远端指间关节（DIPJ）关节炎资料 In-depth

您的感受

疼痛位于手指的最后一个关节，即最靠近指甲的关节。磨损性关节炎（骨关节炎）会磨损使关节顺畅滑动的平滑软骨。随后，关节边缘会形成新骨，这正是您注意到的酸痛、僵硬和肿胀的原因。

该关节通常在早晨或手部活动后最为僵硬。抓握、捏取和弯曲指尖可能会加重疼痛。让手指休息通常能缓解症状。有些人还会发现疼痛在夜间持续存在。

使用指尖的日常任务变得更加困难。扣衬衫纽扣、捡起小硬币、打字或转动钥匙都可能令人不适。由于该关节有助于精细捏取，穿针引线或捡起一张纸等任务可能会感觉笨拙。

您还可能注意到关节附近有一个小而坚硬的肿块或囊肿，有时指甲本身会出现凹槽或脊状突起。这些囊肿与X光片上观察到的相同关节炎性变化有关。随着时间的推移，关节可能会形成无法完全伸直弯曲，且随着僵硬程度加重，该弯曲可能会逐渐增大。

如果该关节曾受过旧伤，例如锤状指，导致其僵硬或弯曲，相同的磨损性变化可能在数年后出现。

实际发生了什么

每根手指都是由一系列小骨组成的链条。紧邻指甲、位于指尖的关节被称为远端指间关节。在这种疾病中，磨损性关节炎对手部其他任何关节的影响都不及对该关节的影响。

健康的软骨在骨骼之间起到减震器的作用。它使关节在弯曲和伸直时能够顺畅滑动。当软骨磨损消失后，骨骼会相互摩擦。身体对此的反应是在关节边缘长出额外的骨质。这种新生骨质连同粗糙的关节表面，正是导致您感到疼痛、肿胀和僵硬的原因。

肌腱在此处也至关重要。肌腱是连接肌肉与骨骼的强韧索带。索带横跨手指的背侧和掌侧，它们需要保持平衡，指尖才能正常地伸直和弯曲。关节炎会破坏这种平衡，因此关节可能会停留在弯曲的位置，并随时间推移逐渐恶化。

陈旧性损伤也可能导致这种情况。如果您曾患过锤状指，即伸直指尖的肌腱撕裂或撕脱，关节可能会失去平衡。指尖下垂，其后的中间关节（近端指间关节）随后可能过度伸直，形成天鹅颈畸形。关节若长期处于该位置，会过早磨损，从而引起疼痛和僵硬。

这种关节炎有两种主要模式。一种在外观和行为上类似于普通的磨损性退变。另一种称为侵蚀性关节炎，关节表面本身会逐渐被侵蚀，这种情况往往疼痛更剧烈，破坏性更强。

好消息是，该关节的功能有限。它有助于精细捏持，但并不承担大部分抓握力。因此，治疗方案的范围从缓解症状到关节固定或关节置换，具体取决于关节炎给您带来的困扰程度。

我们如何处理该问题

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的最微创方案入手。患者通常由全科医生转诊至我们的诊所；如果理疗师建议您就诊，您仍需获得全科医生的转诊才能符合 Medicare 报销资格。就诊时，我们会采集病史，检查您的手指，并在需要时安排 X 光检查以确诊。

对于此类长期存在的问题，我们通常首先采用非手术治疗。定制适合您手指的支具可以缓解疼痛，并有助于关节更好地伸直。佩戴支具不会使关节僵硬或限制其活动范围，大多数人佩戴时均无不适。手部治疗旨在保持关节活动并减轻日常活动中的关节负荷。我们通常建议您先充分尝试这些简单措施，再考虑其他方案。

如果上述措施未能充分缓解症状，可考虑手术治疗。该关节的标准手术为关节融合术，即去除磨损的关节面并将骨骼连接，使其愈合成一个坚固的整体。术后该关节会僵硬，但疼痛消失。融合术还可防止黏液囊肿复发。对于部分患者，保持关节活动更为重要，因此可选择关节置换术或修整磨损骨缘的手术作为替代方案。这些选择取决于您的症状、工作情况以及对手部功能的需求。我们将与您详细讨论各种选项，共同决定最适合您的治疗路径。

预期情况

对大多数人而言，这种关节炎是一种长期状况，而非暂时性问题。疼痛和僵硬感往往时好时坏，通常在手指大量使用后加重。休息通常能缓解症状。随着时间推移，关节可能会进一步僵硬，且无法完全伸直弯曲的角度可能会逐渐增大。

如果关节炎是由旧伤（如锤状指）引起的，预后相似。关节可能会丧失部分活动度，但这种丧失并不总是改变手指在日常生活中的感觉或功能。即使指尖弯曲受限，有些人仍能保持良好的功能。

如果不进行治疗，主要风险是持续疼痛以及关节进一步僵硬或弯曲。如果关节深处的损伤未能在8小时内迅速处理，关节可能会变得非常僵硬。让弯曲的关节保持原状数年，也可能导致其过早磨损。

经过治疗，大多数人发现疼痛会得到缓解。夹板和手部治疗等简单措施通常就足够了。如果需要手术，关节融合术可以消除疼痛，但会使该关节变得僵硬。如果保留活动度对您更为重要，修整磨损的骨边缘或进行关节置换可以在缓解疼痛的同时保留部分活动度。这些选择各自带有风险，您的外科医生会与您详细讨论这些风险。

有一点值得了解：如果同一手指的中指间关节和指尖关节均严重疼痛，有时可以在一次手术中同时治疗。

何时就医

如果指尖关节在休息后仍持续疼痛，或指甲附近的肿块或囊肿持续增大或导致指甲变形，请咨询您的全科医生。如果关节随时间推移变得僵硬或弯曲程度加重，如果扣纽扣或捡硬币等精细动作变得越来越困难，或者旧的锤状指损伤导致关节僵硬或下垂，请要求专科医生评估。如果指尖关节受到挤压或严重损伤，请立即前往急诊科，因为延迟超过8小时可能导致关节变得非常僵硬。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。指尖关节的关节炎值得额外阅读，因为标准手术——即关节融合术，通常被描述为简单直接——其并发症发生率高于其声誉所暗示的水平，并且存在一种很少被提及的保留关节活动度的替代方案。

关节融合术并非听起来那般平稳

指间关节融合术被描述为一种可靠的手术，就疼痛缓解而言确实如此。但其并发症谱并不那么温和。一项针对 173 例患者危险因素的分析直接指出：远端指间关节融合术常导致并发症，并识别出 骨关节炎、翻修融合术和吸烟 为危险因素 [1]。

吸烟出现在该列表中值得采取行动，因为这是患者唯一可控的因素。骨愈合依赖于血液供应，而这是一个位于手指血供末端的微小关节，其软组织包膜很薄。

愈合效果更优的植入物也会引发廉价替代品所不具备的问题

关于固定方式的争论有一个异常清晰的答案，且这并非胜负之分，而是一种权衡。在 1,125 名患者中，无头加压螺钉似乎具有更高的愈合率，但与并发症相关，而这些并发症在其他成熟且更廉价的技术中并未见到，除愈合率外，证据不足以证明螺钉具有优越性 [2]。

螺钉特有的并发症源于解剖结构。螺钉沿指尖轴线运行，因此紧贴甲床，可能导致甲畸形；在非常小的远节指骨中，可能缺乏足够的骨质来固定螺钉。钢丝更廉价，可避免这些特定问题，但愈合可靠性略低。

当愈合率是唯一优先事项时，在翻修融合术或吸烟患者中，螺钉的优势最为相关。当骨质较小且指甲外观重要时，其并非明确的最佳选择。

保留活动度的替代方案

关节融合并非唯一选择，且替代方案鲜少被广泛讨论。对于主要诉求是骨性隆起及其引发的疼痛，而非整个关节的关节炎的患者，可以在保留关节完整性的同时切除突出的骨赘。

指尖关节的开放关节缘切除术被描述为在希望保留关节活动度的症状性骨关节炎患者中，关节融合的安全且有效的替代方案，涉及78**例患者 [3]。

这一点至关重要，因为指尖关节对握力的贡献甚微，但对精细操作和手部外观却有较大影响。对于症状主要由赫伯登结节本身驱动的患者而言，用永久性僵硬的指尖来换取这些结节，其代价可能比听起来更大，且存在一种折中的选择。

常伴随出现的囊肿

该关节的关节炎常导致黏液囊肿，这是一种源自关节炎性关节的小液性肿胀，通常位于指甲旁。由于其由潜在的关节病变驱动，因此在这一点上表现得类似腕部腱鞘囊肿：仅抽吸囊肿可消除肿胀，却无法解决根本病因。该囊肿将在其他章节单独讨论，但了解其与关节炎的关联至关重要，因为反复发作的囊肿提示其下方存在关节炎，而非孤立性问题。

参考文献

[1] Runkel A, Bonaventura B, Sundermann B, Zajonc H, Eisenhardt S, Leibig N. 手部远端指间关节融合术的危险因素：一项回顾性研究。J Hand Surg Eur Vol. 2022;47(9):907-14. https://doi.org/10.1177/17531934221111641

[2] Dickson D, Mehta S, Nuttall D, Ng C. 远端指间关节融合术的系统性综述。J Hand Microsurg. 2014;6(2):74-84. https://doi.org/10.1007/s12593-014-0163-1

[3] Lin EA, Papatheodorou LK, Sotereanos DG. 关节成形术治疗有症状的远端指间关节骨关节炎：78例病例的回顾。J Hand Surg Am. 2017;42(11):889-93. https://doi.org/10.1016/j.jhsa.2017.07.006

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

In select patients, percutaneous DIP joint arthrodesis is advantageous in comparison with open fusion techniques [1].
Swan neck deformity can progress significantly over time due to increasing DIPJ flexion contracture [2].
Simultaneous surgical intervention is recommended for severe painful osteoarthritis of the PIP and DIP joints of the same digit [3].
Denervation with cheilectomy presents a motion-preserving alternative to arthrodesis for symptomatic DIP joint osteoarthritis [4].
A lateral approach and plate fixation for DIP joint arthrodesis yields results equivalent to traditional methods but with fewer major complications [5].
The combination of DIP arthrodesis and PIP Swanson arthroplasty results in a favourable outcome regarding simultaneous bony union and flexibility [7].
Silicone interpositional arthroplasty of the DIP joint is an acceptable alternative to arthrodesis, achieving excellent pain relief and a range of movement of 30–40 degrees with a low overall complication rate of 5% [8].
The smile incision and reverse shotgun approach is a surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary [9].
The nonaxial multiple small screws (NMSS) technique is a feasible option for DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required [11].
A customized structural bone graft addresses issues of bone stock loss and medullary absence in failed DIPJ silicone arthroplasty, achieving reliable union rates and high patient satisfaction [14].
There is no difference in biomechanical performance between K-wires and compression screws for DIPJ arthrodesis, so cost and complication profiles should be considered when choosing an implant [26].

Anatomy & Pathophysiology

Bony Anatomy & Dimensions

A substantial number of distal phalanges are too small to accommodate commonly available headless compression screws, particularly in females and the small finger [25].
The dorsal integument of the distal phalanx is characterized by the presence of the nail bed with its matrix [28].
The hand consists of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [27].

Soft Tissue Anatomy

The terminal tendon of the extensor mechanism inserts at the base of the distal phalanx to extend it [29].
The dorsal covering of the interphalangeal articulations of the digits forms a unique cutaneous unit characterized by a considerable excess of skin when the digits are in extension [28].
The fine tight skin of the dorsal aspect of the middle phalanx forms a distinct functional cutaneous unit [28].

Pathophysiology & Biomechanics

Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form [12].
The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons [12].
Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured [6].
Fracture fragments that are less than 43% of the distal phalanx articular surface usually do not allow volar subluxation, whereas fragments involving larger than 52% of the joint surface consistently allow subluxation [48].
Mallet fractures associated with large fragments may result in volar subluxation of the distal phalanx as the collateral ligaments remain attached to the fracture fragment [48].
If left untreated, mallet fractures with volar subluxation may lead to a secondary swan neck deformity of the finger, premature osteoarthritis, pain, or stiffness [48].
Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers [19].
Positioning the middle finger DIP joint in either extension or 20° of flexion did not significantly affect grip strength or dexterity [38].
Irreducibility was more commonly seen in dorsal than in volar dislocations of the distal interphalangeal joint [49].
Volar dislocations of the distal interphalangeal joint carried a higher risk of instability immediately after reduction compared to dorsal dislocations [49].

Classification

Osteoarthritis of the distal interphalangeal joint has been divided into an erosive and a nonerosive form [12].
The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed [50].

Clinical Presentation

Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand [12].
The pathogenesis of the early stages of osteoarthritis is poorly understood [12].
Considerable emphasis has been placed on the role of cartilage and subchondral bone in the pathogenesis of distal interphalangeal joint osteoarthritis [12].
Soft tissue structures such as collateral ligaments and tendons play a role in the pathogenesis of distal interphalangeal joint osteoarthritis [12].
Radiographic evaluation represents the most standardized method to quantify disease progression in distal interphalangeal joint osteoarthritis [12].
Different systems have been developed for defining and grading radiographic features of distal interphalangeal joint osteoarthritis [12].
Osteoarthritis at the distal interphalangeal joint often results in pain and deformity [15].
Swan neck deformity can progress significantly with time due to increasing distal interphalangeal joint flexion contracture [2].
Palmar subluxation of a distal interphalangeal joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured [6].
Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the distal interphalangeal joint [13].
Radiological osteoarthritis after a mallet finger fracture is accompanied by a decrease in range of motion of the distal interphalangeal joint [13].
The decrease in range of motion following mallet finger fracture does not clinically affect patient-reported outcome measures [13].
Primary synovial chondromatosis of the distal interphalangeal joint is an extremely rare entity [43].
Primary synovial chondromatosis of the distal interphalangeal joint requires accurate diagnosis to distinguish from other arthropathies [43].
Floating distal interphalangeal joint injuries can be misdiagnosed initially due to minimal deformity [21].

Investigations

A distinct collagen septum exists between the extensor tendon and skin at the DIP joint, confirmed using MRI and histology [55].
The curvatures of the DIP joints may lend insight into the biomechanics and disease progression within the DIP joints [10].

Treatment

Non-Operative

DIP joint splinting reduces pain and improves extension at the joint [17].
DIP joint splinting does not result in non-compliance, increased stiffness, or restriction of range of motion [17].
Collagenase Clostridium histolyticum injection is an option for treating DIP joint contractures in Dupuytren disease [54].
The potential risk for recurrence must be carefully weighed prior to using Collagenase Clostridium histolyticum for DIP joint contractures [54].

Operative

Arthrodesis is generally the most accepted surgical option for treatment of degenerative and traumatic conditions involving the DIP joint of the fingers or the IP joint of the thumb [20].
The ideal position for DIP joint arthrodesis is slightly flexed to improve power, fine pinch, and grip [20].
Most surgeons use straight intramedullary implants for DIP joint arthrodesis, which obligates the joint to be positioned in neutral extension [20].
Dorsal plate fixation allows for DIP joint arthrodesis in slight flexion [20].
Indications for DIP joint fusion include rheumatoid arthritis, posttraumatic arthritis, and chronic conditions [20].
Percutaneous DIP joint arthrodesis is advantageous in comparison with open fusion techniques in select patients [1].
A lateral approach with plate fixation for DIP joint arthrodesis yields results equivalent to traditional methods but with fewer major complications [5].
Diabetes and surgeon experience are factors that increase the risk of postoperative complications in DIP/thumb IP joint arthrodeses [16].
Open cheilectomy and debridement of the DIP joint is a safe and effective alternative to DIP joint arthrodesis in patients with symptomatic osteoarthritis who wish to preserve joint motion [15].
In a review of 78 patients, open DIP joint cheilectomy resulted in a significant improvement in mean visual analog scale pain scores from 8 to 1 [15].
In a review of 78 patients, open DIP joint cheilectomy improved DIP joint flexion contracture by a mean of 6 degrees and DIP joint range of motion by a mean of 20 degrees [15].
No postoperative infections or other complications were noted in a review of 78 patients undergoing open DIP joint cheilectomy [15].
No reoperations were required during the follow-up period in a review of 78 patients undergoing open DIP joint cheilectomy [15].
Denervation with cheilectomy presents a compelling motion-preserving alternative to arthrodesis for symptomatic DIP joint osteoarthritis [4].
For patients prioritizing hand aesthetics or with unstable joints, DIP joint arthrodesis is preferable to silicone arthroplasty [18].
The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [7].
The authors recommend simultaneous surgical intervention in case of severe painful OA of the PIP and DIP joints of the same digit [3].
Open reduction and internal fixation is a viable treatment option for chronic floating DIP joint injuries, though osteoarthritis may develop [21].

Complications

Arthrodesis of the distal interphalangeal joint often leads to complications [22].
Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [16].
The complication rate for DIP joint arthrodesis using the AcuTwist headless compression screw was 9% [56].
In a series of 48 primary arthrodeses using the AcuTwist device, three arthrodeses failed to fuse, including two asymptomatic nonunions and one fixation loss requiring revision with autograft [56].
There were no cases of nail deformity, wound complications, tip hypersensitivity, or clinically notable malalignment in a series of 48 primary arthrodeses using the AcuTwist device [56].
The overall complication rate for silicone interpositional arthroplasty of the DIP joint was 5% [8].
No postoperative infections or other complications were noted in a review of 78 patients undergoing open cheilectomy and debridement of the DIP joint [15].
No reoperations were required or performed during the follow-up period for patients undergoing open cheilectomy and debridement of the DIP joint [15].
Swan neck deformity can progress significantly with time due to increasing DIPJ flexion contracture [2].

Recovery

Operative

The results of lateral approach and plate fixation for DIP joint arthrodesis are equivalent to traditional methods but with fewer major complications [5].
A customized structural bone graft using the described technique addresses issues of bone stock loss and medullary absence in failed DIPJ silicone arthroplasty, achieving reliable union rates and high patient satisfaction [14].
Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in DIP/thumb IP joint arthrodeses [16].

Non-Operative

Splinting of the DIP joint does not give rise to non-compliance, increased stiffness or restriction of range of motion [17].

Key Evidence

[L4] In select patients, this percutaneous DIP joint arthrodesis is advantageous in comparison with open fusion techniques. [1] (10.1007/s11552-010-9265-9)
[L5] The swan neck deformity in this individual progressed significantly with time because of increasing DIPJ flexion contracture. [2] (10.1016/j.jht.2009.11.005)
[L3] The authors recommend simultaneous surgical intervention in case of severe painful OA of the PIP and DIP joints of the same digit. [3] (10.1177/17531934231191255)
[L4] It presents a compelling motion-preserving alternative to arthrodesis for symptomatic DIP joint osteoarthritis. [4] (10.1016/j.jhsa.2026.01.027)
[L4] The results obtained in this small series are equivalent to the traditional methods of DIP joint arthrodesis but with fewer major complications. [5] (10.1016/j.jhsa.2007.09.004)
[L5] Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured. [6] (10.1016/j.jhsa.2007.09.006)
[L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. [7] (10.1177/17531934231215790)
[L4] The study confirms that silicone interpositional arthroplasty of the DIP joint is an acceptable alternative to arthrodesis, achieving excellent pain relief and a range of movement of 30–40 degrees with a low overall complication rate of 5%. [8] (10.1177/1753193411422679)
[L4] This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary. [9] (10.1186/s12891-024-08016-6)
[L5] Our understanding of morphology may lend insight into the biomechanics and disease progression within the DIP joints. [10] (10.1007/s11552-014-9605-2)
[L4] Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required. [11] (10.1186/s12891-022-05473-9)
[L5] [12] (10.1016/j.jhsa.2010.09.003)
[L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. [13] (10.1016/j.jhsa.2023.03.027)
[L4] A customized structural bone graft using the described technique addresses issues of bone stock loss and medullary absence in failed DIPJ silicone arthroplasty, achieving reliable union rates and high patient satisfaction. [14] (10.1177/17531934231151217)
[L4] [15] (10.1016/j.jhsa.2017.07.006)
[L3] Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. [16] (10.1186/s12891-024-07361-w)
[L2] It does not give rise to non-compliance, increased stiffness or restriction of range of motion. [17] (10.1016/j.jht.2013.08.004)
[L3] For patients prioritizing hand aesthetics or with unstable joints, distal interphalangeal joint arthrodesis is preferable. [18] (10.1177/1753193420917818)
[L4] Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers. [19] (10.1177/1753193418765068)
[L4] [20] (10.1016/j.jhsa.2018.03.049)
[Case_report] Floating DIP joint injuries can be misdiagnosed initially due to minimal deformity; open reduction and internal fixation is a viable treatment option for chronic cases, though osteoarthritis may develop. [21] (10.1016/j.jhsa.2010.05.025)
[L3] Arthrodesis of the distal interphalangeal joint often leads to complications. [22] (10.1177/17531934221111641)
[L4] A substantial number of distal phalanges are too small to accommodate commonly available headless compression screws, particularly in females and the small finger. [25] (10.1007/s11552-014-9679-x)
[L5] Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion. [26] (10.1177/1558944715627211)
[L2] Positioning the middle finger DIP joint in either extension or 20° of flexion did not significantly affect grip strength or dexterity, allowing other considerations such as appearance to be prioritized. [38] (10.1016/j.jhsa.2014.06.021)
[Case_report] Primary synovial chondromatosis of the distal interphalangeal joint is an extremely rare entity that requires accurate diagnosis to distinguish from other arthropathies. [43] (10.1177/15589447211049520)
[L5] [48] (10.1177/1753193414554772)
[L4] Irreducibility was more commonly seen in dorsal than in volar dislocations, while volar dislocations carried a higher risk of instability immediately after reduction. [49] (10.1177/1753193415616957)
[L4] The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed. [50] (10.1016/j.jhsa.2024.03.012)
[L4] Injection with CCH is an option for the treatment of DIP joint contractures in Dupuytren disease, though the potential risk for recurrence should be carefully weighed prior to its use. [54] (10.1016/j.jhsa.2018.07.004)
[L5] We confirmed the existence of a distinct collagen septum between the extensor tendon and skin at the DIP joint using MRI and histology. [55] (10.1016/j.jhsa.2008.11.030)
[L4] [56] (10.1016/j.jhsa.2013.09.040)

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