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Hand (N Y). 2009 September; 4(3): 270–271.
Published online 2009 March 17. doi:  10.1007/s11552-008-9140-0
PMCID: PMC2724610

The Tag Test for Dupuytren’s Surgery

Abstract

Digital nerve injury is a well-recognised complication of surgical treatment for Dupuytren’s disease. We describe a simple test, the Tag test, that can be used intra-operatively to help identification of the digital nerves.

Keywords: Dupuytren’s, Digital nerve, Test

Digital nerve injury is a well-recognised complication of surgery for Dupuytren’s disease [1, 2]. Identification of the digital nerves during Dupuytren’s surgery is thus vital. In primary surgery, the digital nerves can be entrapped in or displaced by Dupuytren’s tissue. In revision Dupuytren’s surgery, they can be entrapped in the scar tissue and thus be difficult to identify.

When performing primary or revision surgery for Dupuytren’s disease, we initially expose the palmar disease as well as the digital Dupuytren’s cords. We then identify the digital nerves just proximal to the metacarpophalangeal joint, where they are easy to identify in normal tissue.

We then gently tag the digital nerve at the level of the palm using closed non-toothed forceps whilst we observe for corresponding longitudinal movement of the nerve distally in the exposed fingers (Fig. 1). Tagging the nerve in the palm will cause movement of its corresponding part in the digit. In this way, the position of the digital nerve in the finger is identified. Even if the nerve is surrounded by scar tissue, we find that tagging causes the nerve and surrounding scar tissue to move. To further confirm that the structure identified distally is indeed the digital nerve, tagging the distal part of the nerve will cause corresponding movement in its proximal part in the palm.

Figure 1
Schematic presentation of the tag test. Tagging the digital nerve proximally (single-head arrow) causes longitudinal movement of the digital nerve distally (double-head arrow).

We routinely use the tag test in Dupuytren’s surgery and feel that is an invaluable tool in avoiding digital nerve injury.

References

1. Anwar MU, Al Ghazal SK, Boome RS. Results of surgical treatment of Dupuytren’s disease in women: a review of 109 consecutive patients. J Hand Surg [Am] 2007;32:1423–8. doi:10.1016/j.jhsa.2007.06.015. [PubMed]
2. Shaw DL, Wise DI, Holms W. Dupuytren’s disease treated by palmar fasciectomy and an open palm technique. J Hand Surg [Br] 1996;21:484–5. doi:10.1016/S0266-7681(96)80051-9. [PubMed]

Articles from Hand (New York, N.Y.) are provided here courtesy of American Association for Hand Surgery