🇸🇬 MOH Registered Plastic Surgeon | Dual-Accredited (UK & Singapore)
Trigger Finger Treatment & Hand Surgery Singapore
Outpatient Hand Procedures Under Wide Awake Local Anesthesia with No Tourniquet (WALANT). No Hospital Admissions, Fasting Requirements, and Excess Facility Fees.
Doctor Stitch provides specialised, plastic surgeon-led management for trigger finger, carpal tunnel syndrome, and ganglion cysts in Singapore. Utilising the advanced WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique, Dr Ng performs micro-incision surgical releases and therapeutic steroid injections entirely within a streamlined clinic setting. This specialist approach eliminates the need for expensive hospital operating theater admissions, minimises surgical downtime, and allows active professionals and expatriates to safely resume light daily activities immediately.
1. 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 manually). Traditionally, surgery utilises an arm tourniquet, which can cause much pain and discomfort during the procedure, which is also limited to 15 minutes or so when the patient is awake.
Trigger finger is more common in individuals with diabetes, rheumatoid arthritis, or repetitive hand use, but can occur without any underlying condition.
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 under ultrasound guidance and takes but 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 under WALANT: 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 WALANT. This is done entirely without a tourniquet to eliminate arm discomfort, does not require pre-operative fasting, and allows patients to actively flex and extend the finger during the procedure to verify the release instantly. The procedure takes approximately 15-20 minutes and does not require hospital admission. Scarring is barely visible once healed (see picture below)
2. 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.
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.
Treatment options include:
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Aspiration: The ganglion is drained with a needle under local anaesthesia with ultrasound guidance. 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.
3. 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.
Nerve conduction studies are arranged where the diagnosis is uncertain or where surgical planning is required.
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. This is done under ultrasound guidance to avoid unnecessary injury to the median nerve itself.
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Surgical release: Surgical decompression of the median nerve is performed under WALANT, avoiding the need for general anaesthesia or hospital admission. The procedure takes approximately 20 to 30 minutes to release the transverse carpal ligament. Patients retain full use of their fingers immediately after the procedure, which also helps with recovery. 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).
4. 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.
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.
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. This is done under ultrasound guidance to avoid administering steroid to the wrong compartment.
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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.
5. 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.
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. Dr Ng is also a strong proponent of point-of-care ultrasound (POCUS) which means that the majority of cases can be assessed in clinic by him, without the need for further imaging such as MRI scans, which adds further delay to definitive treatment.
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
Performing these minor hand surgery operations within a specialised clinic procedure room rather than booking a major hospital operating theatre removes hospital related costs. This results in a direct financial saving of approximately 20% to 30% on your total medical bill. There is no difference in clinical outcomes.
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 nerve conduction studies, 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.
Indicative surgeon fees (before GST, excluding consultation and follow-up):
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Ultrasound assessment: $100
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Steroid injection (trigger finger, De Quervain's, carpal tunnel): $200
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Surgery
Please note that the above are indicative figures based on MOH fee benchmarks and do not constitute a financial quote. Actual fees depend on clinical complexity and will be discussed transparently before any procedure. Medisave can be applied towards surgeon fees; Flexi-Medisave and CHAS (if applicable) can be applied towards outpatient costs of consultations, follow-up and stitch removal. Private insurance coverage will be dependent on your individual plan.
Frequently Asked Questions
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.
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.
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.
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.
5. Is this covered by insurance?
Trigger finger release, carpal tunnel decompression, and ganglion cyst excisions are medically necessary specialist procedures. We provide structured medical reports, itemised fee breakdowns, and standard insurance memo documentation to support your corporate or international health insurance claims (e.g., Cigna, Bupa, Allianz, AIA Executive). Procedures may also be eligible for partial Medisave claims under standard MOH guidelines.
6. How is carpal tunnel syndrome treated at Doctor Stitch?
For carpal tunnel syndrome, Dr Ng performs a specialised, micro-incision open carpal tunnel release under local anaesthesia using the WALANT technique. By utilising high-magnification surgical loupes, the transverse carpal ligament is precisely divided through a minimal incision to decompress the median nerve with further neurolysis as necessary. This anatomy-led approach provides structural relief, avoids the need for general or regional anaesthesia, sedation and hospital stays, and allows for rapid functional and sensory recovery in the hand.
7. Can a ganglion cyst of the hand or wrist be permanently removed?
While temporary needle aspiration is an option, permanent resolution of a hand or wrist ganglion cyst requires complete surgical excision of the cyst mass along with its underlying stalk or tissue base. At Doctor Stitch, this minor procedure is performed under local anaesthesia with microsurgical precision with the WALANT technique. Dr Ng carefully dissects the cyst capsule away from surrounding tendons and joint linings to minimise the risk of recurrence, utilising multi-layered plastic surgery suturing to ensure a clean, minimal scar line.
8. 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.
Back to Minor Surgery overview
Where complex reconstructive surgery is required, care may continue under Dr Ng Zhi Yang via ZNG Plastic Surgery
