Question: I have an issue with my middle finger which has gotten worse, and now I cannot bend it. I thought it was a trigger finger, but my doctor said it is Dupuytren’s. What’s the difference?

Answer: The muscles that flex and extend the fingers are in the forearm, connected to the bones of the fingers by “string-like” tendons that run through lubricated sheaths, allowing smooth movement. Any condition that interferes with these tendons/sheaths can affect the ability to move the fingers normally.

Patient’s with Dupuytren’s contracture, DC, are unable to straighten one or more of their fingers because, for an unknown reason, a hard nodule of abnormal connective tissue develops in the fascia, a band of connective tissue, primarily made up of collagen, in the palm at the base of the affected finger, compromising the flexor tendon’s function.

DC starts with a “pucker” in the skin from the nodule, and slowly, over the course of several years, the condition worsens to the point where the affected finger is stuck in the flexed position, unable to be straightened even by pushing on it with the other hand. DC is quite common, it eventually affects up to 5% of the population; it most commonly affects men, 80% of cases, over age 50. DC is more common in those of Scandinavian heritage — up to 30% of Norwegians are affected, hence it is sometimes called the “Viking disease” — with risk factors for developing it including family history — 60% to 70% of DC patients have an affected family member — smoking, alcoholism, diabetes, certain liver problems, epilepsy, repetitive trauma, frequent exposure to vibrations and others.

People with DC may develop other areas of abnormal connective tissue, typically as lumps of the back of their fingers (“knuckle pads”), in the arch of the feet, and even in the shoulder, possibly causing “frozen shoulder.” Diagnosis of DC is based on the characteristic history and physical exam. Surgery, there are several different possible surgical approaches, is the usual treatment. Unfortunately, DC often recurs even after successful treatment.

Trigger finger is different than DC; it is due to an inflammation of the tendon, the cause of this is not known, interfering with its smooth glide within the sheath and causing it to “catch,” “click” or “snap,” getting stuck in a flexed position, like the position a finger is in when it pulls a trigger. Being stuck in a flexed position can be overcome by forcibly straightening the finger, and this is useful to inform the diagnosis.

TF is also very common, affecting about 2% of people at some time in their lives. However, unlike DC, TF is more common in women, with onset typically in the patient’s 40s to 50s.

The inflammation causing trigger finger may be treated with steroids — possibly by mouth and possibly by injection — although surgery to “open up” the tendon sheath to relieve the swelling is often recommended.

Even though DC and TF are very common, there are other condition that can cause a finger to be stuck in a flexed position. Since the correct treatment depends on the cause, the severity, and other factors, if you have trouble straightening a finger you need to see your health care provider to have it evaluated and to discuss what next steps are indicated for you.
