TRIGGER FINGER RELEASE SURGERY DAVID GESENSWAY, MD

Transcription

1 TRIGGER FINGER RELEASE SURGERY DAVID GESENSWAY, MD THE DAY OF SURGERY: Welcme! We will try t make yur experience as easy as pssible. Please leave valuables at hme, but the surgery centers d require pht ID. Remve all rings and jewelry. Wear cmfrtable clthes. The surgery centers ften dn t knw their final schedule until 1-2 days prir, s yur arrival time and surgery time may change. Please cnfirm yur arrival time with yur surgery facility the day befre yur surgery, if yu haven t heard frm them (please see page 7 fr the phne numbers). We mst cmmnly use ne f tw types f anesthesia, and the instructins fr befre surgery are different depending n which type f anesthesia yu selected: If Lcal Anesthesia (als knwn as Straight Lcal r Nvcaine Only r Wide Awake Anesthesia): With Lcal Anesthesia, yu will be cmpletely awake during the surgery, withut IV sedatin r any ther anesthesia, just like ging t the dentist. We simply numb the area f yur hand where we are ging t be wrking. There will be n IV, and n breathing tube r mask. Yu will be laying dwn cmfrtably, with drapes up fr sterility and s yu dn t have t lk. I will inject the mdern lcal anesthetic medicine t cmpletely numb the area where we will be wrking. It will nt numb yur entire hand, just the small area where we will be wrking, s that yu will be able t tell that we are wrking, but yu will feel n pain. The numbing medicine des sting a little, fr a few secnds, when it first ges in, but it wrks very quickly. And it usually lasts fr 4-6 hurs, s yu will leave the surgery center with n pain. Occasinally there might still be sme residual numbing r tingling effect even the next day. With Lcal Anesthesia, yu can: Eat and drink nrmally n the day f yur surgery. Take all f yur nrmal medicatins, including insulin. Yu can safely cntinue t take any aspirin, baby aspirin, ibuprfen, advil, aleve, naprxyn, r ther similar prescriptin Nn-steridal Antiinflammatry drug (NSAID). If yu are n strnger bld thinner medicatin (cumadin, warfarin, plavix, clpidgrel, heparin, pradaxa, dabigatran, xarelt, rivarxaban, thers) please tell me befre yur surgery. Many f these medicatins yu

2 can cntinue taking nrmally. Smetimes we will have yu nt take warfarin/cumadin fr 2-3 days befre surgery depending n yur bld thinner level (INR) and why yu are taking the medicatin. If yu take narctic medicatin every day yu can cntinue it nrmally. Yu can drive yurself t and frm the surgery center, but nt if yu are having bth hands perated n the same day. Yur exact surgery time is, unfrtunately, smewhat unpredictable, s please d nt schedule r plan fr wrk r meetings n the same day after yur surgery. If IV Sedatin (als knwn as Cnscius Sedatin r Twilight Anesthesia): With IV Sedatin anesthesia, yu will get an IV placed at the surgery center, and yu will be given medicatin in the perating rm by the anesthesia team t make yu sleepy. Generally they d nt put yu cmpletely asleep, but rather yu will drift ff t sleep and can be cmpletely unaware f the surgery, if yu want. Yu can discuss hw sleepy r unaware yu want t be with yur anesthesia team in the pre-p area befre surgery. Once yu are sedated, I will cmpletely numb the surgery site with the lcal anesthetic, s yu will feel nthing f the injectin r surgery. Yu will start t wake up when we are finishing with the surgery and putting n the bandages, and the sedatin medicine usually wears ff quite quickly. Yu will have n pain, and the numbing medicatin usually lasts abut 4-6 hurs, s yu will leave the surgery center with n pain. Occasinally there might still be sme residual numbing r tingling effect even the next day. With IV Sedatin anesthesia, yu will need t: Have nthing t eat r drink fr at least 8 hurs prir t yur surgery. Yu can and shuld take yur usual imprtant medicatins with a sip f water n the day f yur surgery. If there is ANY chance that yu are pregnant please d a pregnancy test the day befre surgery and ntify the surgery center. If yu have Type 1 insulin dependent diabetes, please let me knw and cnsult pre-peratively with yur endcrinlgist r family dctr. The plan generally includes taking all r half f yur lantus r lng-acting insulin the night befre surgery, r cntinuing yur nrmal basal rate n yur pump vernight. Then depending n yur mrning bld sugar levels, either cntinue r lessen yur basal rate s yu dn t get lw. Yu may need t check yur glucse mre ften than nrmal. Even withut eating befre surgery yur bld sugar can rise due t the nrmal stress f surgery. Yu can cntinue wearing yur pump during the prcedure. Bring yur meter, etc t the surgery center. If yu d get lw, f curse take smething, preferably glucse tabs r hard candy, r juice/cke if needed. Yu will need a driver t take yu hme, and a respnsible adult t g ver the pst-p instructins with yu at the surgery center. Yu shuld nt return t wrk r the ffice r attend meetings n the same day f yur surgery.

3 DURING TRIGGER FINGER RELEASE SURGERY- WHAT IS DONE: Trigger finger r trigger thumb release surgery is dne t eliminate the painful catching r lcking f the flexr tendn at the first guide at the base f the digit. This guide is like a belt lp, abut a half inch lng, and is frmally knwn as the A-1 pulley. At surgery, we simply cut this belt-lp t pen it. Mst times yu will be able t immediately mve yur finger fully withut it catching after the guide is cut. Very, very rarely, further surgery needs t be dne t stp it frm catching/triggering. There are n deep repair sutures, just skin stitches. Yur pstp bandage will be sft s that yu can mve yur fingers fully. AFTER TRIGGER FINGER RELEASE SURGERY: Bandage/splint/surgical dressing care Please keep yur hand elevated as much and as ften as pssible fr 1-2 days after surgery. This helps reduce swelling, and yur hand may thrb and feel wrse if it is hanging dwn. Please keep yur surgical bandage n and clean and dry fr just three days. Yu can then remve it and place a band-aid. Yu may shwer/bath, but keep the bandage dry fr three days until it is remved. An exam glve taped up at the wrist wrks well. After three days, yu can get yur hand and incisin wet and wash, just dn t sak it a lt until the stitches are ut. Cver with a band-aid. Hand Therapy Exercises Mst imprtantly, I want yu t mve yur thumb and fingers and d the finger exercises ften (see picture belw). Yur bdy will make scar tissue each night, and the exercises during the day will break apart the micrscpic scar tissues that stick the tendns tgether. Yu cannt d these exercises t much r t frequently! Yu can mve the fingers slwly. Speed desn t help, but try t get the full excursin (range f mtin), mving them as far as they can g. 1. Make a full clsed fist 2. Extend (pen) the fingers and thumb as far as they can g, then relax the hand 3. Then pull dwn each finger ne at a time, tuching the pulp tip f the finger t the palm (bandage). This is what we call the Independent FDS exercise.

4 Hand Use It is OK t use yur fingers and thumb lightly as much as yu are able. Typing, writing, eating, dressing and light tl use are all gd. Yu will nt be able t d any strng gripping r grasping, pulling r pushing, carrying, r perating f pwer tls. Yu can t damage r harm anything by using yur fingers and thumb lightly. But it might hurt if yu veruse it, s just g by hw yur hand feels. Pain Management Expectatins Yur hand will be pain free when yu leave the surgery center, and the numbing effect f the lcal anesthesia will likely last 4-6 hurs but is variable. Occasinally there might still be sme numbing/tingling effect even the next mrning. We d nt expect much pain after trigger finger r thumb release surgery. Many peple d well with nly nn-narctic medicatin, but pain pills fr the first day r 2 are OK. I recmmend taking the medicine befre the lidcaine lcal anesthesia wears ff, and/r at bedtime. Pain Medicatins There are three types f pain pills. All three types can be taken tgether, and at the same time. Their pain-relieving effects are additive. Tylenl (acetaminphen) Nn-narctic, safe Inexpensive, cmes in generic Regular strength is 325mg Extra-strength is 500mg The dse is 1000mg 3-4 times per day. Many ver the cunter pain and cld preparatins cntain acetaminphen. It is als a fever reducer. Nn-steridal Anti-inflammatry drugs (NSAIDs) Ibuprfen (Advil) Sld ver the cunter as 200mg pills Inexpensive, cmes in generics Can take 1-3 pills every 6 hurs r up t fur times per day (lasts 6 hurs) D nt take if yu are already taking a prescriptin NSAID (there are many) as there is just extra risk and n extra pain relief. D nt take bth ibuprfen and naprxen at the same time Naprxen (Aleve) Sld ver the cunter as 220mg pills Inexpensive, cmes in generics Narctics Can take 1-2 pills twice a day (lasts 12 hurs) D nt take if yu are already taking a prescriptin NSAID (there are many) as there is just extra risk and n extra pain relief.

5 Require a dctr s written prescriptin and generally cannt be refilled ver a weekend r hliday. Fairly safe fr shrt-term use. All types can becme habit frming and addicting. Yu can build up a tlerance t narctics ver time, meaning if yu cntinue t take them lng-term it takes a higher dse t prduce the same effect (like alchl). They affect different peple differently (like alchl) All are cnstipating. Best t take a stl sftener (clace) and a bulk agent (metamucil, fiber, prunes) if yu are susceptible t cnstipatin r are taking these medicatins beynd a week. All can cause sme itching. All can cause sme nausea. All are sedatives that cause varying degrees f sleepiness that can interfere with driving and decisin making, and can cause unsteadiness and lightheadedness. Best nt cmbine narctics with alchl r ther narctics Are ften sld in a cmbinatin pill with acetaminphen (Tylenl). Cmmnly used narctic medicatins are: Tramadl (Ultram) 1 pill every 6 hurs as needed Generally the lightest and best tlerated with the least unpleasant side-effects Ice Hydrcdne with acetaminphen (Vicdin, Nrc, Lrtab) 1-2 pills every 4-6 hurs as needed This medicatin requires the actual written prescriptin fr any refill and cannt be called in. Oxycdne with acetaminphen (Perccet, rxicet) 1-2 pills every 4-6 hurs as needed This medicatin requires the actual written prescriptin fr any refill and cannt be called in. While ice is generally very gd fr pain and swelling fr the first 48 hurs after any injury r surgery, it is nt t effective t ice thrugh yur dressing r splint r cast. Sme peple reprt that it feels gd t ice the skin just abve their dressing/splint/cast and that is OK, but nt necessary. Exercise (fitness) It is OK and beneficial t remain active after yur surgery. Walking is gd, and yu can elevate yur hand and d the FDS finger exercises while walking. Fr the first 1-2 weeks after surgery, it is OK t cntinue any kind f aerbic fitness rutine, but yu may nt be able t swim, ride a regular bike, r lift

6 dumbbells r barbells, r play glf r tennis. It is generally OK t d any exercise if yu are able t d it cmfrtably, letting pain be yur guide. After 1-2 weeks, mst peple are able t return t all f their usual activities. Driving It is OK t drive a car if yu can d it safely and yu are nt n narctic medicatin. Mst peple are able t drive a manual transmissin. Yu cannt drive a mtrcycle r snwmbile fr 1-2 weeks. Yu shuld nt drive if yu have had surgery n multiple digits n bth hands at the same time. Wrk Mst peple are ff wrk fr just the day f surgery, and then n light restrictedduty wrk restrictins fr the perated hand fr abut 2 mre weeks. Peple are different, and their jb demands are different, s yur exact return t wrk plan will be individualized fr yu, and shuld be discussed ahead f time. Almst everyne can get back t ding their usual jb eventually, withut restrictins. Permanent restrictins are very uncmmn. Diet/fd/eating Yu can resume yur usual diet, and there is n need fr anything special r fr any supplements. Prblems Please call us if yu have: Fever ver fr mre than a day Ful smelling drainage frm the dressing r wund Excessive bleeding Uncntrlled pain Please seek ER evaluatin r treatment if yu have: Persistent vmiting Inability t vid (urinate) fr mre than 8-10 hurs after surgery Shrtness f breath r chest pain Severe allergic reactin YOUR FIRST POST- OPERATIVE VISIT: Yu shuld return t the clinic ffice (nt the surgery center) t see me r Julie the Hand Therapist abut a week (4-10 days) after yur surgery. Yur stitches (sutures) will be remved, and skin steri-strips applied. Updated wrk slips will be issued at each and every clinic visit as needed. Charges fr all pst-p dctr visits within 90 days f surgery are generally included with the surgery glbal fee. Charges fr X-rays, splints, casts, supplies, medicatins and Hand Therapy visits are ften nt included in the surgery glbal fee. Fr questins abut yur bill frm Twin Cities Orthpedics, please cntact ur Custmer Service Department at

7 QUESTIONS?: Fr questins abut yur medical cnditin r surgery please cntact me r Julie (my Hand Therapist) thrugh ur Care Crdinatr Sarah at Fr questins abut scheduling, insurance, paperwrk, r wrk slips please call Sarah, ur Care Crdinatr, at Fr prescriptin refills please call Sarah at Fr questins abut surgery arrival time r ther day-f-surgery questins please cntact yur Surgery Center lcatin directly. Crsstwn Surgery Center: WestHealth Surgery Center: Abbtt Nrthwestern Hspital: Fr after-hurs medical urgent questins please reach the n-call Orthpedic Surgen at Our Walk-In Access Clinic, TCO Orthpedic Urgent Care, is pen every day at the Edina lcatin frm 8:00 am 8:00 pm, fr urgent prblems with yur cast r ther urgent pst-p prblems. It is als pen frm 8am 8pm n Saturday and Sunday. Fr any f the many ther metr lcatins and hurs fr ur Urgent Care centers, please visit ur website Fr billing questins, please call TCO Custmer Service at Fr questins abut yur surgery center bill, c-pays r ut-f-pcket csts please call yur specific surgery center directly (abve). Fr questins abut yur anesthesia bill, please call yur anesthesia prvided directly. THANK YOU!