OT- Calling all MGO Hand Experts

Submitted by BlueRude on May 15th, 2013 at 10:20 AM
My hockey days have caught up to me. Diagnosis of trigger finger with pain in knuckle. On a slow day maybe some opinions to avoid the knife?

Comments

MGoAero

May 15th, 2013 at 10:25 AM ^

My wife has had surgery for trigger finger on both hands.  The doctors tried cortisone shots both times before surgery, but that treatment only lasted a couple of weeks at best.  I suspect they'll give that a shot with you, also.  If that doesn't work, the surgery is not fun.  It's outpatient with a local anesthetic, but the recovery is very difficult.  Lots of pain, can't get it wet, have to worry about the incision getting infected, and have zero use of that hand for a good 4-6 weeks.  My wife still has some pain after almost a year on the second hand she had done.  The first one had great results.  In both of her cases, the scar is about an inch long in the palm of her hand.  Best of luck to you, and I hope you have someone who can help you with things since you'll be one-handed for awhile!

Daniel

May 15th, 2013 at 10:29 AM ^

but Steve Lorenz has him coming to Michigan.

Wait, all it takes to become an expert is to have skimmed through some secondary sources on a topic, right?

Also, wrong Hand.

goblueva

May 15th, 2013 at 10:30 AM ^

I've worked in orthopedics for 8 years and do my best to treat most problems conservatively. This is one where I feel surgery is the best option. Minimal risk, quick recovery, predictable outcomes. You can try anti-inflammatories and/or injection but these probably work 10% of the time. Best of luck!

PB-J Time

May 15th, 2013 at 10:40 AM ^

I also work in ortho and respectfully disagree with the above poster. I've seen over half of people have full resolution with an injection. I do agree that meds (NSAIDs) aren't useful here. An injection to the area could also be a quick fix and if it doesn't work surgery remains an option.

cazzie

May 15th, 2013 at 11:08 AM ^

33 years experience. injections of weak concentrations of cortisone  (e.g. 5mg of triamcinolone), using ultrasound needle guidance for correct placement of the needle tip within the sheath, but not the tendon, often gives lasting relief, especially in your case where the inciting cause is no longer in the picture (hockey). there is also a very good treatment called friction massage that is useful, given for 10 min. every other day for 3-6 visits is worth trying first. also beginning to have some success with platelet rich plasma injections (prp), which is like stem cells. bracing can also help.  rehabilitaion to prevent recurrence is also very important. surgery may be needed and can have a good result, but noted as above, is not always without complications, prolonged recovery, and sometimes incomplete resolution of the pain, but should only be considered after all reasonable non surgical options are exhausted. if all else fails, find a hand surgeon who has done tons of these.

occasionally, the diagnosis is erroneous so make sure that this is not a joint problem, rather than a tenosynovitis (trigger finger).

good luck.

on the other hand, why the hell would he go to virginia tech over UM?

 

teldar

May 15th, 2013 at 11:18 AM ^

Relatively painless as far as operations go. I see bunches of them. Some sedation, small incision, release, on your way. I just do the anesthesia though. I guess the important thing with anything medical is ymmv. Some figure it fixes everything, others, not so much.

thisisme08

May 15th, 2013 at 11:49 AM ^

Is MGoBlog the reason why every doctor is running "a little behind this morning", and  you wait 2 hours after your scheduled apt. time? Seems like everytime there is a MD thread, we get some very specific advice/recommendations during...ahem work hours. (Full disclosure; I drive a desk all day, with only internal meetings/apointments) 

cbook

May 15th, 2013 at 12:44 PM ^

Injections are effective about 80% of the time if done properly.  Surgery is effective and relatively easy surgery to get over. I am an orthopaedic surgeon and I do both frequently. I typically recommend trying injection first.  They can recur with injection, surgery is the definitive cure.

mooseman

May 15th, 2013 at 2:27 PM ^

It's no big deal. The shot is painful because the hand is sensitive but I get about 50% resolution with injection so it's worth a try. Outpatient trigger release (I do under an IV regional although some do local) provides cure in 99% of people. Short term there will be some scar pain with grip/direct pressure. One thing I always tell people is that "people who trigger are people who trigger" meaning that you're more likely to get another trigger digit later than the gen pop.

BlueRude

May 15th, 2013 at 2:50 PM ^

Thank you all for your feedback. Yes, I had my last injection a few months ago. This was my third and was advised not to get any more as this could cause addtional problems with the sheeth. There were several ideas I'm going to follow up on. The other mentionables I will wish them good luck on their freshman year with Patch Adams.