DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Right ring finger trigger digit.
POSTOPERATIVE DIAGNOSIS:
Right ring finger trigger digit.
PROCEDURES PERFORMED:
1. Right ring finger A1 pulley release.
2. Right ring finger digital block.
SURGEON: John Doe, MD
ANESTHESIA:
Digital block.
COMPLICATIONS:
None.
SPECIMENS:
None.
INDICATIONS FOR PROCEDURE: The patient is an (XX)-year-old right-hand dominant male who presented with pain in the right fourth digit that started shortly after undergoing bilateral carpal tunnel release. He had good resolution of his symptoms after his carpal tunnel release; however, pain in the ring finger was limiting recovery. Clinically, this was consistent with a trigger finger with tenderness to palpation over the A1 pulley with a palpable nodule and mild locking. After failing a course of conservative treatment, the patient decided to proceed with surgical intervention consisting of right ring finger A1 pulley release.
OPERATIVE FINDINGS: Severe thickening of the A1 pulley was appreciated overlying the flexor sheath. The underlying flexor tendons had mild degenerative changes within them. Full range of motion of the digit without locking or catching was achieved after adequate A1 release.
DESCRIPTION OF OPERATION: After obtaining informed consent, identifying the correct patient and correct operative site, the patient had placement of a right ring finger digital block anesthetic using 1% lidocaine mixed with 0.5% Marcaine in a 50/50 mixture. He was then taken to the operating suite and the right hand and upper extremity were prepped and draped in the usual sterile fashion. He received preoperative IV antibiotics and the hand was exsanguinated with an Esmarch bandage and a well-padded forearm tourniquet inflated to appropriate arm pressure.
A transverse incision was created in the MP flexion crease overlying the fourth ray. Dissection was carried down through the skin and subcutaneous tissues and a combination of blunt and sharp dissection was utilized to identify the flexor sheath. The digital nerves were retracted to either side of the sheath and the A1 pulley was exposed. It was completely incised from its most proximal extent distally into the most proximal aspect of the A2 pulley. The palmar pulley was also released. The flexor tendons were retracted from the wound with a Ragnell retractor. Mild degenerative changes were appreciated. A small amount of synovitis was sharply excised. The patient was asked to flex and extend the digit and there was no locking or catching.
The wound bed was then irrigated with normal saline and the skin edges reapproximated with 4-0 Prolene suture followed by application of a light sterile dressing. The tourniquet was then deflated with excellent circulation returning to his hand. He was taken to the recovery room in stable condition, having tolerated the procedure without difficulty. The patient was discharged to home in satisfactory condition. The patient was sent home with instructions on maintenance of his dressings and elevation of his hand. He was given a prescription for appropriate oral analgesics and will remove the bandage in approximately 3 days and apply a light Band-Aid. The patient is to perform range of motion exercises every hour and will return to the office in approximately 10 to 14 days for suture removal.
