Trigger Finger & Hand Conditions in Singapore
Specialist assessment and treatment by a plastic surgeon with subspecialty interest in hand surgery
Common hand conditions such as trigger finger, ganglion cysts, De Quervain's tenosynovitis, and carpal tunnel syndrome are frequently manageable without hospital admission or general anaesthesia. At Doctor Stitch, assessment and treatment are led by Dr Ng Zhi Yang, who is a dual accredited plastic surgeon in Singapore and UK, and has a subspecialty interest in hand surgery, a combination that is uncommon in private practice in Singapore. Most conditions can be treated in clinic with an injection or minor surgery under local anaesthesia, with you going home the same day.
Trigger Finger
Trigger finger, or stenosing tenosynovitis, occurs when the tendon sheath surrounding a finger flexor tendon becomes inflamed and thickened, causing the tendon to catch or lock as the finger bends. It presents as clicking, catching, or a finger that locks in a bent position and requires passive straightening (by the patient pulling it straight himself).
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Trigger finger is more common in individuals with diabetes, rheumatoid arthritis, or repetitive hand use, but can occur without any underlying condition.
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Treatment options include:
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Steroid injection: A corticosteroid injection into the tendon sheath reduces inflammation and resolves symptoms in the majority of cases. This is performed in clinic and takes a few minutes. More than one injection may be required, and usually up to 2 or 3 as a maximum otherwise there is a risk of tendon rupture.
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Surgical release: Where injection has not provided lasting relief, or where the triggering is severe, a minor surgical procedure to release the constricting tendon sheath (at the A1 pulley) is performed under local anaesthesia. The procedure takes approximately 20 minutes and does not require hospital admission. Scarring is barely visible once healed (see picture below)
Ganglion Cysts
A ganglion cyst is a benign, fluid-filled swelling that arises from a joint or tendon sheath, most commonly on the back of the wrist, the base of a finger, or the fingertip. Ganglions are one of the most common soft tissue swellings of the hand and wrist; other differentials include osteophytes (bony growth) or benign growths such as a giant cell tumour of the tendon sheath.
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Many ganglions are asymptomatic and can be observed without treatment. Those causing pain, weakness, or functional limitation, or those that are cosmetically bothersome, can be treated.
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Treatment options include:
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Aspiration: The ganglion is drained with a needle under local anaesthesia. This is a simple in-clinic procedure with a reasonable short-term success rate, though recurrence is possible.
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Surgical excision: Complete excision of the ganglion and its root, performed under local anaesthesia, carries a lower recurrence rate than aspiration. For wrist ganglions, this is performed through a small incision with careful attention to the underlying joint structures.
Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the carpal tunnel at the wrist. It typically presents as numbness, tingling, or pain in the thumb, index, middle, and part of the ring finger, often worse at night or with prolonged hand use. In more advanced cases, weakness of grip and thenar muscle wasting may be present. Other differentials include lacertus syndrome and other areas of compression along the path of the median nerve.
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Nerve conduction studies are arranged where the diagnosis is uncertain or where surgical planning is required.
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Treatment options include:
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Steroid injection: A corticosteroid injection into the carpal tunnel can provide temporary symptomatic relief and is useful for mild to moderate cases or as a bridge to surgery.
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Carpal tunnel release: Surgical decompression of the median nerve is performed under local anaesthesia without tourniquet (WALANT technique), avoiding the need for general anaesthesia or hospital admission. The procedure takes approximately 20 to 30 minutes. Most patients notice improvement in night symptoms promptly, with return of sensation over weeks to months depending on the duration of compression. Scarring is also barely visible once healed (see picture below).
De Quervain's Tenosynovitis
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It causes pain and swelling just above the wrist, aggravated by thumb and wrist movements - particularly gripping, pinching, and lifting. It is common in new parents and those with repetitive thumb use. Other differentials include intersection syndrome and 1st metacarpal base osteoarthritis.
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The Finkelstein test, tucking the thumb into the palm and bending the wrist toward the little finger, typically reproduces the pain and is used to confirm the diagnosis in clinic.
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Treatment options include:
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Steroid injection: A corticosteroid injection into the first dorsal compartment is the first-line treatment in most cases and resolves symptoms in the majority of patients.
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Surgical release: Where injection has not provided sustained relief, surgical release of the first dorsal compartment is performed under local anaesthesia as a minor day procedure.
Mucous Cysts
Mucous cysts are small, fluid-filled cysts that arise from the distal interphalangeal (last) joint of a finger, typically in association with underlying osteoarthritis. They appear as a smooth swelling near the base of the fingernail and can occasionally cause grooving of the nail or, if they rupture, an entry point for infection into the joint.
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Symptomatic or enlarging mucous cysts are best managed by surgical excision, which includes addressing the underlying osteophyte where present to reduce the risk of recurrence.
Why See a Plastic Surgeon for Hand Conditions?
Hand surgery requires an understanding of the intricate anatomy of tendons, nerves, and joints within a confined space. Dr Ng holds dual accreditation in plastic surgery (UK & Singapore) and hand surgery (FEBHS), and has completed dedicated hand and wrist surgery fellowships in Hong Kong and Switzerland. This level of specialist training is not required to perform these procedures but it informs the quality of assessment, the decision about when to operate and when not to, and the precision of the surgical technique when it is required.
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For more complex hand conditions such as Dupuytren's contracture, complex trauma with fractures, tendon and nerve injuries requiring hospital-based surgery, continuity of care is available through ZNG Plastic Surgery.
Pricing
Pricing varies depending on the condition and its complexity in accordance with Singapore MOH Table of Surgical Procedure (TOSP) fees. Consultation and follow-up, as well as medications and further tests (such as X-ray and/or CT, MRI), if necessary, are charged separately. A clear cost estimate is provided before any treatment is initiated. Medisave and insurance are almost always claimable for hand surgery management.
Frequently Asked Questions
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1. Do I need a referral?
No referral is required. Contact us directly via WhatsApp to arrange an assessment. Sending a brief description of your symptoms in advance allows Dr Ng to advise on the likely management pathway before your appointment.
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2. Can my condition be treated on the same day?
In many cases, yes. Steroid injections are routinely performed at the initial assessment appointment. Minor surgical procedures may require a separate booking depending on scheduling. You will be advised clearly at the time of assessment.
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3. Will I need general anaesthesia?
No. All hand surgery procedures at Doctor Stitch are performed under WALANT (wide awake local anaesthesia no tourniquet), which is well-established as safe and effective and avoids the risks and recovery associated with general and regional anaesthesia.
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4. How long is recovery after hand surgery?
Most patients return to light activities within a few days. Full recovery, including resolution of any residual stiffness, typically takes two to four weeks. You will be given clear guidance on hand therapy exercises after the procedure.
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5. Is this covered by insurance?
Hand surgery procedures performed for functional indications are generally claimable under medical insurance. We recommend checking your policy and can provide documentation to support your claim.
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6. What if my condition needs more extensive surgery?
If your assessment reveals a condition requiring hospital-based surgery - for example, tendon repair or more complex reconstruction - this can be arranged through ZNG Plastic Surgery, Dr Ng's main hand and reconstructive surgery practice, ensuring continuity of care with the same surgeon.
To arrange an assessment, contact us via WhatsApp.
Same-day appointments are available subject to scheduling.
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