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Office Based Trigger Finger Release
Andrew K. Palmer, MD1; Dale Dellacqua, MD2
1Orthopedic Surgery, Upstate Medical University, Syracuse, NY; 2Department of Orthopedics, Indiana University; Monroe Hospital, Bloomington, IN

Introduction: The costs of healthcare have continuously grown to the point where many individuals must decide between treatment and living with their condition. Costs associated with trigger finger release involve both set costs such as the surgical and facility fees and variable costs that result from time away from home or work associated with office and facility visits. In an attempt to decrease the costs of trigger finger release, a study was undertaken in which trigger finger release was performed through a mini incision, in a physician office under local anesthesia thus eliminating the facility fee and significantly reducing the number of office visits required for treatment. This paper comprises the results of that study.

Methods and Materials: 105 trigger finger releases were performed in 104 patients under local anesthesia through a mini incision that required no sutures for skin closure. There were 38 males and 66 females ranging in age from 31 to 99 years with a mean of 68 years. Trigger fingers were graded as: grade 1: pain without mechanical locking; grade 2: mechanical locking that can actively be overcome; grade 3: mechanical locking requiring passive force to achieve finger extension; grade 4: grade 3 associated with extension contracture. The majority of patients undergoing surgery had grade 2 or 3 triggers. Surgery for grade 4 triggers was performed to treat the triggering and not joint contracture. All grade 1 and 2 ‘s were offered a preoperative steroid injection if appropriate. 30 patients who elected to have the injection subsequently underwent surgery. The majority of the additional 70+ patients underwent surgery in the office at the time of their initial presentation. Follow up was by phone.

Results: All trigger fingers were successfully released through a mini incision requiring no sutures. All wounds healed primarily with no sign of infection. The majority of patients returned to normal activity within 2-7 days. All patients were pleased with their results and enthusiastically endorsed having trigger finger surgery performed in the office vs a surgical facility. 3 patients reported pain and swelling that required post op office evaluation. 2 responded to steroid injection and the 3rddecided to live with a mild extensor lag.

Conclusions: The costs associated with trigger finger release can be significantly and safely decreased by performing the procedure through a mini incision in a surgeon’s office under local anesthesia.

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