Hand surgeon

I went for my second visit to the hand doctor yesterday. I had first gone a few months ago, primarily for osteoarthritis in my right wrist. I went back for the right wrist and also brought up my fingers. So I have trigger finger in 4 fingers, or maybe it was five?

The cortisone shot seems to have worked in the finger, as I only had it done in the painful finger. In the wrist. . . Well, I was really hopeful that this time it would work, but I get the feeling that it won't, again. So here's the thing, at some point I need to decide when it is time to go for surgery, and whether/when to get a second opinion.

Most of the arthritis in my wrists is at the basal joint. The pain level is not extreme most of the time, which is why this may wind up being a really hard decision. But I have lost a lot of use of that hand, and a lot of enjoyment. There are WAY too many things that I can't do anymore. Cutting with scissors hurts within a minute. I tried knitting, and it was very painful. Some days I can't grasp much of anything, while others are a bit better. Whenever I get that wrist done, I will likely get a few trigger fingers done at the same time.

Unlike for a knee or hip, the decision for surgery isn't as obvious, as it's not a weight bearing joint. Instead, it's impacting my quality of life, and it's not going to get any better. So how much do I give up before deciding to have surgery. BTW, I'm 41 years old, and my kids are 6yrs old and almost 11yrs. We're past the worst of the heavy duty child lifting.

Has anyone had any experience with either of these surgeries, thumb basal joint or trigger fingers? Advantages to waiting? Doing the surgery?

Stony I am sorry your hands are causing such problems. I have had my trigger fingers injected but I have never had surgery on them. I was having so many things injected I realized I needed to get the PsA under better control so I started Remicade as the Enbrel really wasn't working any more.What does the surgery entail? Will it need to be repeated or will it last indefinitely? How long is the recovery? I am sorry you are having to deal with this. Esp. with young children. I am lucky mine are grown but boy do I miss their energy some days!

Michael- I'm thinking that the injection for trigger finger may have worked some. The wrist, I don't think at all. The surgery for trigger finger, or release, is pretty simple. It's the same exact idea as for carpal tunnel. Cut the ligament the is constricting the tendon, and you release the tendon from it's trap and cause of the pain and triggering. The key thing for that seems to be doing the exercises so that the tendon doesn't get trapped in scar tissue.

The wrist, it would be removing a bone, and putting a coiled up tendon in its place. I realized that one of my neighbors had this (or a similar) surgery, so I may check with her on the recovery process. Both issues are impacted by the PsA, but not necessarily related to poor control. I should talk to my rheumy more about this. I actually feel like my PsA is under decent, but not perfect, control right now. Give me a month, and I won't be singing the same tune though. I always have a spring flare, and it seems like it starts way earlier than it should.

The kids? Maybe it will be a growing experience for them. My daughter will be able to be helpful. My son will be able to help with small stuff, like turning pages and holding books. Food will be interesting for a while.

Did you get a good response from the injections? Just one per finger and it seemed to work?

My triggering is always in the second joint, not the one near the nail. The injections work for a couble of monthe for me. What made the biggest change is to stop working. I was over using my hands. I have very little problem with them triggering now. I found injecting them hurts badly for about 48 hours. That was the worst part. One time I had a finger on each hand and couldn't use either hand for about 24 hours. I had to grab a wash cloth with both hands, which were balled up into little fists, every time I went pee! Not pretty!

Of all of my aches, I think that the hand stuff is the most interfering. Most of the things I really enjoy require me to have un-puffy, graceful fingers and a little strength. For me, that is the line in the sand! :stuck_out_tongue:

Trigger finger release is generally a simple, successful surgery with fairly short recovery time. Most people feel better 2 weeks after surgery and back to normal in 6 weeks post-op. Most patients experience less pain in the post operative period than they did prior to surgery. Also, the pain is usually centered on the incision site instead of being more diffuse over the hand. If you have had any pain from nerve compression, or the tension of the tendons, that will disappear very quickly after surgery. A majority of the patients that I follow up with after this surgery are very happy and complain of little pain. (I usually speak to them 24-48 hours post-op)

There are several surgeries for the Basal joint. Each had their own set of benefits and risks. The best reasons for having surgery sooner rather than later is so that you can get some of your mobility back in your hand and reduce your pain.
There is a Basal Joint Fusion in which the surgeon fuses the Carpal and Metacarpal bones together using a metal pin. Then you have LRTI or Ligament Reconstruction and Tendon Interposition Arthroplasty and theTendon Transfer Arthroplasty. These surgeries are a little more complex than the trigger finger release and will require more recovery time (minimum of 12 weeks in a splint). My personal preference is for surgeries without any pins or plates inserted. They can come loose, even after a short period of time and cause friction resulting in pain. This is a fairly common event. The fusion is also an “open” surgery with a larger incision, whereas the arthroscopic surgeries have a much smaller incision with no added parts.

If you decide to have surgery, let me know. I’ll send you some easy casserole recipes that your kiddos can help you make before hand, so you’ll stil be able to eat :slight_smile:

Good luck!

Here are some links:
http://www.biomath.info/Protocols/Duke/docs/HeyworthBenton.pdf (this is a few years old, but it explains the surgeries really well)

Thanks so much GrumpyCat. I think, but am not sure, that it would be the tendon transfer surgery. I spoke to a neighbor of mine who had this done about a year and a half ago, and she's been very happy overall. She said the strength isn't perfect, but the pain is gone, and dexterity is improved. The surgeon she used is the same one that I will, and she did all of her homework.

What's funny is that my mom had two trigger fingers released a few years ago. It went well, but she wound up with an infection. I will point out, she's high risk to begin with, as she is diabetic.

I've already given my family fair warning on the things that I won't be able to do, including styling hair. I'm thinking that my 10 year old will be doing my hair every day.

Hi stoney, sure have, fingers get stuck all the time. I was chatting with someone here, can't remember, but they gave me the medical term. I also have carpal tunnel in both wrists.

hi i had a trigger finger release a few years back and it sucked. now i am facing it again. i think the main advantage to having the surgery is that it relieved the pain for a while. but that was before i was dxed with PSa. Both hands now have the fingers messed up, especially my primary hand. I am hoping an occupational therapist can help with that hand that is not so bad, but i am almost certain that my primary hand will need surgery again.