Every day, there are new advancements in medicine and surgical procedures. New technology and specially trained surgeons mean a greater number of minimally invasive surgical procedures are being performed in hospitals or clinics on an outpatient (no overnight hospital stay) basis, allowing the patient to go home within hours after surgery.
Recently, a breakthrough in these minimally invasive procedures is beginning to take shape. These surgeries can now take place in adapted procedure rooms within the physician clinic office while the patient is wide awake. This means surgeons can now perform minor surgeries without the typical expenses of surgery rooms and lengthy wait times, which will significantly decrease costs and create a better experience for patients – less pain and less time, quicker recovery and lower costs.
In-office hand surgeries are becoming one of the most commonly performed procedures in hand centers across the U.S. At the top of the list is the minimally invasive surgery to treat trigger finger.
What is Trigger Finger?
Trigger finger is a condition in which a finger or thumb gets stuck in a bent position – much like the position of squeezing a trigger. Often, the finger bends or straightens with a snap or click because of a catch and release of the tendons in the finger, gets stuck in a bent position and/or is unable to be straightened or bend.
Trigger finger usually shows up between the ages of 40 and 60 and is more common in women than in men. Health conditions such as diabetes, gout and arthritis can cause trigger finger. The condition is prevalent in farmers, musicians, rock climbers and those who use repeated finger and thumb movements.
The problem occurs in the “pulley” system in the hand that is comprised of sheaths or tunnels that hold tendons close to the finger bones so the fingers can bend and straighten when the tendons are flexed or extended via the muscles in the forearm. Trigger finger is caused by inflammation (swelling, redness, warmth, pain and/or immobility) and narrowing of the sheath, resulting in compression on the tendons. When the compression gets too much and the pulley gets too tight, the finger will curl into a bent position, making it difficult and painful to straighten.
Non-Surgical Treatment Options
Some sufferers find relief by doing specific exercises, taking over-the-counter anti-inflammatory medication such as Ibuprofen and reducing or stopping the repetitive activity causing the problem.
If these interventions don’t provide relief, the next step may be steroid injections. Cortisone is a steroid normally produced in the body, and it is a powerful anti-inflammatory. Cortico-steroid injections can help shrink the inflamed areas and slow down the inflammation process allowing the body to relax and heal. If steroid injections don’t provide enough relief, then surgery is considered.
Surgery: Without a Surgery Room or Hospital
Trigger finger surgery is an outpatient (no hospitalization required) procedure. Until recently, it needed to be performed in a surgical suite or operating room. There have been many technological advancements that have allowed some surgeons to perform this procedure right in the clinic room. Patients experience a much easier surgery and enjoy the convenience of walking out and beginning their recovery immediately. The hand surgeon uses a local anesthesia to numb the affected area and perhaps a mild sedative to help the patient relax and remain comfortable during surgery.
The goal of surgery is to give the tendon more room to slide through the sheath. An incision, about one centimeter long is made in the hand in the same direction as the affected finger. The surgeon then carefully snips the sheath to release the entrapped tendon. Improvement is immediate, including a full range of motion and pain relief.
After surgery, it’s important to continue moving the fingers after surgery so scar tissue doesn’t build up. In most cases, patients will be back to work or daily activities within 48 hours after surgery and are able to perform more strenuous manual tasks within two weeks. A soft bandage over the incision site is recommended for four to five days following surgery to help keep the wound dry and clean during healing. QCBN
By Peter Gibson, M.D.
Dr. Peter Gibson is a fellowship-trained surgeon specializing in hand, wrist and elbow surgery. He and Dr. Mark Mellinger provide in-office surgical procedures at NAO’s Hand Center, inside the Summit Center. For more information or to make an appointment with him or any of the other specialists at Northern Arizona Orthopaedics, call 928-774-7757 or visit www.northAZortho.com.