The care of the hand in the post-operative period is very important in helping to ensure a good result. Initially the aims are comfort and elevation. These are met by keeping the hand up (elevated) especially in the first few days and by use of a long acting local anaesthetic (Bupivicaine). The local anaesthtic lasts at least 12 hours and sometimes 48 hours. Patients should start taking painkillers before the pain starts . on return home and for at least 24 hours from there. This way most of our patients report little or any pain.
The bandage can be removed after 2-7 days, leaving a sticky dressing beneath. The patient or GP practice nurse can do this. If well healed at that stage then the wound can be left open (exposed). If in doubt it can be covered with a light dressing for a few more days. The patient is reviewed in clinic between 2-4 weeks following the operation. Typically dissolvable stitches are used so they should not require to be removed.
The hand can be used for normal activity after the first few days. Most patients can drive after a 2-3 days. Most patients return to work in 2-5 weeks, but this varies with occupation; heavy manual work usually takes about 4 weeks. The wound should be massaged by the patient 3 times a day with a bland soft cream for 3 months once the wound is well healed (typically after 2 weeks). This reduces the scar sensitivity which can be a nuisance. If this is marked a Physio may be organised to help reduce the scar tenderness but this is rarely required. Patients should avoid pressing heavily on the scar for 3 months following the operation as this will be quite painful. Examples of activities to avoid are using the palm to grip/twist a heavy or tight object or use the palm to help get out of a chair.
What are the results of the operation?
At least 85-90% of patients say they have a good result following this operation, with relief of the pain and triggering. If there is already severe stiffness of the finger, then this may not improve. Recurrent symptoms do occur but in our experience in only a 2-3% mainly in patient with more severe symptoms and particularly patients with Diabetes.
To diagnose trigger finger, a doctor will perform a physical examination and discuss the symptoms. This may include feeling for lumps in the palm, checking for how smooth mobility is in the affected finger, and looking for areas of pain. Usually a physical exam is enough to make a diagnosis, however, further tests to determine any underlying conditions, such as arthritis, may be used. This may include blood tests to look for certain indicators of underlying conditions or magnetic resonance imaging to see the structure of the finger or hand.
1900 Welcome and introduction to the webinar. Mr Richard Pinder MD FRCS(Plast) DipHandSurg, Hull, UK
1910 Trigger fingers: how do you treat them? Emmi Friedman MD EPOBRAS, Jeroen Bosch Hospital, Den Bosch, The Netherlands
1930 BEST Guidelines for trigger finger. Jeremy Rodrigues MD PhD, University of Oxford, UK
2000 Power of research collaboratives. Matt Gardiner MD PhD FRCS(Plast), Oxford, UK
2020 Introducing the TRIGGER Trial. Anita Dijksterhuis MD, UMC Utrecht, The Netherlands
2030 Discussion and brainstorming RCT