These are two frequent problems of the palm that are often confused: one makes the finger catch as you bend it, and the other stops the finger straightening.
In trigger finger, the flexor tendon thickens and catches as it passes through a pulley in the palm. The result is a finger that catches as you bend it and snaps as it straightens, with a characteristic click, and that in advanced cases locks in flexion and has to be straightened with the other hand. It hurts at the base of the finger and is more frequent in women, in people with diabetes and in those who grip repeatedly. It is a mechanical, localised problem, and its surgery — opening the pulley — resolves it definitively in a few minutes.
Dupuytren's disease is something else. It is a disease of the fibrous tissue of the palm that forms nodules and cords which gradually pull the fingers inwards, usually the ring and little fingers, until they can no longer be straightened. It does not hurt; what limits is the contracture, and it progresses slowly over years. It has a hereditary component, and here is the difference that matters most: it is a disease, not a mechanical injury, so surgery corrects the contracture but does not cure the disease, which can show itself again over time.
It usually helps when there is
- A finger that catches, snaps or locks when you bend it.
- Pain at the base of the finger with a palpable nodule in the palm.
- A cord in the palm stopping a finger straightening fully.
- Being unable to lay the hand flat on a table.
- A contracture interfering with everyday activities.
Worth discussing first if
- Dupuytren's with nodules but no contracture: it is monitored, not operated on.
- Poorly controlled diabetes, which worsens both conditions and healing.
- Recent, mild trigger finger, which may respond to an injection.
- Expecting Dupuytren's not to come back: it can recur.
- Very aggressive, early-onset Dupuytren's, which has a worse outlook.
None of these rules the procedure out on its own; all of them change the conversation.
What applies to each
They are operations of very different scale despite sharing a location.
Injection for trigger finger
Corticosteroid into the tendon sheath. It resolves a good proportion of recent cases, and its effectiveness drops in people with diabetes and on repeat.
Pulley release
Brief surgery, under local anaesthesia, opening the pulley that catches the tendon. Immediate and definitive result: it does not recur.
Fasciectomy for Dupuytren's
The fibrous cords pulling on the finger are removed, protecting the nerves running between them. It is the larger of the two operations.
In Dupuytren's, timing matters
Dupuytren's disease is not operated on because it is there but because of what it does. A nodule in the palm with no contracture is monitored; surgery is indicated when the finger no longer straightens enough and that interferes with daily life. The practical test is simple: if the hand cannot be laid flat on a table, the contracture is significant.
Operating too late has a cost: when a joint has spent years flexed it stiffens, and releasing the cord no longer restores full extension because the problem has moved into the joint. Operating too early, on the other hand, exposes you to the complications of surgery without having gained anything.
It is delicate surgery because the digital nerves are caught inside the diseased tissue and displaced from their usual position. They are dissected out one by one, which is why the operation takes far longer than its size suggests. In trigger finger, by contrast, the key is opening the pulley completely: an incomplete release leaves the catching.
What the process is like
Very different depending on which of the two it is.
Consultation
Which of the two conditions it is is established clearly, the degree of contracture measured and whether to operate now or monitor assessed.
Trigger finger
An injection in recent cases or brief surgery under local anaesthesia. The finger stops catching immediately. Movement from the first day.
Dupuytren's
Longer surgery under regional anaesthesia, with careful dissection of the digital nerves. A night splint in extension afterwards.
Rehabilitation
In Dupuytren's it is essential: hand therapy and a splint for weeks. Without it the finger closes up again.
What to expect
These timings are for Dupuytren's, the longer of the two.
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Weeks 1 to 2
Dressings and a night splint in extension. Finger movement from the first day. With trigger finger, practically normal life.
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Weeks 3 to 6
Hand therapy and work on extension. The scar in the palm is firm and tender, which is normal at this stage.
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Weeks 6 to 12
Grip strength and the extension gained are recovered. Back to manual work.
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Months 3 to 12
The scar softens. The night splint is kept up for as long as directed and new cords are watched for.
Risks, and what is not promised
In trigger finger: infection, a tender scar, temporary stiffness and, infrequently, an incomplete release or injury to a nerve branch. It is a low-risk procedure with a very reliable result.
In Dupuytren's the risks are greater: injury to a digital nerve — the nerves are displaced within the diseased tissue — haematoma, healing problems in the skin of the palm, stiffness, partial loss of flexion as extension is gained, and complex regional pain syndrome, more frequent here than in other hand surgery.
And the central point: Dupuytren's is a disease, not an injury. Surgery corrects the contracture, it does not cure the disease, and it can recur years later or appear in another finger. Nothing to the contrary is promised. In trigger finger, by contrast, the release is definitive. These risks are reduced by operating at the right moment, careful dissection and completed rehabilitation. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most
Trigger finger catches as you bend it and snaps as it straightens, with pain at the base of the finger: it is a mechanical problem of the tendon and its pulley.
Dupuytren's does not hurt and does not catch: it forms cords in the palm that pull the finger inwards until it cannot be straightened. It is a disease of the fibrous tissue, with a hereditary component.
It can, yes, and it is worth knowing beforehand. Surgery corrects the existing contracture but does not cure the underlying disease.
Recurrence is more likely in younger people, with a family history and with disease in several areas. In many patients the correction lasts years; in others new cords appear.
When the contracture interferes with daily life. The most used practical test is simple: if you cannot lay your hand flat on a table, the contracture is significant.
A nodule with no contracture is not operated on, it is monitored. And waiting too long is not advisable either: the joint stiffens and no longer recovers full extension.
Yes, and it resolves a good proportion of recent cases. It is reasonable to try it first.
Its effectiveness drops in people with diabetes, when the problem has been there a long time and with repeated injections. In those cases, surgery is brief and definitive.
Question not answered here? There are more answers in the frequently asked questions.
