Trigger Finger and Dupuytren Contracture

How is trigger finger different from Dupuytren contracture?

As a reader of this website, you probably have a good idea about Dupuytren contracture, but not a clear idea of what is called a trigger finger.

Trigger finger defined

A trigger finger is a mildly to moderately painful condition in which any finger or thumb becomes suddenly stopped or blocked during finger movement while in a flexed or curled position.  In severe cases, the trigger finger cannot be voluntarily straightened; in less severe cases of trigger finger the locked finger can only be straightened or unlocked with deliberate effort.  The trigger finger name comes from the sudden release and snapping or popping sensation that occurs when the finger finally does straighten – much like the trigger of a gun that suddenly releases with a clicking sound.

To understand what happens when a trigger finger locks while it is flexed, it is necessary to understand a bit of hand anatomy.  Those muscles that bend and straighten the fingers are not located in the hands – they are located in the forearms.  These forearm muscles can operate the fingers because they are connected to the fingers by long tendons that extend to each fingertip.  When these tendons pass through the palm on the way to the fingers, they are encased or covered with a fibrous sheathe (like a sword is kept in a sheath).  The sheath protects the tendon, guides the tendon where it passes between bones, and keeps it lubricated to make movement smoother and easier.

A trigger finger develops when there is a narrowing or constriction in the tendon sheath and a nodule develops as a result of overuse or injury.  When the finger is flexed, causing the nodule on the tendon to pass through the narrowed part of the sheath, the nodule or thickened are will catch or resist at that same point in the flexed position that brings the narrow area and the nodule together.  The sudden snap release of the trigger finger occurs when the nodule or thickening suddenly passes the restricted portion and can again freely slide past it.

The cause of trigger finger is often related to a large sudden injury or small repeated injury or overuse of the hand, or as a result of a degenerative process as with aging or disease.

Most often a trigger finger will act up in the morning, or after a period of rest after heavy hand exertion.  The finger will suddenly catch or lock while in the flexed or bent position and then with a little effort to straighten the finger it will suddenly straighten accompanied by a clicking sensation.  A trigger finger occurs more often in the dominant use hand, since this is the one most subject to overuse and injury, and most often develops in the thumb, middle or ring finger. More than one finger can be affected at a time, as well as both hands can have a trigger finger.

Trigger finger different from Dupuytren’s contracture

Trigger finger is not the same as Dupuytren’s contracture; they are only similar in that both involve finger flexion.  Dupuytren contracture is a condition in which thickening and shortening of the connective tissue occurs in the palm of the hand,  that resemble cords and nodules, in which there is some finger flexion as a result.    Both Dupuytren contracture and trigger finger can occur at the same time in the same hand, since the soft tissue changes of the former can favor development of the later.

In the experience of DCI working with this problem since 2002, we find that many of our Dupuytren contracture treatment ideas can help to reduce or eliminate a chronic trigger finger problem.

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Comments

4 Responses to “Trigger Finger and Dupuytren Contracture”
  1. Trigger finger is one of those things that sounds like it is caused by pulling a trigger too much. Thanks to this article, I have learned that it is similar to tennis elbow. It can be developed without ever pulling a trigger or swinging a racket. I also have learned that it is different from Dupuytren’s contracture, which I thought was the medical terminology for it.

  2. Dr.Herazy says:

    Greetings Jasper,

    Yes, the term “trigger finger” is more about what the condition feels like to the person who has it rather that how it is caused. And it is certainly not always a part of having Dupuytren’s contracture, although a person can develop a trigger finger because of having Dupuytren’s contracture. TRH

  3. Mark Bernhardt says:

    I have had two successful operations (one on each hand ) for Dupuytren’s contracture.
    However I have recently developed trigger finger in my middle finger of my left hand it occurs when I awake in the morning, so I presume this could be a result of my Dupytrens!

  4. Dr.Herazy says:

    Greetings,

    So glad to learn you believe your two Dupuytren’s contracture surgeries were successful. How long ago did each hand surgery happen?

    I ask that question for a reason. Most of the time when a person says he has a good Dupuytren’s contracture hand surgery it is because it was done recently (within the last few months to a year) and complications like numbness, tingling, loss of movement, or recurrence of Dupuytren’s contracture has not yet appeared. So much of the time the evaluation of the surgical outcome is based on the idea the hand lump or cord was removed, and the fingers might be moving better so the assumption is made that the surgery was a huge success. I am always a lot more interested, and surprised, if someone can tell me they had Dupuytren’s contracture surgery five or ten years ago and they are enjoying full finger and hand movement and strength, no loss of sensation, no pain, and most of all no recurrence of their Dupuytren’s contracture.

    For most people who undergo Dupuytren’s contracture surgery, from my perspective, the story is not so good. They either realize within a few days after hand surgery that something is wrong and the surgery went badly because they are in more pain, or have numbness they did not have before, or have no more and perhaps even less finger movement than before the surgery, or they begin to see within a few months many of these symptoms of pain, numbness and loss of finger movement crop up.

    I sincerely hope none of this is true for you, and you have had a fantastic outcome from your hand surgery and your Dupuytren’s contracture never recurs. You, of course, would be the exception. All honest surgeons have to admit that recurrence happens eventually (within a few months to within a few years on average, sometimes going as long as ten years or more in some lucky folks) but it always eventually happens. Surgery for Dupuytren’s contracture is a stop-gap measure that gives temporary relief from the palm lump and cord, with many people a year or so. I recently spoke to a woman who is getting ready for her 4th Dupuytren’s contracture surgery in seven years, and the surgeon has told her this will be the last one before they will do amputation.

    Yes, your trigger is probably related to your Dupuytren’s contracture. This suggests that perhaps either your surgery was not as successful as you assume, or it is the first sign of recurrence of your hand problem. I suggest you contact another surgeon for an evaluation of what might be going on in your situation. Good luck to you and your Dupuytren’s contracture. TRH

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