A finger that catches and a finger that will not straighten are not the same thing

These are two common problems of the palm that arrive at the consultation mixed together, and they are worth separating from the start because the outlook for one and the other are nothing alike.

The difference, in one sentence

Trigger finger catches the finger as you bend it: it sticks and then snaps straight, with a characteristic click. It hurts at the base of the finger.

Dupuytren's stops you straightening the finger: a cord in the palm pulls it inwards and it no longer opens. It does not hurt.

The test at home is to lay your open palm flat on a table. If the finger does not reach it and you can feel a hard cord under the skin, that is Dupuytren's.

Trigger finger is mechanical, and it gets fixed

The flexor tendon thickens and catches as it passes through a pulley in the palm. In advanced cases the finger locks in flexion and has to be straightened with the other hand.

It is more frequent in women, in people with diabetes and in anyone who grips repeatedly. And it is a local problem: opening that pulley resolves it for good, in a few minutes, as a day case under local anaesthesia.

In recent, mild cases an injection may be enough. If it comes back, surgery is the next step and it does not usually need repeating.

Dupuytren's is a disease, and that changes everything

It is a disease of the fibrous tissue of the palm that forms nodules and cords which pull the fingers inwards — usually the ring and little fingers — over years. It runs in families.

Here is the difference that matters most: surgery corrects the contracture, but it does not cure the disease. It can reappear years later, or in another finger.

Saying so beforehand is part of the deal. A patient who knows it can recur experiences a recurrence as what it is; one who was promised a permanent fix experiences it as a failure.

When to operate and when not to

Dupuytren's with nodules but no contracture is not operated on: it is monitored. Operating too early prevents nothing and uses up tissue that may be needed later.

The usual threshold is when the finger no longer straightens enough to lay the palm flat on a table, or when the contracture interferes with specific tasks: putting a hand in a pocket, shaking hands, putting on a glove, washing your face.

The recovery, which is where the gain is kept

• Weeks 1 to 2. Wound care and a night splint in extension. The fingers are moved from the first day. With trigger finger, life is practically normal.
• Weeks 3 to 6. Hand therapy and work on extension. The scar in the palm is hard and tender: that is normal at this stage.
• Weeks 6 to 12. Grip strength returns. Back to manual work.
• Months 3 to 12. The scar softens. The night splint is kept for as long as indicated and new cords are watched for.

With Dupuytren's, the night splint and hand therapy are not an optional extra: they are half the result. The extension gained in theatre is lost if it is not held afterwards.

A note on diabetes

Both conditions are more frequent and more stubborn in people with diabetes, and poorly controlled blood sugar also makes the palm heal worse. Getting it under control before surgery is not a formality: it changes the result.