Trigger finger and Dupuytren’s contracture are two distinct hand conditions that affect finger function. While both impact the fingers, they stem from different underlying issues and present with unique characteristics. This article clarifies their differences and explains their features.
What is Trigger Finger?
Trigger finger, medically known as stenosing tenosynovitis, affects the flexor tendons and their protective sheaths in the hand. These tendons help bend the fingers and normally glide smoothly through a series of pulleys. When the tendon or its sheath becomes inflamed, swollen, or develops a small nodule, it can impede this smooth movement.
Trigger finger commonly causes a catching, clicking, or locking sensation when attempting to bend or straighten an affected finger. Pain is often felt at the base of the finger or thumb, where it joins the palm. The finger may also feel stiff, particularly in the morning, and in severe cases, it can become locked in a bent position. Repetitive gripping motions, as well as conditions like diabetes and rheumatoid arthritis, are considered risk factors.
What is Dupuytren’s Contracture?
Dupuytren’s contracture, also referred to as Dupuytren’s disease, is a progressive hand condition involving the fascia, a layer of tissue located just beneath the skin in the palm. This fascia gradually thickens and shortens, forming nodules and cords that can pull one or more fingers into a bent position. The condition typically begins with small, firm lumps in the palm, which may or may not be painful.
Over time, these nodules can develop into visible cords that extend into the fingers, progressively making it difficult or impossible to fully straighten the affected digits. The ring and pinky fingers are most frequently involved, though any finger can be affected. Dupuytren’s contracture has a strong genetic component, often running in families, and is more common in men over 40, people of Northern European descent, and those with certain health conditions such as diabetes or epilepsy.
Distinguishing Between the Conditions
Trigger finger and Dupuytren’s contracture, despite their shared impact on finger mobility, arise from fundamentally different pathologies. Trigger finger involves inflammation or narrowing of the tendon sheath, causing mechanical obstruction. In contrast, Dupuytren’s contracture is a disorder of the palmar fascia, which thickens and shortens, forming cords.
The primary symptom also differs significantly. Trigger finger’s hallmark is a catching or locking sensation, where the finger may get stuck but can often be passively straightened. Dupuytren’s contracture, however, leads to a gradual, progressive inability to straighten the finger due to tightening cords, resulting in a fixed bent position.
Visually, trigger finger often presents with tenderness or a small nodule at the base of the affected finger, near the palm. Dupuytren’s contracture, on the other hand, typically shows visible nodules and firm cords directly within the palm itself, which may extend into the fingers. The skin in the palm might also appear puckered. Trigger finger can sometimes resolve with conservative treatment or be intermittent, while Dupuytren’s contracture is usually progressive, potentially leading to permanent contracture if left untreated.
Diagnosis and Treatment
Both trigger finger and Dupuytren’s contracture are primarily diagnosed through a thorough physical examination of the hand and a review of the patient’s medical history. Healthcare providers observe the range of motion, palpate for nodules or cords, and assess the degree of finger bending or locking. Imaging tests are usually not necessary for diagnosis unless other conditions are suspected.
Treatment approaches for these conditions differ substantially due to their distinct underlying causes. For trigger finger, conservative options are often the first line of treatment. These include rest, splinting to keep the finger straight, anti-inflammatory medications, and corticosteroid injections into the tendon sheath to reduce inflammation. If conservative measures are ineffective or symptoms are severe, surgical intervention, known as a trigger finger release, may be performed to open the narrowed tendon sheath, allowing the tendon to glide freely.
Conversely, Dupuytren’s contracture treatment varies based on its severity and progression. For mild cases with minimal impact on function, observation may be recommended. Non-surgical interventions for more advanced cases can include enzyme injections, such as collagenase, which help break down the fibrous cords, or needle aponeurotomy, a procedure that uses a needle to puncture and release the cords. Surgical procedures, such as fasciectomy, are considered for significant contractures that impair hand function, aiming to remove the thickened fascial tissue and restore finger extension.