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Trigger Finger Release

Planning

B

Preoperative Plan

1

Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case

2

Description of potential complications and steps to avoid them

C

Room Preparation

1

Surgical Instrumentation

  • Loupe magnification

2

Room setup and Equipment

  • standard operating table
  • hand table

3

Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity

Technique

D

Superficial Dissection

1

Mark and make incision

  • mark and make a 1 cm incision directly over the affected A1 pulley
  • avoid crossing palmar skin creases at a right angle with any incision type
  • incise only the skin and dermis with a no. 15 blade
E

Deep Dissection

1

Dissect through subcutaneous tissue

  • use blunt dissection to spread the subcutaneous tissue
F

Neurovascular Structure Identification

1

Identify the neurovascular structures

  • protect and retract the neurovascular structures
  • the digital radial nerve is the nerve that is most at risk because it typically crosses the surgical field
G

A1 Pulley Release

1

Expose the A1 pulley

  • use a sponge to expose the A1 pulley

2

Release the A1 pulley

  • do not incise the A1 pulley until it is completely exposed
  • use a knife to start the A1 pulley incision
  • complete the release with scissors until the leaflets of the A1 pulley can be completely spread apart
  • avoid cutting the A2 pulley
H

Wound Closure

1

Irrigation and hemostasis

  • copiously irrigate the wound

2

Superficial closure

  • use 4-0 nylon to close the skin

3

Dressing and immediate immobilization

  • place in soft dressing

Patient Care

K

Preoperative H & P

1

Perform basic medical and orthopaedic history and physical

  • check neurovascular status
  • check range of motion

2

Perform operative consent

  • describe complications of surgery including
  • wound complications
  • neurovascular injury
  • bowstringing
L

Perioperative Inpatient Management

1

Write comprehensive postoperative orders

  • pain management
  • outpatient PT
  • start active range of motion exercises

2

Discharges patient appropriately

  • write for pain meds
  • schedule follow up appointment in 2 weeks
M

Intermediate Evaluation and Management

1

Obtain focused history and performs focused exam

  • check range of motion
  • check radial and ulnar pulses

2

Prescribes and manages nonoperative treatment

  • attempts trial of physical therapy

3

Makes informed decision to proceed with operative treatment

  • documents failure of nonoperative management
  • describes accepted indications and contraindications for surgical intervention

4

Provides postoperative management and rehabilitation

  • 2 week postoperative visit
  • remove sutures
  • diagnose and management of early complications
  • continue range of motion exercises
N

Advanced Evaluation and Management

1

Provides post-op management and rehabilitation

  • gradually increase range of motion
O

Complex Patient Care

1

Comprehensive pre-op planning/alternatives.

2

Modify and adjust post-op plan as needed

 

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