Plastic, Hand and Reconstructive Surgeon

When you are able to make an emergency stop and have a firm grip on the steering wheel. Although, this may vary for the individual, the usual time for minor hand surgery is 2-4 weeks, and for major hand surgery 6-12 weeks, or even longer

It depends, like everything, about what surgery you have had done, but as a guide:

Light office work: most likely after 2-4 weeks

Medium work: After 6-8 weeks

Heavy construction work: 8-12 weeks

Complex regional pain syndrome (3%), cold intolerance, infection, bleeding, scarring, prolonged swelling, decreased range of movement, nerve & vessel injuries, recurrence of initial problem

https://www.handsurgeryresource.net/trigger-finger

Introduction

Trigger finger, or stenosing tenosynovitis, occurs when the flexor tendons cannot pass smoothly through the A-1 pulley because the tendon sheath has become thickened and swollen. In the child’s thumb, this swollen portion of the tendon is referred to as a nodule or “Notta’s Node,” named after nineteenth century French physician, Alphonse Notta.1,2 This nodule is secondary to, not the cause of the primary pathology. Whether the pulley thickens or the tenosynovium thickens with fibrosis, the result is the same: loss of smooth active flexion and extension in the digit. The digit can lock, snap, click, or catch in flexion or extension or simply be difficult to move with or without significant pain. Trigger fingers affect hand function and, in severe cases, may lead to limitations in activities of daily living. In patients with diabetes, the condition is likely to affect multiple digits and both hands. Initial treatment can include activity modification, splinting and non-steroidal anti-inflammatory medications. Nonsurgical treatment options may also include local corticosteroid injection or platelet-rich plasma injection.3 Definitive treatment most often requires surgical release of the A1 pulley through an open, endoscopic or percutaneous approach.4,5 Related Anatomy

• Histology shows non-inflammatory fibrosis; occasionally, chronic inflammatory cells are present. Pro-inflammatory cytokines like IL-β, TNF-α, and MMP’s are elevated and TGF-β is upregulated.6, 7

• Triggering is rarely caused by irregular anatomy like abnormal lumbrical insertion, a proximal decussation of flexor digitorum sublimis (FDS) tendon, or narrowing and/or thick ening of FDS tendon sheath at the A-1 pulley level.8

Current Relevant Basic Science In patients with trigger fingers the number of chondrocytes and the adjacent extracellular matrix, especially collagen Type II and III, are notably increased compared to non-symptomatic patients.9,10 When a tendon sheath becomes swollen, the sheath becomes fibrotic and may undergo cartilaginous metaplasia. The flexor tendon becomes thinner under the area of constriction and thickens proximal to the constriction.11 These tendon changes appear to be exacerbated by repetitive microtrauma, especially with high-load activities.12,13,14,15 Incidence and Related Conditions

• The prevalence of trigger finger affects 2-3% of the population.16,17

• Triggering affects thumb and fingers, most commonly the thumb and ring finger

• Trigger fingers can occur in infants and children

• More common in women (2-6 times); pregnancy is a predisposing risk factor14

• Additional predisposing systemic conditions: rheumatoid arthritis, gout, amyloidosis, mucopolysaccharidoses

• Diabetes mellitus and hypothyroidism are also linked to trigger finger, with glycolated collagen contributing to tissue stiffness.18

• Prevalence in diabetes ranges from 5-20%.16

• Risk factors in diabetic patients include female gender, age >60, insulin use, elevated HbA1c levels, and diabetic complications like neuropathy.

• Trigger fingers are often co-morbid with DeQuervain’s disease, carpal tunnel syndrome, elbow tendinopathy, gout, and rheumatoid arthritis.19,20,21,22,23

• Repetitive trauma or work activities may play a role in the etiology of this condition; however, there is no decisive evidence to support the relationship between triggering and overuse.24

Differential Diagnosis

• DeQuervain’s disease

• Dupuytren’s contracture

• Metacarpophalangeal (MP) joint loose body/dislocation

• Proximal interphalangeal (PIP) joint dislocation

• Volar plate avulsion with entrapment

• Tendon sheath tumor

• Intrinsic tendon injury on an irregular metacarpal head

• Rheumatoid arthritis (RA)

• Ganglion cyst

• Abnormal sesamoids

• Subluxation of extensor digitorum communis

• Boxer’s knuckle

Updated - 10/2025

My hand surgery treatments cover conditions such as nerve impingements: carpal tunnel syndrome/ supinator syndrome, Ulnar nerve entrapment at the elbow or wrist, radial nerve entrapment, nerve transfers or tendon transfers (for longstanding nerve wasting), tenosynovitis of tendons in the hand, such as trigger finger, at the wrist such as De Quervain's, Dupuytren's disease, joint replacements for Rheumatoid or Osteoarthritis, operations for thumb osteoarthritis, refashioning fingertips after amputations, nerve pain from neuromas, primary and delayed repair of flexor tendon injuries and extensors, fusion of joints, and sequelae from complex hand injuries. We use advanced techniques to ensure the best possible outcomes.

Finger fractures can result in considerable inconvenience in the short term. In the long-term, they can cause dysfunction due to stiffness and pain, and deformity. Many can be managed non-operatively without an operation. Even this process can be complex. The fracture may be manipulated into a better position (reduction). Rehabilitation often requires splints to protect the fracture and exercises to maintain movement as well as to mould the fracture into the best position. Repeat x-rays may be required to check that the fracture is healing and that the position has not slipped.

Fractures that are unstable, displaced or involve joint surfaces may be best managed by surgery. The fractures can be fixed in a wide variety of ways depending on the precise pattern of fracture and associated injuries to skin, nerve and tendons. Some can be stabilised by wires or screws being drilled through the skin without an incision. This is called closed reduction and internal fixation (CRIF). Others require an incision to reposition and fix the bone, termed open reduction and fixation (ORIF). The principles of surgery are similar, whatever method is used. We try to achieve enough stability at the site of fracture to allow you to move the injured area immediately. This is crucial to prevent stiffness.

∙ Wires These may either buried under the skin or a portion left outside.

Internal wires are often left inside permanently but occasionally they need

to be removed later if they become a nuisance. External wires are

removed by the doctor about 3-4 weeks after the operation when the

bones have begun to join. Patients are always anxious about this but

removal of a wire is simple and virtually painless.

∙ Plates/screws These are generally left inside permanently

∙ External fixation These techniques are used when fractures are

comminuted (multiple fragments) such that stability cannot be achieved

by other methods.

Soon after the operation, the dressing will be removed and you will be provided with your splint. The fixed fracture will be kept protected from knocks and stresses by a splint for 6 weeks approximately. The fusion will not be really "solid" and ready for heavy jobs until 12 weeks. In the meantime you will be working on movement to help fracture healing, to prevent swelling, to maintain gliding of tendons and to prevent the joints stiffening.

You will be given an individual rehabilitation program by the hand therapist. It is important to move the rest of your hand joints through their full range (including the others on the same finger) to prevent stiffness. Although your splint will be worn much of the time (especially at night and walking about), it will be removed to allow finger movement. Movement ("active ranging") alone will do no harm to the fixation but until it has healed the operated finger(s) must not be forcibly bent ("passive ranging") or strained by heavy use. Once dressings are removed, it is safe to get the hand wet including pin-sites and wounds, but the wounds should be thoroughly dried. Any stitches will be removed about 2 weeks after the operation. The wound and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied.

An easy way of doing this is to briefly immerse your hand in some warm water to which some Johnson’s baby oil has been added.

Timing of your return to work is variable according to your precise injury, progress, occupation and I and your therapist will discuss this with you.

Wound Possible problems include swelling, bruising, bleeding from the wound, blood collection under the wound (haematoma) and splitting of the wound (dehiscence).

Infection This is indicated by the appearance of redness around the wound or the exposed wires. This must be reported quickly and will be treated with antibiotics. If it does not settle, it may be necessary to remove the fixation.

Stiffness Healing is a sticking process and there is a tendency for tendons to adhere to fractures, plates and scars, and for joints to seize up unless gliding and stretching is maintained by exercise. Fractures that damage the joint surfaces inevitably cause loss of movement and they may cause arthritis in the long-term. Non-union The bones can fail to join for many reasons such as too much movement or infection. It may be necessary to redo the operation if this occurs.

Mal-union The bones can fail to join at the best angle if the fixation is damaged or becomes infected. It may be necessary to redo the operation if this occurs.

Regional pain syndrome About 5% (1 in 20) of people are sensitive to injury and/or hand surgery and their hand may become swollen, painful and stiff. This problem cannot be predicted, is variable in severity and is principally treated with physiotherapy.

Cold intolerance Sensitivity of the finger to cold exposure is very common and often permanent.