Trigger Finger and Dupuytren's Contracture: Common Hand Conditions Explained

Not every hand problem starts with an injury. Trigger finger and Dupuytren's contracture are two of the most common conditions we see that develop gradually, without any specific trauma.

Trigger finger

Trigger finger happens when a flexor tendon in the finger has difficulty sliding smoothly through its pulley system at the base of the finger — usually due to a mismatch between the tendon's thickness and the pulley opening.

Symptoms: a catching or locking sensation when bending or straightening the finger, sometimes with an audible or palpable "pop"; tenderness at the base of the finger; in more advanced cases, the finger may lock in a bent position.

Treatment, usually staged:

• Activity modification and splinting for mild cases
• Corticosteroid injection, which resolves symptoms in a substantial proportion of cases, sometimes requiring a repeat injection
• A simple surgical release of the pulley for cases that don't respond to injection, usually done under local anaesthesia as a day procedure with a short recovery

Dupuytren's contracture

Dupuytren's contracture is a gradual thickening and tightening of the tissue layer just beneath the skin of the palm (the palmar fascia), which can eventually pull one or more fingers into a bent position that can't be fully straightened.

Symptoms: firm nodules or cords in the palm, gradual inability to fully straighten the affected finger(s) — usually the ring and little finger — typically painless.

Who it affects: it has a strong genetic and ethnic predisposition, is more common with age, and is associated with certain factors including smoking, diabetes and alcohol use, though many people with none of these risk factors develop it too.

Treatment options, chosen based on severity and how much the contracture affects function:

• Observation for early, non-progressive cases with minimal functional impact
• Needle aponeurotomy — a minimally invasive procedure to divide the tightened cord through a needle, with a quicker recovery
• Enzyme injection to soften and help rupture the cord in appropriate cases
• Surgical fasciectomy (removing the affected tissue) for more advanced or recurrent contractures

The common thread

Neither condition is an emergency, but both tend to progress gradually if left untreated, and outcomes are generally better the earlier appropriate treatment starts once function is genuinely affected — which is why it's worth having a new catching sensation or a finger that won't fully straighten assessed rather than waiting.