Plastic, Hand and Reconstructive Surgeon

You can drive after hand surgery when you can make an emergency stop and have a firm grip on the steering wheel. This varies by individual, but generally: Minor hand surgery: 2-4 weeks Major hand surgery: 6-12 weeks or longer. Always follow your surgeon's specific advice for your recovery.

The timeline for returning to work after hand surgery varies based on the type of surgery you had. Generally, you can expect: Light office work: 2-4 weeks Medium work: 6-8 weeks Heavy construction work: 8-12 weeks. Always follow your surgeon's specific advice for your recovery.

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 (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.

For simple operations like trigger finger release or carpal tunnel decompression: Remove the hand dressing after 5 days. Wash with soap and water, dry with a clean paper towel or hairdryer, and apply a Band-Aid until 2 weeks. For Dupuytren's dermatofasciectomy: You will be seen 1 week post-surgery by either myself or your hand therapists. The graft will need a dressing for about 6 weeks. The donor site for the skin graft: Leave the steristrips on until they fall off themselves. The outer dressing can come off at 2 weeks.

Why this matters The skin on your hands moves, stretches, and gets used constantly. After an injury or surgery, keeping the wound clean and protected helps it heal well and reduces the risk of infection. Many patients worry about getting their wound wet — this guide explains what is safe and what to avoid. Can I get my wound wet? During the first 5 days • Keep the wound completely dry. • Avoid handwashing directly on the site; use a clean cloth or sanitising gel around the fingers and palm (avoid soaking). • Keep dressings clean and dry. After 5 days (if the wound is closed and covered) You may briefly get the wound wet in the shower/washing hands: • Use running water, not soaking. • Shower is fine; no baths, no swimming, no washing-up bowls. • Do not let the wound be under direct high-pressure water. Stitches present? • It is usually safe to shower 5 days, unless your clinician advised otherwise. • Pat the area dry afterwards — never rub. • Keep your dressing on unless you were advised to remove it. Steristrips (paper strips)? • Avoid getting them wet for the first 5 days. • When you start washing hands, just pat the strip dry and they will stick better • If they become soaked or start peeling early, contact your clinic. What you must avoid • Soaking the wound (baths, washing dishes, swimming, hot tubs). • Prolonged water exposure — this softens the skin and slows healing. • Dirty water (streams, lakes, pools) — high infection risk. • Scrubbing the wound or removing loose scabs. After showering • Pat dry gently with a clean towel/paper or use a hair drier • Replace any dressing that has become damp. • Moisturise the surrounding skin (not the wound itself) if dry. When is it safe to soak the hand again? • Usually 14 days, or once the wound is fully sealed and stitches removed. • Surgical wounds on hands may take a little longer due to movement and skin tension. Warning signs — seek medical advice if you notice: • Increasing redness, swelling, or warmth • Pus or foul-smelling discharge • Worsening pain • Fever • The wound opening or glue lifting early Summary • First 5 days: keep completely dry. • After 5 days: brief showering/hand washing is safe, no soaking. • Avoid swimming and baths until the wound is fully healed. • If in doubt, protect with a waterproof cover or ask your clinician.

Yoke splinting (also called a relative motion splint) is a simple but highly effective concept in the management of extensor tendon injuries of the hand, especially in zones IV–VII. What is a yoke (relative motion) splint? A yoke splint positions the injured finger in relative extension (or flexion) compared with adjacent fingers, usually by about 15–25°. Instead of immobilising everything, it redistributes extensor force across the extensor digitorum communis (EDC) tendons. Think of it as “off-loading” the injured tendon by letting its neighbours do more work. Biomechanical principle The EDC tendons share a common muscle belly. By holding the injured digit more extended than the others: • It requires less active force to extend • Adjacent digits take up more tension • The repaired or injured tendon is protected but still glides This allows: • Early controlled motion • Reduced adhesions • Better final range of motion Indications Yoke splints are particularly useful for: 1. EDC lacerations / repairs • Zones IV–VII (over proximal phalanx to dorsum of hand) • Especially after surgical repair 2. Sagittal band injuries • Boxer’s knuckle • Prevents ulnar subluxation of the extensor tendon 3. Extensor tendon ruptures • Rheumatoid or attritional 4. Post-tenolysis • To encourage safe differential glide Classic setup Injured finger: • Held in 15–25° more extension Adjacent fingers: • In neutral or slight flexion Wrist: • Often free, or in slight extension (depending on protocol) Types: • Thermoplastic custom splint • Or simple elastic/neoprene yoke Why it’s so popular Compared to traditional immobilisation: Traditional splintYoke splintImmobilises wrist and MCPsAllows wrist + finger motionHigh stiffness riskLow stiffnessDelayed rehabEarly active motionPoor complianceExcellent compliance Evidence and clinical outcomes Multiple studies show that relative motion splinting: • Improves total active motion (TAM) • Reduces extensor lag • Shortens return-to-work time • Has low rupture rates when properly supervised It has largely replaced dynamic splints for many extensor repairs. Typical rehabilitation protocol (simplified) Weeks 0–3: • Yoke splint full time • Active flexion allowed • Extension occurs passively via splint position Weeks 3–6: • Gradual reduction in splint use • Strengthening begins After 6 weeks: • Usually full activity (Exact protocol varies by zone, surgeon, and therapist.) Common pitfalls 1. Wrong finger position • Too much extension → stiffness • Too little → inadequate protection 1. Poor patient education • Must understand this is a protective splint, not a fashion accessory 1. Using it for terminal tendon injuries • Mallet finger (Zone I) needs different management Where yoke splints shine the most They are arguably best for: • Zone V extensor repairs (MCP level) • Sagittal band ruptures • Surgeons who want early active motion without complexity One-line summary Yoke splinting protects extensor tendon repairs by shifting workload to adjacent digits, allowing early motion, less stiffness, and better functional outcomes than traditional immobilisation. In modern hand surgery, it’s one of those techniques that is simple, elegant, and disproportionately effective.

Short answer: because the hand reacts to surgery with inflammation, and gravity makes it worse. Swelling after hand surgery is normal and expected, even after small procedures. Why it happens 1. Surgical trauma → inflammation Any incision causes: • Increased blood flow • Leaky capillaries • Fluid moving into tissues The hand has: • Very loose tissue • Lots of small compartments So it swells more than most body parts. 2. Gravity When your hand is down: • Fluid pools in the fingers • Swelling increases dramatically This is why it’s worse: • In the evening • When walking around • When not elevated 3. Reduced movement After surgery you: • Move less • Muscle pumping is reduced So lymphatic drainage is poor. 4. Dressings and splints These: • Limit motion • Can act like a mild tourniquet → worsening oedema. Your swelling reduces if you have your hand elevated and your splint/dressing usually becomes looser over the first couple of days. How long does it last? Typical timeline: Time after surgery: Swelling 0–3 days Peaks 1–2 weeks Gradually improves 4–6 weeks Mostly gone 3 months Only minimal residual For big operations (Dupuytren’s, tendon repairs): Swelling can last 2–3 months. What actually helps (evidence-based) 1. Elevation (most important) Hand above heart: • Sleeping • Sitting • Walking (use sling) If your fingers aren’t above your elbow, it doesn’t count. Use pillows, in your bed, when sitting, everywhere. Things to discuss with your surgeon or Hand therapist: 2. Early gentle movement Even in splints: • Wiggle fingers from side to side • Pumping motion improves lymph drainage 3. Light compression • Coban wrap, only after discussion with Hand Therapist , do not do this without guidance • Tubigrip (Not tight, just snug) 4. Hand therapy Therapists use: • Edema massage • Kinesiotape • Compression gloves This makes a huge difference. When swelling is not normal Red flags: • Rapidly worsening pain • Fingers turning blue/white • Increasing tightness under dressings • Fever or spreading redness These suggest: • Compartment syndrome (rare) • Infection • Dressing too tight → needs urgent review. The key misconception Patients often think: “Swelling means something went wrong.” In reality: Swelling means your body is healing. One-line summary Your hand is swollen because surgery causes inflammation, gravity pulls fluid into the fingers, and reduced movement slows drainage — elevation and early motion are the two most powerful treatments. As always: If in doubt, please contact the office and get seen, thank you