Hayes Hand Center Blog

You may have seen someone with a “crooked finger” or may have one yourself. There was no injury to cause the problem. It just seemed to gradually get more pronounced. Usually, the ring or small finger is the one affected. Most people do not consult with their doctor until it begins interfering with function-- when you reach in your pocket, you can’t get the finger in easily or you pull out objects you didn’t mean to pull out.

Your doctor will examine your hand and take a careful history. Eliminating the possibility of an injury to the digit, the doctor may diagnose you as having Dupuytren’s disease. This is a thickening of the dense tissue in the palm that is called fascia. It usually begins as a sore knot in the palm. As it progresses, a distinctive cord can develop that actually begins to bend the finger into the palm, making it difficult or even painful to straighten out the finger. Left untreated, the finger will continue to bend and be a nuisance. In some cases, it can flex so much that it can become a hygiene problem.

Your next step is to consult with a hand surgeon to review your options. The most common approach is to have surgery to remove the diseased palmar fascia. Following the surgery, you are placed in a splint for night time to keep the finger straight. Sutures come out at 2weeks post op and you are allowed to gradually return to using the hand with daily activities. On occasion it is necessary to have therapy to help you get your fingers moving well. Therapy will involve active exercise, modalities to soften the tissues in the palm, and gradual strengthening to help you return to your daily activities.

A new approach to treating Dupuytren’s disease is the use of an injectable called XIAFLEX. It is a prescription medicine that is injected directly into a Dupuytren’s cord, where it helps break down the collagen, which can help straighten the finger. If you are determined to be a good candidate for the procedure, the doctor will inject the cord and wrap your hand in gauze dressing to keep you from using it until you return the next day. When you return to the doctor the following day he will evaluate the finger. If necessary, he will attempt to extend, or straighten, your finger by applying moderate pressure. After this visit your doctor will have you wear a splint to wear at night for up to 4 months to help keep the treated finger straight. As with the surgical approach, it will be necessary for you to do finger exercises several times a day for several months to get your mobility in the fingers.

So, if you, or someone you know has a “crooked finger” that is getting in the way of daily activities, consult with you doctor. You don’t have to “live with it”.