Potential complications in connection with surgery on trigger finger (stenosing tenosynovitis)

Which results can be expected after surgery on De Quervain´s syndrome (De Quervain´s tenosynovitis)?

The majority of the cases may expect the elimination of pain in the affected (thus constricted) area of the forearm after surgery. Even the reduced resilience may improve after only few months.

Is it possible to still retain some pain even after an uncomplicated surgery?

Yes. It is possible to retain some pain even if the surgical procedure went well. The reason may be:

  • the existence of osteoarthritis in the thumb saddle joint (would be visible in an x-ray image)
  • a left-unsplit, separate compartment (sub-sheath) within the tendon sheath
The latter mentioned scenario requires further details:

The tendon sheath (first extensor compartment) usually hosts two tendons for the thumb. Some people however dispose of three tendons and sometimes one of these three tendons is located in a separate sub-sheath within the main sheath, if you will. (Isolated compartment for the short thumb extensor). This isolated tendon sheath may also be constricted and therefore should also be separated during primary surgery. If this does not happen it may represent the reason for lingering pains later on.

Does this procedure bare risks?   

In the majority of the cases this is a fairly uncomplicated procedure. However: there is no such thing as surgery with zero risk! Following are some (not all) of the potential risks that may occur:

Course of the superficial nerves close to the first extensor compartment.

The red arrow in the graph marks the spot where the incision will be placed. The blue arrows show the course of the radial nerves within the operating area.

The image shows how close nerve tracts (marked in yellow in the graph) run within the tendon sheath that requires separating. Even if it does not happen to frequently, occasionally the radial nerve or one of its branches may get severed or bruised.

The nerve may get injured directly through the scalpel, but also indirectly through surgical hook pressure, swellings or during the electric welding used for bleeding control.

This may lead to numbness on the radial side of the forearm and to the extensor side of the thumb.

In many cases a few days into the procedure the patient experiences an unpleasant “electrifying” pain (a neuroma).

The torturing symptoms as a result of a damaged radial nerve may even persist permanently in the worst case.

Sudeck´s disease.

Advanced stage of CRPS (Sudeck´s dystrophy with massive swelling and painful motion malfunctions).

Does one have to be concerned with an infection or impaired wound healing following surgery on De Quervain´s syndrome?

Even if infections or impaired wound healing are rather uncommon after surgery on De Quervain´s syndrome one must always consider this option too if the course of the pain development deviates from standard experiences.

Pain associated with surgery on De Quervain´s syndrome should recede considerably after a few days from the procedure. The mobility of the thumb and the wrist should improve and the night rest should no longer be impaired by hand pains.

However, should the pain return after days of undisputed improvement and should the quality of mobility decrease, then it is advisable to have an experienced hand surgeon examine the wound.

If the wound looks reddish and swollen it is particularly important to act swiftly to exclude a potential infection. Should indeed an infection be diagnosed the wound must immediately be reopened. Under no circumstances should secondary surgery in a case like that be procrastinated.

In case of superficial wound healing impairments it will suffice to remove the stitches early and to allow the wound secretion to properly drain. (It may also be recommendable to administer antibiotics).

Does the scar hurt for a long time after surgery?   

Even if the scar resulting from this type of surgery is typically very small, the scarring process in connection with any hand surgery requires longer than in other areas of the body. Keloidal scars are rather uncommon. Right underneath the surgery scar resulting from a procedure on De Quervain´s syndrome, nerve tracks of the radial nerve lay close to the surface. This many times will render the scar sensitive to the touch and to pressure for an extensive amount of time.

Is it possible to experience secondary haemorraghing after the procedure?   

Yes. This complication however is rather uncommon. At risk are those patients who take drugs which impact the blood clotting process (e.g. Aspirin®, ASS 100®, Plavix®, Godamed®, Marcumar®….) Please be sure to inform the operating surgeon if you do take any medication that impacts the blood clotting process!

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