The usual solution for treating a trigger digit is surgery to open the pulley that is obstructing the nodule and keeping the tendon from sliding smoothly. This surgery can usually be done as a day case procedure, meaning you can leave the hospital the same day.
The surgery is done using a general anaesthetic or a regional anaesthetic. A regional anaesthetic blocks the nerves going to only a portion of the body. Injection of medications similar to lidocaine are used to block the nerves for several hours. This type of anesthesia could be an axillary block (only the arm is asleep) or a wrist block (only the hand is asleep). The surgery can also be performed by simply injecting local anaesthetic around the area of the incision. Once you have anaesthesia, your surgeon will make sure the skin of your hand is free of infection by cleaning the skin with a germ killing solution.
An incision will be made in the skin. There are several types of incisions that can be made, but most are made along the natural creases and lines in the hand. This will help make the scar less noticeable once the hand is healed. The skin and fascia are separated so the doctor can see the tendon pulley. Special care is taken not to damage the nearby nerves and blood vessels. Next, your surgeon carefully divides the tendon pulley. Once the tendon pulley has been separated, the wound was closed with 5.0 Prolene sutures.
You will wear a bandage over the area after surgery until the stitches are removed. You will probably have a fairly large padded bandage on your hand when you return from surgery. This is to provide gentle compression and reduce the bleeding and swelling that occurs immediately after surgery. This can be removed fairly quickly, and usually only a bandage is required after the first 24 to 48 hours. Sutures will be removed by the outpatient nurses ten days post operation. Your surgeon will see you in clinic in six weeks post operation.
You will begin gentle range-of-motion exercises a few days after surgery. Most patients will not need to participate ina formal rehabilitation program unless the finger or thumb was locked for a while before surgery. In these cases, the finger or thumb may not straighten out right away after the surgery. A specialist hand physiotherapist may apply a special brace to get the finger or thumb to straighten. The hand therapist may also apply heat treatments, soft-tissue massage, and hands-on stretching to help with the range of motion. Some of the exercises you will begin to do are to help strengthen and stabilise the muscles and joints in the hand. Other exercises are used to improve fine motor control and dexterity. You will be given tips on ways to do your activities while avoiding extra strain on the healing tendon. You may need to return to physiotherapy two to three sessions each week for up to six weeks.