The care of the hand in the post-operative period is very important in helping to ensure a good result. Initially the aims are comfort and elevation. These are met by keeping the hand up (elevated) especially in the first few days and by use of a long acting local anaesthetic (Bupivicaine). The local anaesthetic lasts at least 12 hours and sometimes 48 hours. Patients should start taking painkillers before the pain starts . on return home and for at least 24 hours from there. This way most of our patients report little or any pain.
The patient is reviewed in clinic within 2 weeks of the operation. Typically dissolvable stitches are used so they should not require to be removed. A splint may be provided. Careful follow up is required to ensure a successful result with good relief of pain and a good range of movement.
The hand can be used for gentle activity after the first few days out of the dressing/plaster. Most patients can drive after a 2-3 weeks. Most patients return to work in 5-6 weeks, but this varies with occupation; heavy manual work usually takes about 3 months if ever. The wound should be massaged by the patient 3 times a day with a bland soft cream for 3 months once the wound is well healed (typically after 2 weeks). This reduces the scar sensitivity which can be a nuisance. If this is marked a Physio may be organised to help reduce the scar tenderness but this is rarely required. Patients should avoid pressing heavy use of the hand for a good 3 months from surgery.
In common with other corticosteroids, triamcinolone is metabolised largely hepatically but also by the kidney and is excreted in urine. The main metabolic route is 6-beta-hydroxylation; no significant hydrolytic cleavage of the acetonide occurs. In view of the hepatic metabolism and renal excretion of triamcinolone acetonide, functional impairments of the liver or kidney may affect the pharmacokinetics of the drug. This may become clinically significant if large or frequent doses of intradermal or intra-articular triamcinolone acetonide are given.