Name of the Procedure:

Tendon Sheath Incision (Trigger Finger Release)

Summary

Tendon sheath incision, commonly known as trigger finger release, is a minor surgical procedure that involves making a small incision in the tendon sheath of the affected finger to release the constriction, allowing the finger to move freely without locking or catching.

Purpose

The medical condition it addresses is "trigger finger" (stenosing tenosynovitis), which causes pain, stiffness, and a locking sensation in one or more fingers. The goal is to alleviate these symptoms, restoring normal finger function and movement.

Indications

Trigger finger release is indicated for patients experiencing:

• Persistent pain or stiffness in a finger that does not improve with conservative treatments like splinting or steroid injections.
• A triggering or locking sensation that interferes with daily activities.
• Finger stiffness, especially in the morning.

Patient criteria include:

• Diagnosis of trigger finger through physical examination.
• Failure to respond to non-surgical treatments.

Preparation

Patients are typically advised to:

• Avoid eating or drinking for at least 6 hours before the procedure if it involves sedation.
• Inform their healthcare provider about all medications being taken (some may need to be stopped prior to surgery).

Diagnostic tests may include:

• Detailed physical examination of the hand.
• X-rays or ultrasounds, if needed, to rule out other conditions.

Procedure Description

1. Local anesthesia is administered to numb the affected area.
2. The surgeon makes a small incision at the base of the finger on the palm.
3. The tendon sheath is carefully cut to release the constriction.
4. The surgeon ensures the tendon can move freely.
5. The incision is closed with sutures and dressed with a sterile bandage.

Tools and equipment include:

• Scalpel, surgical scissors, and suturing materials.
• Local anesthetic.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

It is usually performed in an outpatient clinic or a surgical center.

Personnel

The healthcare team includes:

• A hand surgeon or orthopedic surgeon.
• A surgical nurse or technician.
• An anesthetist if sedation is required.

Risks and Complications

Common risks include:

• Infection at the incision site.
• Pain or swelling.
• Stiffness or reduced range of motion. Rare complications:
• Persistent symptoms if the release is incomplete.
• Nerve damage or scarring.

Benefits

Expected benefits include:

• Immediate relief from pain and triggering.
• Improved finger movement and function. Full recovery and benefits are typically realized within a few weeks.

Recovery

Patients should follow these post-procedure instructions:

• Keep the incision site clean and dry.
• Use prescribed pain medication as needed.
• Engage in gentle exercises to restore movement.
• Attend follow-up appointments to monitor healing.

Expected recovery time:

• Most patients resume normal activities within a few days to weeks, but heavy lifting or strenuous activity should be avoided for a few weeks.

Alternatives

Alternative treatments include:

• Non-surgical options like splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroid injections.
• Percutaneous release, a less invasive procedure using a needle. Each alternative has its own pros and cons, such as differences in recovery time, effectiveness, and potential need for repeated treatments.

Patient Experience

During the procedure, patients may feel a sensation of pressure or tugging, but no pain. Afterward, there may be mild pain or discomfort managed with over-the-counter or prescribed pain relievers. Keeping the hand elevated and following post-care instructions helps to reduce swelling and promote healing.