finger contracture is stroke with hemiparesis, which affects approximately 60% of patients within the first year post-stroke, particularly affecting the wrist and fingers on the affected side. 1

Neurological Causes

• Stroke is the leading cause of unilateral finger contractures, with wrist contractures occurring most commonly in patients who do not recover functional hand use 1
• The presence of spasticity within the first 4 months post-stroke is strongly associated with the development of elbow contractures within the first year 1
• These contractures typically develop on the hemiplegic side and can cause pain and make self-care activities difficult 1

Musculoskeletal and Connective Tissue Causes

• Dupuytren's contracture is a common cause of one-sided finger contracture, particularly affecting the ring and little fingers 2, 3
• Traumatic injury to the hand or wrist can trigger the development of Dupuytren's contracture, accounting for approximately 22% of cases 4
• Injury-induced Dupuytren's contracture tends to present at a younger age (mean 52 years vs. 56 years for non-injury cases) 4
• Isolated contracture of a single finger joint, such as the distal interphalangeal joint, can occur after minor trauma 5

Other Causes

• Neuromuscular disorders can cause finger contractures that may initially present unilaterally 2
• Prolonged immobilization of a limb can lead to contracture development 1
• Inflammatory conditions affecting the joints or tendons of the hand can result in contractures 6
• Vascular injuries or compromise to a specific digit can lead to contracture 7

Risk Factors

• Lack of functional hand use following neurological injury 1
• Presence of spasticity in the affected limb 1
• History of alcoholism, diabetes mellitus, dyslipidemia, or epilepsy (particularly for Dupuytren's contracture) 3
• Genetic predisposition (particularly for Dupuytren's contracture, with 40% of patients having a hereditary component) 3
• Advanced age (particularly for Dupuytren's contracture) 6

Clinical Evaluation

• Physical examination should focus on determining the specific joints affected and measuring the degree of contracture using goniometry 4
• Assessment should include evaluation for spasticity, which may contribute to contracture development 1
• Examination should differentiate between reducible and fixed contractures 5
• For suspected Dupuytren's contracture, look for palmar nodules or cords 6
• In post-stroke patients, evaluate for other signs of hemiparesis 1

Diagnostic Considerations

• MRI can be valuable for evaluating tendon injuries and planning surgical intervention for finger contractures 1
• MRI can assess capsule and collateral ligament injuries of the proximal interphalangeal and metacarpophalangeal joints 1
• For suspected Dupuytren's contracture, diagnosis is primarily clinical based on physical examination 3
• In cases of traumatic injury, radiographs should be obtained to rule out fractures 1

Prevention and Management

• Daily stretching of affected limbs is recommended to prevent contractures, with proper techniques taught to patients and families 1
• Positioning of the hemiplegic shoulder in maximum external rotation for 30 minutes daily can help prevent shoulder contracture 1
• Resting hand/wrist splints, combined with regular stretching and spasticity management, may be considered for patients lacking active hand movement 1
• Serial casting or static adjustable splints may be used to reduce mild to moderate elbow and wrist contractures 1
• For established contractures, surgical options may include release of specific muscles for elbow contractures or fasciectomy for Dupuytren's contracture 1, 6

Clinical Pitfalls and Caveats

• Contractures can be mistaken for active spasticity, but they represent fixed tissue changes rather than dynamic muscle activity 1
• Resting hand splints have conflicting evidence for effectiveness, with some guidelines recommending against their use while others support them 1
• Overlooking early signs of contracture development can lead to permanent disability and functional limitations 1
• Aggressive stretching without proper technique can cause injury rather than benefit 1
• For Dupuytren's contracture, recurrence rates are high even after treatment, requiring ongoing monitoring 6