Trigger Finger (Stenosing Tenosynovitis) and Dupuytren’s Contracture are common conditions causing disability and pain in the hand, often leading to confusion between the two. While both disorders affect the fingers and the palm, they arise from completely different biological processes. Although the final result may be a bent or restricted finger, the underlying cause determines the appropriate diagnosis and effective treatment path.
The Underlying Anatomical Cause
The difference between these two conditions lies in the specific anatomical structure affected. Trigger Finger (Stenosing Tenosynovitis) involves the flexor tendon system that controls finger movement. The condition occurs when the flexor tendon sheath, a tunnel composed of pulleys, becomes inflamed and thickened, most commonly at the A1 pulley near the base of the finger. This thickening constricts the space through which the tendon must glide. The tendon may also develop a nodule, further impeding its smooth movement through the narrow pulley, causing it to catch.
Dupuytren’s Contracture is a progressive fibroproliferative disorder affecting the palmar fascia, a fibrous layer of tissue beneath the skin of the palm. In Dupuytren’s, this fascia thickens and shortens abnormally, leading to the formation of dense, tough cords. The tendons responsible for moving the fingers are not directly involved in the disease process, though the cords of diseased fascia lie very close to them.
How Symptoms Manifest Differently
Trigger Finger is characterized by mechanical locking, catching, or snapping when the finger is flexed and then straightened. This sensation is often accompanied by pain and tenderness localized to the palm at the base of the affected digit, near the constricted pulley. Symptoms are frequently worse in the morning or after a period of inactivity. Although the finger may become temporarily stuck in a bent position, it can usually be forcibly straightened, sometimes with a painful pop.
Dupuytren’s Contracture begins with the appearance of firm, often painless nodules in the palm, composed of abnormal, thickened fascial tissue. These nodules eventually develop into longitudinal cords that extend from the palm into the fingers, most commonly the ring and pinky fingers. As these cords contract, they physically pull the finger into a fixed, bent position, known as a flexion contracture. Unlike Trigger Finger, a finger affected by Dupuytren’s Contracture cannot be fully straightened, even with the assistance of the other hand.
Identifying the Condition and Disease Progression
Diagnosis relies primarily on a thorough physical examination of the hand. For Trigger Finger, the clinician observes the characteristic catching or locking motion as the patient actively flexes and extends the affected finger. They also palpate the palm at the base of the finger to feel for tenderness and the small nodule that may be present on the tendon sheath. Trigger Finger progression is often acute, meaning it appears suddenly, and the symptoms can be intermittent, sometimes resolving spontaneously with rest.
The diagnosis of Dupuytren’s Contracture relies on identifying the hallmark features: palpable nodules and cord-like thickening of the palmar fascia. A common diagnostic method is the tabletop test, which is positive if the patient cannot flatten their palm completely against a surface due to the fixed flexion contracture. Dupuytren’s is a slow, progressive disease, worsening over months or years as the fascial cords shorten. The disease is often chronic and tends to recur even after treatment.
Specific Treatment Pathways
Treatment for Trigger Finger focuses on reducing inflammation and creating more space for the flexor tendon to glide freely. Non-surgical options include splinting to rest the finger and corticosteroid injections delivered directly into the tendon sheath to decrease swelling. If non-surgical methods fail, surgical treatment involves a minor procedure to release the A1 pulley, which physically widens the tunnel and resolves the mechanical catching.
Treatment for Dupuytren’s Contracture is directed at disrupting or removing the diseased fascial cords causing the contracture. Non-surgical treatments include needle aponeurotomy, which uses a fine needle to puncture and break the contracting cord in several places. Another option is the injection of an enzyme, such as collagenase, which chemically dissolves the collagen in the cord tissue. The definitive surgical treatment is a fasciectomy, where the abnormal, thickened tissue and cords are surgically excised from the palm and fingers.