Trying to understand what my old orthopedic surgeon was doing.

This was my 3rd visit since September 2019

Discussion Note 5/13/20
"The patient is suffering from a Trigger Finger.
The treatment options were discussed specifically observation, cortisone injection and surgery.
The patient decided to undergo cortisone. (This was my 3rd cortisone shot. I was informed that there was no reason not to do it since I will be able waiting to schedule surgery and that it could ease the pain)
If the symptoms do not improve, the patient will undergo trigger finger release when able d/tcovid 19"

So....if no corona, surgery would have scheduled during 5/13/20 visit and I would not have needed a 3rd cortisone.


Saw him today.....he did nothing but touch my hand

Discussion Note 6/11/2020

"recommend a second opinion dr Choi , as pts sx are cramping in the hand , and not consistent with a trigger finger. gaurded prognosis for TFR."

The 3rd cortisone didn't do anything but allow my finger to crack.
I never said my hand was cramping. I informed him that my hand is extremely sore with the grip that I am being forced to use. The hand is painful. TFR is painful.


How did it get from "If the symptoms do not improve,the patient will undergo trigger finger release when able d/tcovid 19" to this?

I am so fucking confused....

This post was edited by ZxFamily-GuyxZ on Jun 11 2020 01:31pm

TLDR: Patient is a chronic finger bandit at the clubs

DPT here. Hard to really know what’s going on without checking it out myself but I can throw you a link that’s a great read if you think it’s trigger finger.

https://www.physio-pedia.com/Trigger_Finger

Always always always do conservative treatment first and never jump into surgery. Surgeons don’t give a shit about your quality of life after they cut you open and get paid.

Personally I’m not the biggest fan of cortisone shots, especially three in the same area in less than a year. It’s actually borderline criminal if the same doc did that to you three times without much improvement with any of them.

3rd year DPT student here. I'd suggest the conservative route and only get surgery if it truly is your only and last out. There could be a plethora of reasons behind the pain in your hand and the only way to correctly diagnose your condition is to do proper tests on your hand.

Definitely go get that second opinion and even a third if you don't feel confident in what your surgeon is telling you.

As for cortisone shots i'd agree with the post above me. Cortisone shots can provide temporary relief (usually wears off around 3 month mark after shot) but it doesn't necessarily work for every individual (very hit or miss).

The problem with the cortisone shot is that if you keep getting the injections, over time it will cause degeneration of your joints and will leave you worse off than before.

You’ve given no insight as to the nature of your symptoms, precluding an ability to either confirm, or doubt the docs diagnosis and vacillating thoughts. If it is trigger finger treatment algorithm goes like this: first activity modification + splinting for 3-6 weeks. The splinting is really the key there. If no to minimal improvement, 1-2 corticosteroid injections (obviously well spaced). If no improvement.. then surgery.

You mean, I provided no symptoms on here lol....he's well aware, obv.

It's clear he's aware of my symptoms and even went on to say he cannot schedule surgery at the moment due to covid. That's when he offered a 3rd shot because while I am waiting, it "could" help. Though, the previous 2 failed.
I reported no change, so he believed nothing could be done...though, that's not how our previous discussion went.
So that's when I was fed up and asked for a referral for a 2nd opinion.

I saw the Dr. he recommended and I already have an MRI scheduled for Aug. 5th and a release can definitely be scheduled after.
I felt a HUGE different between the each doctor...I wondering, should the other doctor have ordered an MRI before giving me 3 cortisone shots?

This post was edited by ZxFamily-GuyxZ on Jul 31 2020 11:42am

MRI’s are very expensive so it depends on the persons train of thought and also insurance. Some insurances won’t do things until conservative treatment has been tried.

I’ll say it again though, I personally think three cortisone shots with no signs of improvement is criminal and negligent on the docs part. One is fine because it’s quick and easy and much cheaper than an MRI and could potentially fix the problem. A second MAY be okay just because cortisone is so 50/50 based on so many things like placement of the needle and stuff but I don’t think he should have done the second one, let alone the third.

Well, I did inform him I was open to any and all types of treatments. Insurance not an issue.
What I don't understand is the previous doctor didn't order an MRI when he told me that we would go ahead and try surgery now that 2 cortisone shots shows minimal to no improvement. Maybe because it was in May, so an MRI closer to a surgery date would have been better? I'm not an health expert so idk how much that matters. MRI maybe not needed?
But he did of course, suggest a 3rd shot since "It doesn't hurt since I am waiting and it "could" help". Exactly how he told me after the previous 2 showed no improvement.

I understand the doctor I am now seeing ordered the MRI right away since I have already tried other options, but right away he told me surgery is def possible.

This post was edited by ZxFamily-GuyxZ on Jul 31 2020 01:25pm

Unfortunately, a lot of surgeons are chasing after the cash and don't really give a shit about anything other than cutting you open. I've experienced it a lot with the patients that I've treated and I have also experienced it myself as a patient.

I once went to see a wrist/hand specialist because my forearms and wrists were on fire nonstop and I couldn't grip or lift anything without pain. My first visit they did a cortisone shot and said that if it didn't work that we'd be discussing surgery. I went back for my second visit and they were ready to schedule surgery. Between both visits they spent maybe 30 minutes with me if that and they didn't suggest PT or any other conservative measure at all. Unless you have a serious problem (fracture, vascular, etc) no doc should ever be talking about surgery on your first visit. Now, this was before I was in PT school myself so I reached out to a buddy and he rehabbed me within a couple of weeks. Obviously the situations between us are different but it sounds a lot like I went through personally with the docs.

Surgeons play off of your fear and you not really knowing what's going on with your body. They want to be your first option so they can get your money because if they refer you to PT/other conservative measures, they lose out.

I can't speak to your situation at all and I can say that not all surgeons are bad, but I will say that if something feels off and you feel rushed into surgery I would bring up conservative approaches to them and see how they respond. I would also recommend just going out on your own and finding a PT or OT who is a hand specialist (PT school we cover the hand but most PT's including myself aren't very experienced with the hand and a hand specialist needs to go through like 2,000 extra hours of studying for that cert) if you're not worried about insurances and stuff. I don't know your states laws and if you need referrals or not but a lot of states for PT have direct access where you don't need a referral. You could also find cash based therapy that might be more expensive but no insurances involved at all and usually you'll find the cash based PT to do a better job.

With all of that being said, if you feel fine and comfortable with the surgery and the vibes from the doc then by all means go ahead with it. I'm just a firm believer in exhausting all of your options before being cut open because you can't undo the damage that could possibly be done from surgery.

I appreciate all the information you've provided. Truly.

The previous doctor did recommend desensitization and an aggressive course of therapy post op. I am assuming this is standard?
I mentioned everything to the current doctor and even brought the summary discussion notes from the visits with the previous doctor.

The surgery will get rid of my pain, but the range of motion/flexibility etc may not fully return. He didn't rule it out though.
I understand this of course. I had bi maxillofacial surgery in 2012. Still feels weird

It's gradually worsening as well...I'm using a 3 finger grip basically and it's destroying my thumb. Using more wrist and no hand. Sort of Thumb to pinky and not fingers torwards wrist and thumb over fingers. If that makes any sense LMAO.

Surgery seems like my only option after speaking with a 2nd doctor. I could get a 3rd opinion but I really liked the doctor. I don't think it's needed and I am getting pretty desperate.

This post was edited by ZxFamily-GuyxZ on Jul 31 2020 03:00pm