Ep 23 - Discover the Secrets to a Smooth Recovery Post-Trigger Finger Surgery

This engaging discussion unpacks the key aspects of trigger finger and the intricacies of its release surgery, focusing on effective recovery strategies. Listeners can gain practical insights to enhance their recovery process.

• Explanation of trigger finger and its symptoms 
• When surgery becomes necessary after conservative treatments 
• Detailed overview of recovery: dos and don’ts 
• Importance of scar management and healing techniques 
• Encouragement to engage with healthcare professionals for optimal recovery 

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Chapters

• 0:08 Welcome and Introduction to Trigger Finger
• 40:14 Understanding Trigger Finger Release Surgery
• 1:51:29 Recovery: What to Do and What to Avoid

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm Carl Petito. I'm an occupational therapist and a board-certified hand therapist. As a hand therapist, I focus on the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. Orthopedic conditions are anything that involves the bones, the muscles, the tenons which connect muscle to bone, the ligaments which connect bone to bone and the nerves which connect the brain to the muscles and make the muscles contract. So it pulls on the tendons, pulls on the bones, moves things. So basically the whole mechanical aspect of the body, including the wiring system, and my specialty is the fingertips to the shoulder again. So I want to talk to you today about trigger finger release surgery. So you have trigger finger. You've done everything. You went to hand therapy. It's not really 100% effective. So now you have to have the release surgery. What is it? What should you do? What are the do's and don'ts? You know what are tips and tricks, so let's get down to it.

Speaker 1: 1:00

You know I want to do just a targeted, you know short video. This is not treatment or treatment advice. You really have to get into the clinic. There's just too many details. As with anything, your success is in the details. You have to get a thorough evaluation. Every, any person dealing with anything really needs to be seen by a professional, because there are a lot of unknowns, there's a lot of details that have to be addressed and we need to get things well in minimal time, because the longer it goes on, almost always the worse something gets. So, all right, you get the picture. You got to be seen in the clinic. So I want to inform you to what is this, briefly, what is trigger finger? And then, if you have to have the surgery, what is the surgery? And then what should you not do after surgery? And also, what should you do after surgery. And this is just a general, no pun intended, general rule of thumb that you know. This is sort of the trends that I see. I share this information with the public because in the clinic I'm sitting with patients one-on-one. I'm repeating myself all day long Stuff. I repeatedly say all day that I think, gee whiz, if a patient, if the public knows these things ahead of time, they cannot do certain things, then it's going to be a lot easier for my patient and easier for me and better for them to get better, quicker. Uh, it's going to be a lot more efficient. So all right, let's get to it. So I made this.

Speaker 1: 2:32

The red cord here is a representative representation of the tendon which connects the muscle in the forearm to the bones of the finger. The tendon travels through the carpal tunnel and it travels on our pulleys. The pulleys are designed to hold the tendon against the bone, so when you're closing your finger you're the tendon stays against the bone and keeps its mechanical advantage so it doesn't get bowstringing. Because if it gets bowstringing or it starts to pull away from the bone, then now the finger just won't bend because now there's no mechanical advantage. So watch, when I'm doing this, it goes about that far. But if I pull this and it stays against the bone, now it can bend every hinge or every joint of the finger. But these are friction points.

Speaker 1: 3:19

So you see where it's catching, right there on my palm where I have the white tape wrapped around on a ball. That's a callus on the tendon. So there's a friction, it's rubbing, it's gliding on that. It's like a rope on the edge of a edge of the table. And you keep sawing that rope on the edge of the table. And you keep sawing that rope on the edge of the table, that rope is going to get hot and you can even make a fire like that out in the woods. You take a string and you spin the stick and the stick makes friction and creates a spark. So this, all this friction, a callus forms and it's catching on one of the pulleys. It's called the A1 pulley. There's one on every bone that goes to every finger in the palm.

Speaker 1: 3:59

And in therapy for conservative treatment which conservative means not with surgery, so with therapeutic treatment we can decrease the glide of the tendon, give that a chance to heal, use specific icing, ultrasound and also cold laser, reduce the size of that nodule where the callus, so it's no longer catching on the pulley. If, if that doesn't work and also injections sometimes are given to put steroid right in this area to reduce the size of that nodule or callus, now if everything fails and a person needs surgery, the surgery is to go under the skin and cut that pulley. So now there's nothing for the callus to catch on. Now the surgery leaves a scar of about probably half an inch, but with it being in the palm there's a lot of nerve endings there so sometimes it gets a little hypersensitive, meaning even just a light touch it'll be really just aggravational and it'll just feel really sensitive. Also, sometimes a scar in the area will get pretty thick and people scar down differently. Some people lay down really thin, flat scar. Others lay down really thick, heavy scar and scars mature over a period of about two years. The first eight months are most important and there's some specific excuse me scar maturation techniques that can be done to ensure that we have a nice, flat, not sensitive scar.

Speaker 1: 5:34

So there's a couple of things to not do. One thing is, after surgery, to not try to loosen up by continuously moving it or habitually moving it, trying to keep it loose. That is going to increase inflammation, it's going to increase irritation because it's just too much movement. You know, I like the analogy of gardening. You have to water the plants, but you can't water them all day long. This is living tissue too, so overdoing it just really ruins everything. The therapist will really teach people how to restore range of motion by appropriately stretching this area and elongating the tissue with a very light, sustained, very specific stretch. Then also, if flexion or bending the finger is compromised, we teach folks how to properly stretch individual joints. Then also the the full finger into a full fist position, ending in a light place and hold to retrain it to go down all the way into a fist. Because if this has been persisting over a long period of time and movement is compromised, stiffness starts to set in. So now, when things are freed up from the surgery, the finger's still stiff because it's been stiff for a long time you're probably most likely going to need therapy to restore your range of motion. And therapy, you know, I usually see people once a week for a few weeks educate them to a thorough home exercise program where they spend five minutes two or three times a day doing some range of motion using appropriate heat and cold mostly cold shortly after surgery to reduce inflammation. But let's really focus on what are the main things to not do. So I mentioned not doing repetitive range of motion in an effort to try to keep it loose. Range of motion should only be performed a couple of times per day and you'll be shown exactly what technique to use.

Speaker 1: 7:31

The second thing is not to rub the scar, especially obviously when the stitches are still in. Of course you wouldn't want to rub it anyway, but after it's healed and it starts to get, it starts to get itchy, starts to get a little bit sore or if that scar is kind of thick, it's a natural reaction to want to just rub that. And it's quite a trap because when you're rubbing and when you're putting the deep pressure, deep pressure is soothing and that feels good while you're doing it, but then the after effect is, wow, now it's more inflamed, now it hurts more, and I'm not. And I remember, wow, when I rubbed it it felt better. So you see this vicious cycle that folks will come in and they'll sit in front of me and they're they're talking to me and they're rubbing it, and then they're moving it and they're rubbing it some more. So that really, uh, has to just not happen.

Speaker 1: 8:18

One thing people sometimes I have people do in certain instances is just put a little. I tell people, just give it a little hug, a little light pressure, steady pressure, and that helps flatten the scar fibers and smooth things out a little bit. Oh, for 20 seconds, one or two repetitions, two or three times a day, not to overdo it. And I really stress with people to not make anything a habit. It's the hand, it's handy, it's right there, you can just kind of do whenever you think of it. But that's the trap. All right, so you get the picture. A little light pressure.

Speaker 1: 8:50

And then we need to reduce inflammation. So cold running water only until deeply cold, right under the faucet or a container out of the refrigerator that you stick your hand right in it until deeply cold we're talking 10 to 20 seconds. Or ice directly on the skin, 10 to 20 seconds, just until deeply cold and it'll shrink because everything cold shrinks. So that'll shrink down the inflammation, scar maturation back to the scars. So let's get a nice, flat, healthy scar and nice supple tissue. And remember, scars mature, develop over a period of two years. The first eight months are most important.

Speaker 1: 9:26

Vitamin E oil, a lot of the vitamin E oils over the counter and again, this isn't treatment advice, but this is what I do in the clinic with some people is have them get the vitamin E gel tabs that you would take as a supplement but just hold the capsule and then they snip off the end or poke it with a pin, just put a couple of drops of oil, smear it on and let it soak in topically. And I'll have people just do that before bed or when they're unwinding. At the end of the day they're going to watch TV or something. Put the vitamin E oil in there and just let it soak in. They're going to watch TV or something. Put the vitamin E oil in there and just let it soak in. So it's all about reducing inflammation, restoring range of motion. It's not complicated.

Speaker 1: 10:12

Most of the time less is more, but being seen by your hand therapist, being seen by the hand surgeon, being seen by these specialists, will make sure it's very efficient and very targeted to get you well in minimal time. We don't want to keep people coming back in. We want people to get well and get what they need when they need it and to get it done. So any questions, write in about those. I really appreciate you subscribing to the channel to support the channel. I want to get the word out. This is easy stuff. It's the basics, and the basics go a long way. Almost every topic in life, the basics go a long way and timing is important and what to do when it's all important. So thank you for subscribing, writing with any questions, share your experiences. We'll talk again soon, thank you.