Steroid injection is the most common non-surgical treatment with approximately a 60% success rate. The effect may wear off with time. Surgery has a higher success rate.
Description of Surgery
The operation is usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital. You will need to remove any rings and jewelery from the hand and ideally false nails / nail varnish.
The operation is performed through a small incision at the base of the finger. The surgeon will then identify the pulley and divide it. The wound is then stitched closed. The operation itself takes about 10 minutes. A tourniquet is used on the upper arm for this time.
Anaesthetic
The operation is usually performed under a local anaesthetic and so you will be able to eat and drink as normal.
What are the risks?
All operations involve an element of risk. The risks for this particular operation are small but it is important that you are aware of them.
The risk of infection is very small and is thought to be less than 1%. Most infections will settle simply with antibiotics.
Damage to the nerves next to the pulley is very rare.
The scar can be uncomfortable at first with heavy grip, but usually settles soon.
It is rare that symptoms don’t settle.
Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.
Pain
The local anaesthetic lasts for several hours after the operation and simple painkillers are usually all that is needed after this. It is important that you take regular pain relief at first so that you can keep your fingers moving.
Dressings
Your hand will be dressed in a bulky bandage. This will be removed 2 or 3 days following the surgery by the hand therapy team. There will be a dressing applied to the wound under this bandage. These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.
The dressings are splash proof but not waterproof and so you should avoid getting them wet.
The wound is closed using non-dissolvable stitches. These will be removed at approximately 10 days following surgery by the hand therapy team.
You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.
Using the hand
You are encouraged to move the hand and wrist straight away in the dressings for light tasks.
Driving
the way of something in the road. This will vary between patients but normally is after the stitches have been removed.
Return to work
This depends on what your job is. You should be able to return to a “desk job” in about a week or two of your surgery. If you have a more manual job it can take up to 6 weeks before you feel ready to return to work. Please discuss this further with your surgeon or physiotherapist if you feel unsure. A sick note can be given to you at the time of your surgery if required. Please ask the nurses on the ward if you need one.
Improvement in catching symptoms following surgery is usually immediate and noticeable during the operation. Discomfort at the level of the pulley can take longer to settle.