Doing My Own Trigger Finger Surgery (Dr Henry David Nava Dimaano, FPOA)

[misraproductions]

damn dude you're tough even if you've got numbing which I am sure you did, but I just got this surgery on my thumb and I made sure I fell asleep, with you doing your own surgery your not only unsedated but your making the incisions!

[d36u9]

@misraproductions

thanks for that comment.

[shinobimodder]

I got here from watching cod mods

[Crirule]

Is he able to feel any pain?

[XxHatredxX13]

Ouch Charlie!!

... no lol but that looks like that would hurt >_<..

[d36u9]

@XxHatredxX13

who's Charlie?

[XxHatredxX13]

@d36u9

/watch?v=_OBlgSz8sSM

... Charlie bit me >_<

[sweetbiella]

@d36u9 just type what he said on youtube. It's a very famous two babies video

[DenisValeev]

@d36u9 Charlie is this little boy that bit his brother's finger. It's from a viral video on youtube and very popular on the internet.

[d36u9]

@XxHatredxX13

it hurt a bit the first day following the carpal tunnel release & trigger finger release surgeries. by the 3rd post-operative day, the pain had gone down considerably.

[mopisalang]

noted doc..ill figure in all ur advice once i get to decision point on what to do with this.. grabe pla pareconnect ng nerves lalo pg tumagal.. im convinced ndi experienced enough si doc na nagtreat nito. anyway doc,salamat ng marami..kahit unconventional ginawa mo both to operate on yourself and have it posted, i still admire your knowledge and passion for your work. ive checked the FB pages, but cant seem to add you up. gotta have this trigger checked, i think the nodule's huge! hehe. mabuhay!

[mopisalang]

the trigger finger doesnt worry me as much as the severed nerve..but treating it could really bring a lot of relief. gusto ko na nga buksan kamay ko at gayahin ung ginawa mo sa video. hehehe sakit kasi pg nagcacatch and mukhang di gagaling magisa so ipapatreat ko tlga siya sooner or later. its really depressing, i play musical instruments all the time and do a lot of work with my hands. im sorry for ranting. i know you understand doc. do you know anyone in manila who can treat me? thanks a lot.

[d36u9]

@mopisalang

of course, i'd also offer my own services for any needed nerve repair -- if you'd be willing to have it done here in Cebu. the main advantage?.. medical costs here in Cebu are about 1/2 to 1/3 that of what you'd spend in Metro Manila. (for example, check out my vid "Left Knee Arthroscopic Debridement / Meniscectomy", showing my godmother's procedure. even my dad had his spine surgery done here last year -- see Facebook page for ASIAN ORTHOPEDIC SPINE INSTITUTE, all caps on search).

[d36u9]

the cost reduction is largely due to hospital charges -- Cebu Doctors' University Hospital is by far less expensive than Metro Manila hospitals. (check out my album "Dad's Lumbar Foraminal Stenosis & Decompression Surgery" on the AOSI Facebook wall.)

doctors' fees are also quite cheaper here than there. and even if you factor in the roundtrip airfare & lodging expenses, the total cost of medical care still comes out more affordable. ^_^

[mopisalang]

too bad you dont go to manila anymore..im gonna have a hard time trusting other doctors,after an experience with that seemingly careless doctor.i dont know,maybe he's banking on the distal and proximal ends of the nerve reapproximating and reconnecting on their own.i really dont know.and im kinda scared to see someone who cant prove to me they know about my condition. and watching you do a procedure on yourself, and listening to you, i know you are the one i can entrust this with..just too bad.

[d36u9]

@mopisalang

try consulting Dra. Ida Tacata or Dr. Angel Gozum, both of Makati Medical Center, or Dr. Leo Caro in PGH. They're the people who taught me most of what i know about hand surgery. lahat sila mga Orthopedic Hand specialists. (and incidentally, no, nerve repair is not like a simple tendon or tunnel release which, as i've proven, can be done on oneself. hirap hanapin ang severed nerve ends in scar tisuue -- that's work for two people with experience, actually.)

[d36u9]

of course, practically all of them think what i did on myself (as well as posting it on YT) was ill-advised. i respect their opinion on it, but the judgement call was mine to make. given my situation here, i either do it or lose the full use of my right thumb. (as it turned out, they taught me well enough.)

[mopisalang]

the doctor who treated me at this public hosp didnt ask me anything, not about how i felt, not about if i had any sensation in the injury site, if i liked dogs, nothing. he just sutured it up, and though i still was not that informed as i am now about how nerve injuries are supposed to be treated, i had a feeling the doc was downplaying my injury and loss of sensation called for a procedure much bigger than just closing the wound up. i would love to have my hand opened again. getting depressed.

[d36u9]

@mopisalang

normally, we check for sensation/motor loss on first-time examination, then decide on whether to just clean & close a laceration (no nerve injury suspected), or to schedule for wound exploration (suspected nerve transection) & possible primary nerve repair. baka hindi ortho doctor yung tumingin sa'yo; seems like di masyadong experienced sa hand trauma e, to just stitch up a wound without checking for nerve function. (happens more often than you may think, actually.)

[mopisalang]

thanks for the replies doc henry..good thing i stumbled upon this vid of yours. its exactly 4 weeks since the accident, and still no sign of sensation coming back. ive done a lot of research and i understand that transected nerves take a lot of time to regrow and reconnect, if they would at all. but i really doubt if this nerve injury would fully recover without surgery. though the electric-like shock i get when stretching my hand is not as strong as it had been. the trig finger is another case.

[mopisalang]

good day doc..this video is a big relief for me..is there anyway i can contact you? I live in manila..im 26. i sustained a deep slit in the base of my left middle finger. i think a median branch was cut as i had lost sensation in half of my finger. right after the suturing up of the wound, i noticed that if a flexed my hand into a ball and returned it to normal position, there is a pop. a month after the surgery,the trig finger had worsened. need help. thanks doc

[d36u9]

@mopisalang

that does sound like a cut digital nerve. usually, when we see patients with cuts in the hands, we test for loss of sensation related to known nerves that may have been severed. this is because we'd like to repair the cut nerve ASAP. the longer a nerve stays cut, the less likely a repair attempt can be made, or the less likely that sensation can be restored even if a repair is done. as for triggering, that's easy -- just release the A1 pulley tunnel to free up the tendon.

[d36u9]

@mopisalang

...the problem with your finger triggering is that your prior injury probably produced a lot of scarring & adhesion (not necessarily all in the A1 pulley). even possible that the tendons themselves got partially injured. when did your original accident happen?

as for contacting me, i'm afraid i live & practice in Cebu & Mandaue City now. i no longer go to Metro Manila for orthopedic-related work. if you'd like to see me or talk to me, you'd have to fly here to Cebu for it. sorry,

[d36u9]

@mopisalang

... if you want to just chat online to ask about your condition, you can find my Facebook profile connected with ASIAN ORTHOPEDIC SPINE INSTITUTE (search FB using all caps). i see 3 options for you:

#1, leave your hand as is;

#2, do a flexor tendon exploration/release to eliminate triggering/locking;

#3, do #2 along with digital nerve exploration -- & if still found to be anatomically in good shape, repair the nerve & hope it heals well.

[atomalbert]

Respect!

[Solitude075]

What did you do to your middle finger? All I see is u were playing with your nerve.

[d36u9]

@Solitude075

nothing happened w/ d middle finger. that long incision u see in the base of my palm is from the carpal tunnel release surgery which i did just before doing the ring finger.

[skitzonacid]

was it successful did you heal well?

[d36u9]

@skitzonacid

took out the sutures by the second week. but the inflammation around the released part of the flexor tendons took 3 months to fully subside. during this time (especially in the 2nd month following surgical release), there was some swelling such that i couldn't fully extend my right ring finger as far up as the left. grip & pinch power was also reduced during these 3 months. but after that, i was back to normal.

[skitzonacid]

@d36u9 back to normal....and better then before the surgery i assume?...

d36u9...i wish i knew your real name and could shake your hand...

this is really quite amazing! truly, thank you for the video its quite unusual and a great lesson. keep up the good work.

[d36u9]

@skitzonacid

i was back to full normal by the 6th month after the surgeries. grip strength & pinch strength are 100% now. and no more tingling/numbness/weakness & finger locking whenever i do carpentry work or go mountain biking.

BTW, my real name is on the title. and i really am a doctor -- an orthopedic surgeon. i do spine decompressions & fixations, fracture/tendon/nerve repair, joint arthroscopies (including knee ACL reconstruction) & joint replacements (knee & hip).

[d36u9]

i practice in the Philippines, in the province of Cebu (Cebu City & Mandaue City). i also teach in two medical schools here, and i'm a director for medical research in one of these schools. i went to medschool in UP Manila, initially got in the UP-PGH Neurosurgery training program, but opted to go private -- which is why i ended up doing 3 years of general surgery (in Medical City) before transitioning into orthopedics (in Makati Medical Center).

oh, and thanks for your appreciation.

[KaitKatt]

What are you speaking? I recognise it but don't understand it

[petulia67]

Are you operating on your right hand with your left hand? I have that locking ring finger but it only seems to be an issue upon awakening when it hurts to make a fist. You are a rare surgeon with a nice sense of humor!

[d36u9]

@petulia67

yes, i'm operating on my right hand using my left. but i have our senior clinic nurse assisting me with it. plus, i'm using a self-retaining retractor to keep my field of view open.

[Princess100112]

DID THAT HURT???!!!??!!! Ewww

[d36u9]

@Princess100112

nope. i did this right after i finished with the carpal tunnel release - see my other surgical vid - and the anesthesia from that prior procedure was still in effect, so no pain for this surgery.

[ZawShin]

what happens if you do to much surgery? Does it cost any side effects? Were you nervous? What do you practice in?

[d36u9]

@ZawShin

well, it's basically impossible to do "too much surgery", since the skin incision is right over the structure that needs to be cut open. if you know the surgical anatomy, what else is there to cut?.. and if you don't know the surgical anatomy, then why would you even consider doing this procedure to begin with, right?

incidentally, i'm an orthopedic surgeon. this kind of surgery is part of my professional training; and as far as i know, we're the only MDs who do this kind of thing.

[ZawShin]

@d36u9 Oh that's cool, thx!

[skitzonacid]

@d36u9 hahahahaha my hero!

[d36u9]

@skitzonacid

oh? how so?

[d36u9]

@falcon29302

thanx for ur comment. and no, no flexion contractures of the PIP or MCP joints. PIP actively hyperextends to 5 degrees, & MCP does the same. re: my technique, i stopped after i had no more A1 to release. i make it a point to not even release the adjacent cruciate (if i don't violate that, then no way i'd stray into the region of A2.)

[d36u9]

i would like to assure you that i make it a point to not get over-zealous with releasing the A1 (especially since i do this surgery on other people using a more cosmetically acceptable transverse incision that limits the visualization of the distal border of the A1 pulley -- i did mine using a longitudinal cut, mainly for ease of visualization).

[KiddBiz]

Aaaah! i can't stand watching this!

[anakngkulugo]

Filipino?

[d36u9]

@anakngkulugo

why ask?... would it have mattered, either way? ^_^

[Mufaso1000]

Wouldn't the carpal tunnel surgery have relieved the pain in the trigger finger?

[d36u9]

@Mufaso1000

afraid not. pain & catching from the trigger finger comes from impingement of the flexor tendon's A1 pulley tunnel system -- anatomically distinct from the carpal tunnel flexor tendon system.

[miguellianos]

usually surgery videos wont make me shiver but for some reason this one did

[martyaus2905]

I would like to see this guy do his own vasectomy.

[d36u9]

@martyaus2905

funny. but humor aside, i don't think there's any emergency indication for a vasectomy that would make anyone even think of doing it on himself. i did however hear of an documented case of a Russian surgeon doing an appendectomy on himself. try googling "auto-appendectomy in the Antarctic", "British Medical Journal volume 339", "Dr Leonid Rogozov". it's even on Pubmed (index number 20008968). then again, that was an emergency situation, much like my carpal tunnel syndrome.

[krysolite]

very interesting. i looked up what trigger finger was and realized i have similar symptoms on my pinky, although it occurs on my knuckle rather than the second joint of my finger (from the illustrations i've seen).

not asking for a diagnosis over a youtube comment, but is it possible that trigger finger occurs on the knuckle of a finger as well? happened after a great impact on my knuckle (taekwondo) and presently has a small lump over it. =b

[d36u9]

dear @krysolite,

thanks for the question. if by "knuckle", you mean those round protruberances that you use to punch with, then the answer is "no, trigger finger is not a pathology of the knuckles." anatomically, each of your four knuckles corresponds to the metacarpo-phalangeal joints of your index, long, ring & small fingers. the tendons that pass over knuckles don't have the same tunnels or pulleys that flexor tendons have, so no, it can't be called "trigger finger".

[d36u9]

what is possible is that the contacting surfaces of your knuckles are inflamed from all the punching which you do (especially if you do board or brick breaking - here's a tip, if you wanna break a board or brick, use a hammer). the extensor tendons which pass over your knuckles may also be inflamed. take a break from tae kwon do, and see an orthopedic hand surgeon for a consult. you might be setting yourself up for early metacarpo-phalangeal osteoarthritis.

[martyaus2905]

@krysolite Stop crying about it and grab a scalpel.