Review Question - QID 220114

A 44-year-old right-hand dominant helicopter pilot presents to the orthopedic clinic with a chief complaint of right-hand pain and difficulty using hand controls within his helicopter. He was diagnosed with Dupuytren’s contracture of his right hand and underwent collagenase clostridium histolyticum (CCH) injections 12 months ago. He received some initial benefits in motion; however, the cords have returned. On exam, he has painful nodules and cords to the small and ring finger. He cannot put his hand flat on the exam table and has a 55° contracture at the ring finger metacarpophalangeal (MCP) joint and a 45° contracture at the proximal interphalangeal (PIP) joint. The patient would prefer treatment that limits having another recurrence. Which of the following history or exam findings makes the patient a more appropriate candidate for partial palmar fasciectomy?