Trigger Finger Release Aftercare

Transcript

Welcome And The Surgery Site

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Welcome to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board-certified hand therapist. I specialize in the rehabilitation of orthopedic conditions that affect the fingertips through the shoulder. Today I want to talk about trigger finger release surgery. It's something that I see very often in the clinic is significant irritation after the surgery. And the surgery location is right near this, what's called the distal palmer crease, and that's where the big knuckles bend. So if you look at your palm and you see this crease that forms when you bend your fing when you bend your big knuckles, that is the location of a small, what we call a pulley, it's a small ligament that keeps the tendons that connect the muscles to the bones, it keeps the tendons against the finger as you make a fist so you don't get bowstringing so the tendon doesn't pull away from the skeletal structures or the bones. I invite you to watch the other episodes that I made regarding trigger finger, what it is, and how it's treated. Now,

Why The Scar Gets Sensitive

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let's talk about the irritation afterwards because the palm, as we know, there's a lot of nerve endings there. We have to feel things and it's a very sensitive area. The trigger finger release surgery scar, and I'll draw one on myself, is about a centimeter wide and right near that distal parmer crease, and that is a very deep cut. And when you cut through skin, you're automatically cutting through some sensory nerves, and they're very small whiffs of nerves, and they grow back, um, but they can often get quite sensitive, especially in this location. So the scar would be about that big, and often there would be sometimes scar tissue will form quite lumpy, and that could also be sensitive. And then, you know, most people who are 40 and older have some arthritis. Our bodies are designed to last optimally for about 40 years, and then wear and tear starts to occur, and that's the osteoarthritis of the joint surfaces, you know, the cartilage wearing out. And as I mentioned in a previous episode, arthritis loves a party. So even a little surgery like that, with quite a deep cut, um results

Stop Massaging And Overmoving

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in some irritation of the arthritis, and then the fingers can get quite stiff. Now, here's where a lot of people go wrong: they'll start to massage the scar or massage the painful area after it heals up and the scar is formed. And a lot of patients will come in after going to therapy for a while at other places and they're just not getting better. Then they come in for another opinion, and while they're talking to me, they're sitting there rubbing it, and they tell me that the therapist instructed them to massage the scar, and it becomes a habit. Instead of massaging the scar, rubbing it, I have people just use a soft pad of their thumb and just pressing it lightly and giving it light pressure, uh, not aggressive pressure, but just light pressure and holding it for about 20 or 30 seconds a few times per day. And that's enough to really flatten out those tissues, and that really helps to desensitize it. Another thing that is wrong to do is frequent habitual range of motion because that it feels good while you're doing it, but then when you stop, the inflammation just increases. It's inside that the tendon sliding, sliding, sliding, sliding, sliding. Then you have the joint surfaces of the fingers rubbing, rubbing, rubbing, rubbing, rubbing, and it's just so aggravational.

Smarter Stretching To Reduce Stiffness

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So I'll have folks do specific stretching where they'll push the finger down into a fist, hold that light stretch, not painful, but you know, maybe one at one slash ten, one out of ten, or two out of ten discomfort, light sustained stretch for 20 seconds, and then hold the fist for one and two and three and relax, which retrains the muscle to pull to the end of the flexibility, so that as you regain flexibility, you regain control of the movement. So light sustained stretch, 20 seconds, and by the way, the neighboring fingers tend to get very stiff too. And I will have folks stretch each individual finger for 10 or 20 seconds or so, and then end with the active hold. Now, here's a detail to pay attention to. Let's say, for example, the ring fingers, most commonly the ring finger where there's trigger finger, it occurs, it can occur in any finger, but let's talk about the ring finger. Folks will do their stretches and try to keep the other fingers out of the way, but guess what? The tendons on the backside, they're all connected. So if these fingers are straightening and this finger is bending, these fingers are causing this to resist the bend into the fist. These neighbors are causing it to straighten out. So they all should go as a team, they should all go together. Each finger stretch 10 to 20 seconds and then hold. It should only take a few minutes to do. And I only have patients do this two or three times a day, maybe four times a day, but that's it. Because if it's done too much, it just aggravates everything. Because remember, this is living tissue, and a great analogy is you have to water your tomato plants, but you can't water them all day. So it usually takes folks a couple of days to really break the habit. And

Move Fingers Together As A Team

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why do I have a mirror here? So this really helps the neurological system to remember what normal feeling feels like, and remember what normal movement feels like. On the surface of the brain, it's called the motor cortex, and there's a specific map, there's sort of a path that because you know when the brain sends signals to our muscles on how to move, and the coordination can get smudged, or the path can get smudged as early as three days after surgery or three days after injury. So, to say it a different way, let's say you're in a cast, as early as three days after that cast has been put on, the brain forgets a little bit the nuances or the specific path for efficient movement. So we can retrain that and show the brain again exactly what normal movement feels like. So if I have my hand with a scar where I had the surgery, I'm gonna put that inside the mirror box. I'm gonna move both hands together at the same time. This really helps with the uh the stiffness too. So the involved hand goes

Mirror Therapy For Pain And Control

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inside the mirror box, the hand that I did not have surgery on goes on the outside. And then I instruct the patient to look in the mirror and I tell them, okay, that hand inside the mirror is the hand you had surgery on. And then both hands move together at the same time, and as I watch the hand in the mirror, and I'm telling myself, that hand in the mirror is my right hand, that really feels strange. Then when I watch the patient's hand that they had surgery on, I'm on the other side of the table, I can almost instantly see their hands starting to move better. Another thing I do when it's really sensitive on that scar, is I'll have, again, the the surgery that the hand that had surgery is inside the inside the box. I'll have the patient continue to look at the image in the mirror, and then what I will do is I will touch their hand that did not have the surgery, and I'm touching that, and I'm reminding their brain what it feels like to not have sensitivity and pain. This also works great with complex regional pain syndrome, CRPS, which we used to call reflex sympathetic dystrophy, RSD. We can talk about this later, and we'll talk about the brain, and we'll talk about the neurological system in more detail, but I want you to have an awareness that that is a very effective tool.

Do Less Early And Heal Faster

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So I want to end with stating that what you don't do is equally as important as what you do. You know, we're good hardworking people, so when something is going wrong, we want to do something. Let's fix this. We have to do, do, do. No, sometimes taking a step back, letting things calm down, letting the all the living tissues just ease up a little really makes all the difference. Another thing that happens is people will start strengthening way too soon, way too early, before inflammation is down, before stiffness is taken care of. And then the strengthening itself increases the inflammation and pain and stiffness. There's time to get stronger later, but let's the goal here, the goal is always to get well in minimal time and get back to normal in minimal time. So working most efficiently, regarding, regardless of what industry anyone is in, working most efficiently is the key. And we're dealing with living tissue, understanding the living tissue, understanding the processes means everything.

Efficient Therapy And Home Program

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And that's why it's very important to get into your healthcare professionals for a thorough evaluation, to set up a thorough home program. I see patients usually once a week, a lot of conditions, you know, something like this, or get them a good start, show them what to do at home. I use their cell phone to take a video of them doing their exercises so they can reference it later. It's not a ton of exercises, it's just very targeted. And then I'll say, you know what, come back in two weeks. Let's reassess. We'll modify the home program. We'll do, I'll do specific treatments for you in my clinic that you can't do for yourself at home. And that's the reason for coming into the clinic. And then I'll coach you for an upgraded home program and show you along the way. So it's not a lot of therapy. You know, that's a that's a really uh a misunderstanding that a lot of folks will under will will falsely believe that they have to keep going to therapy often for some conditions, initially, you know, a couple of times a week, but everything is different. That's why, again, it's really important to be seen by your healthcare professional. So, thank you again for watching another episode of the Hand and Shoulder Solution, where we are the solution to your pain. And thank you for liking and subscribing.