This page is for my current patients only
此網頁只供我現時病人閱讀
Background 背景
Fingers can move because there are two tendons lying on either side, the palm side and the back side. When the muscle of these tendon contract, it will pull the bone and thus the finger move, quite alike a marionette.
The tendon at the palm side, called flexor tendon, goes through a tight fit fibrous tunnel (in medical terms it is called pulley) before it reaches the finger tip. If the tendon was swollen, for example due to degeneration or inflammation, it will be jammed by tunnel. In early stage, the patient will noticed the catching of the finger when straightening it from a bending position. He needs to use more force to straighten it, and will experience the snapping or sudden give. In later stage, the tendon will be harden and shortened. The contracted tendon will cause the finger held in bent position permanently.
In order to create enough space for the tendon to glide, the fibrous tunnel roof will needed to be split.
There are 2 different ways of performing it.
- Percutaneous trigger finger release
Release the tendon by a needle. Least invasive, no surgical wound, needle hole seal up in 1 day, but might not allow complete release due to lack of direct visualisation. Due to possible anatomical variation, only indicated for middle and ring finger.
- Mini-open trigger finger release
A minimal invasive surgical procedure done with a small wound of 10mm. Direct visualisation to ensure complete release, good for thumb, index finger, little finger and revision case.
- 經皮彈弓手指鬆解 用針鬆解肌腱管道。微創，無手術傷口，針孔在1天內密封防水。但由於不能直接觀看鬆解組織的過程，可能無法完全破開管道頂。而且由於拇指食指和尾指的肌腱位置有較多解剖學上的變化，所以僅適用於中指和無名指。
- 迷你刀口彈弓手指鬆解 用10mm小傷口完成的微創手術程序。直接可看到整個鬆解組織的過程，所以能夠確保完全鬆解，而且適用於拇指，食指，小指和翻修個案。
Indication 適應症
- Trigger finger due to degeneration 因退化引起的彈弓手指
- Trigger finger due to chronic inflammation 因慢性炎症引起的彈弓手指
Preparation 預備
- Continue usual medication on operative day 手術當天照常食藥
Risk 風險
While all medical and nursing professionals endeavor to provide best and safest practice, complications still would occur.
General operative risks including heart attack, stroke, wound infection, wound hemorrhage, urinary tract infection, deep vein thrombosis, scar pain, etc, is possibly encountered.
Digital nerve injury is rarely occurred risk. Tendon bowstringing might cause weaker hand grip. Tendon rupture can occur.
Other rare complications include digital and palmar vascular injury. Anatomical variants carry more risk. Limb loss is a remote possibility.
Recurrence is around 2%. Persistent pain was related to the tendon pathology, i.e. degeneration or inflammation. As surgery only address the triggering part, therefore these symptom which should be counted as natural course rather than complication.
儘管醫生和護士都會盡最大努力提供最佳和最安全的治療，但併發症仍會發生。
一般手術可能會遇到的風險，包括心臟病發作，中風，傷口感染，傷口出血，尿道感染，深層靜脈血栓形成，傷口疼痛等，這手術也不例外。
手指神經根損傷是很罕見的風險。肌腱比正常凸及握力變弱。其他罕見的併發症包括血管穿刺及肌腱斷開。先天結構異常也會有更高的風險。嚴重個案可能需截肢。
復發大概為2%。由於手術只是鬆解，令到手指不再卡住，但是肌腱本身的痛症，是源於退化及炎症，所以手術後這些病徵可能並沒有改善，但這屬疾病的自然進程，不屬併發症。
Budget Estimation 預算費用
CPT code and RVU is as follows
- 26055 trigger finger release, thumb to little finger, RVU 3.11
CPT碼和RVU如下
- 26055 彈弓手指鬆解，RVU 3.11
Estimation based on general ward as in Aug-2020,
- Surgeon fee $12,440 (mini-open), $6,220 (percutaneous with steroid injection)
- Anaesthetist fee $4,147 (mini-open)
- Ward round $1,200/day
- Hospital charge $10,000
Total $27,787(mini-open), $7,420 (percutaneous with steroid injection) around
根據普通房於2020年8月進行的估算，
- 外科醫生費$12,440 (迷你刀口鬆解), $6,220 (經皮彈弓手指鬆解加類固醇注射)
- 麻醉師費$4,147(迷你刀口鬆解)
- 巡房費$1,200
- 醫院費$10,000
- 總計$ 27,787 (迷你刀口鬆解), $7,420 (經皮彈弓手指鬆解加類固醇注射) 左右
Reference figures from private hospitals 醫院提供的參考數據
St Paul’s Hospital 聖保祿醫院
Median Charge 收費中位數
- Doctors’ fee 醫生費 $21,200
- Hospital charge 醫院收費 $8,855
- Total 總費 $30,055
Cannosa Hospital 嘉諾撒醫院
Median Charge 收費中位數
- Doctors’ fee 醫生費 $7,500
- Hospital charge 醫院收費 $8,310
- Total 總費 $15,810
Baptist Hospital 浸會醫院
Median Charge 收費中位數
- Doctors’ fee 醫生費 $14,200
- Hospital charge 醫院收費 $7,456
- Total 總費 $21,656
Hong Kong Sanatorium Hospital 養和醫院
Median Charge 收費中位數
- Doctors’ fee 醫生費 $34,800
- Hospital charge 醫院收費 $15,877
- Total 總費 $50,677
Post-op care 術後照顧
- Control inflammation with regular usage of anti-inflammatory drug.
- The wound is covered by a waterproof dressing. You can shower, preferably wearing a glove with cling film sealing the end. Do not take bath or rub on it. Keep the dressing intact, there is no need to change it regularly.
- For 2 days, you should keep the hand above your chest, and use the other hand to press on the operated site to prevent bleeding.
- On the 3rd day, you should try to gently move the finger. Putting the hand on table and press on the back of the hand to straighten out the finger.
- 定時服藥，控制發炎
- 傷口已用防水敷料覆蓋。您可以淋浴，但最好戴手套，並用保鮮紙密封末端。不要浸浴，也不要摸或擦傷口敷料。保持敷料完整，無需定期更換。
- 手術當天及後一天，應將手保持在胸口以上，並用另一隻手按壓手術部位以防止流血。記緊不要捽，會令流血更多。
- 手術後第三天，您可以嘗試輕輕移動手指。將手板放在桌子上，然後按壓手背以拉直手指。
Early Post-op Complication 手術後早期併發症
Notify surgeon in case you have
- Persistent fever of more than 37.5 Celcius
- Chills and rigor
- Wound pain despite rest
- Wound redness and swelling
- Purulent discharge from wound
- Calf pain
- Ankle swelling, progressive
- Sudden onset of shortness of breath
- Chest pain
如發現以下情況，要立即通知醫生
- 持續高燒（口探高於攝氏37.5度）
- 發冷打顫
- 無論運動或休息時，傷口痛楚都持續增加
- 傷口持續發紅腫脹
- 傷口有膿液
- 小腿愈見痛楚
- 小腿、腳踝和腿部腫脹持續增加
- 突發性的氣促
- 胸口突然疼痛
Rehabilitation after Day 14 手術後2週復健
Range of Motion Exercise:
- Continue full range of motion exercise, gradual stretching to gain additional range.
Strengthening:
- Gradual increase in weight and number of repetition.
活動範圍運動:
- 全幅度活動，並逐漸拉伸，增加活動範圍。
肌力訓練：
- 逐漸增加重量及重複次數
Reference 參考文獻
- Werthel JD, Cortez M, Elhassan BT. Modified percutaneous trigger finger release. Hand Surg Rehabil. 2016 Jun;35(3):179-182. https://pubmed.ncbi.nlm.nih.gov/27740459/
- Aksoy A, Sir E. Complications of Percutaneous Release of the Trigger Finger Cureus. 2019 Feb 25;11(2):e4132. doi: 10.7759/cureus.4132. https://pubmed.ncbi.nlm.nih.gov/31058015/