In Office Trigger Finger Surgery

Do you have a trigger finger? That is to say, a finger that is locking and popping and causing you pain?

In the past, when you needed surgery for this condition, a surgeon would take you to the operating room, which means you had to fast overnight before the surgery, go to hospital, get a ride there and back, take off your clothes, have an IV started, get sedation (which means you would be mentally cloudy the rest of the day),  take the whole day off of work ( and sometimes the next day fever nauseated from the sedation),  and  essentially, spent two whole days preparing and recovering from a surgery that takes 5 minutes.

 Does not make any sense?

It did make sense to a lot of hand surgeons, so they started doing surgery in the office with just local anesthesia.  And gets what?  It worked perfectly.

This is the hardest part  of the surgery.  I inject local anesthesia which is mildly painful.  But once that is done the surgery is a breeze and literally takes less than 5 minutes for most patients.

  Once  I make the incision, I dissect down to the A1 pulley which was released and freed up the finger.  Patient can literally see their finger stp popping right in front of theri eyes.  Fingers they have not moved in weeks can now be used to make a full fist.

Once the A1 pulley was released, I checked to make sure that the patient could make a full fist without any popping or trigger.  Once this was verified, and the triggering was corrected with surgery, I began to close with a few stitches.

The patient can wash their hand that night and use their hand that night.

Many patients who have a desk job just go back to work and work the rest of the day.

It has been an excellent procedure for many of my patients.

Endoscopic Carpal Tunnel Release

Endoscopic carpal tunnel release is one of the great advances in  hand surgery carpal tunnel surgery.

It allows for quick recovery after surgery, so you can get back to your life in your job, sometimes within days.

The incision is literally 1 cm (compared to 3-4 cm in the palm with traditional techniques), and you can use your hand that night. You can drive the next day, and ahower and wash normally within hours. (The video below will show you where the incsion is.)

It take about 10 minutes in the operating room.

You don't always need sedation/anesthesia (though most people prefer that).

It is quick and easy to perform by doctors like myself who are extensively trained in hand surgery. A hand surgeon like myself will be able to do testing the office for carpal tunnel syndrome, as well as treatment that is non surgical (including steroid injections, splinting, and therapy). I will also be able to determine if other issues exist like arthritis and tendinitis, and treat those as well.

I use the Arthrex Centerline system, which looks like this:

I use this system simply because I feel most comfortable with it. Though I think it confers a significant advantage compared to other techniques, I have done 1500 of these cases in roughly the last 4-5 years. There have been no major issues, and most patients recover to a functional status in a matter of hours, and often return to work (depending on what they do) in a matter of days.

If you have questions, then please contact me through the website.

Enscopic carpal tunnel surgery: A few things you can expect

Since coming to  Muskegon in August of 2015, I have performed nearly 1500 endoscopic carpal tunnel releases.  This is a very safe and effective technique, that can reduce recovery time immensely compared to the traditional open technique.

In the past, I performed many carpal tunnel releases utilizing the open technique.  I utilized a large incision with multiple sutures that required 2-3 weeks of healing.  In addition people needed additional 2-3 weeks to recover after that to go back to their work.  This was for even light duty jobs that do not require a lot of lifting. Its a lot of time off for most people, especially if they work with their hands.

 All that has changed with the endoscopic (minimally invasive) technique.

What should I expect during carpal tunnel surgery? 

The surgery itself takes only about 10 minutes.  It could be done in a hospital setting under light sedation or even local anesthesia.  If  you choose to undergo  surgery using sedation, then you will need to fast the night before and not eat anything the day of surgery, as well as getting someone to drive you to the hospital and back.  Otherwise, if you use local anesthesia you could do the surgery without fasting and drive yourself home from the hospital.  Although,  a driver is always preferred when possible.

Currently, techniques are being developed in order to be able to do the surgery in an in-office setting.  (We are very close to having that become a reality in the next 3-6 months, that will be available at a fixed price like the Oklahoma Surgery Center,  so stayed tuned in future blog posts.)

What to expect after endoscopic carpal tunnel surgery? 

What I tell patients is:  after they go home from surgery, in the evening, they can take the dressing off, wash their hands normally, and if they feel good they can even go out to dinner.  The next day they can drive, and run errands if they need to. They can lifting up to 10 lbs., which is about a gallon of milk. They can shower normally. Bathing and soaking of the hand is prohibited. They can call with any other questions they have, and they should return for suture removal in about 10-14 days.

In regards to pain, most patients do not need pain meds for more than one night, and  often ibuprofen or tylenol is more than enough.

In regards to carpal tunnel symptoms, although some residual numbness may remain for a period opf time as the nerve is healing, nighttime numbness and pain (that wakes people up from sleep and is a major reason why patients seek medical care in the first place) is gone the very first night.

In regards to a return to work, I have had a numbe of patients who hold deskjobs or lighter demand jobs go back on a Monday after Friday surgery. This is not unusual. For heavier demand jobs, it really does depend on the individual, but once again, many patients will go back after a week, with stitches still in, and perform perfectly well. This is also not unsual.

In my medical opinion, I see virtually no reason to ever perform open carpal tunnel release for carpal tunnel syndrome anymore, as long as the surgeon is a hand surgeon trained in the technique.