A local nurse was experiencing pain in her left pinky finger that was only worsening with time. Initially, she had pain seldomly with minimal activities but then it progressed to the point where even jostling the hand hurt. She even gave up playing piano to try to alleviate her pain. Eventually she sought care from another surgeon and received a steroid injection, which did relieve her pain for about three months. Once the symptoms returned, the conventional answer to her pain was to perform a fusion which is what the surgeon recommended as a permanent solution. The obvious downside of such a procedure is to have permanent stiffness in the joint that was causing her pain with any activity. This is where our nurse decided to search online for any other possible solution.
“I’m in the medical profession and I know Proliance is a trusted group, so I was looking for hand specialists within that company,” she shared. “What I loved about Dr. Galle’s biography was that he was open to alternative treatments.”
Our nurse called into the Proliance Hand Wrist & Elbow Physicians office and was able to schedule an appointment easily. The clinic staff was welcoming and she mentioned how seamlessly they accommodated her being hard of hearing during her visits.
Her diagnosis was osteoarthritis of the distal interphalangeal joint as confirmed by her radiographs and conservative management had been thorough prior to seeing Dr. Galle. A fusion procedure is very standard in the hand surgery world and our nurse’s finger met criteria to perform such an operation. The challenge is the trade that every patient makes after such a procedure whereby the finger is painful before the operation and after the operation, stiff to the point of no motion at all. It is this loss of motion that is simply too much for some patients to bear, and this is where our nurse found herself. While not commonly performed, a denervation procedure is another option that has been popularized in the hand surgery world and is what Dr. Galle recommended.
A denervation procedure is an operation that focuses on reducing pain and preserving motion in osteoarthritic joints about the hand and wrist. This type of procedure has been performed for many years in the wrist; however the thumb and finger version of the procedure is relatively new to the surgical world, which is why it may not have been considered by the initial physician. The metaphor to best explain the procedure is a car with an engine problem whereby the check engine light is coming on. The engine in this metaphor is the joint which is slowly wearing out and the check engine light is the nerve to that joint sending the pain signal to your brain. These are not the sensation nerves to your skin or fingertips by the way which is important to know before reading on. Now your mechanic would probably not recommend doing this in your car, but your orthopedic surgeon may recommend cutting the check engine light, which is the nerve in this analogy. The benefit of doing this in a patient is to decrease pain and preserve the joint motion as best we can with the understanding that pain relief will likely be partial in nature. And somewhere down the road we may have to address the engine (joint) that is wearing out. Your mechanic is more likely to order whatever engine part that has failed to replace it before it causes early wear on the rest of the engine. If only we had a catalog to order replacement parts for the fingers, but there is no joint replacement available for the distal interphalangeal joint at the time of writing this article.
After undergoing the denervation procedure, the nurse reported her experience with Proliance Eastside Surgery Center in Kirkland, Washington was excellent.
“I can’t say enough how well the surgery center staff treated me. And the actual procedure itself was so easy! Dr. Galle gave me local anesthesia and it was no more uncomfortable than getting a flu shot. The surgery center staff even walked me out to my car when I was able to leave.”
At six weeks post-procedure, the nurse has nothing but positive results to share regarding Dr. Galle. In fact, she has already referred people to him!
“I wasn’t expecting to get back the finger I had when I was 20 years old,” she says, “and while I hoped I would be pain-free, I did expect that I might still have some discomfort. I’m thrilled to say that I’m back to playing piano and folding socks without any trouble. Last week, I visited my grandkids and we held hands without my experiencing any pain at all.”
Another excellent result thanks to an operation at the forefront of medicine on the right patient at the right time.
