The trouble with trigger finger

Local surgeon develops alternate solution for a tricky procedure

There’s no getting around this fact: you need your hands.  When one or more of your fingers or thumbs doesn’t function properly, it interferes with work and play.  Correcting a condition such as trigger finger once meant a trip to a hospital or surgery center for an operation. That is, until recently.

Lakeland orthopaedic surgeon Dr. Brian Jurbala, a Polk County Medical Association member at Highland Center for Orthopaedics, invented the Trigger Tome— a surgical device that takes this corrective surgery out of the operating room.  Instead, trigger finger repair can be performed the same day a patient is diagnosed.  In addition to convenience, the procedure also brings savings of 65-70 percent.

To truly understand the innovation of an in-office trigger finger repair, it’s important to understand the surgical alternative.  Prior to Dr. Jurbala inventing the Trigger Tome, he performed these surgeries at a surgery center.  That resulted in patients having separate fees for the facility, the doctor, and the anesthesiologist.  “There are all kinds of collateral costs people don’t think about when they get these procedures,” Dr. Jurbala says.

And then there’s the surgery itself.  It involves a painful incision, loss of feeling, and stitches that must be removed.  Recovery also took longer.  “Patients wouldn’t want to have surgery,” he says.  “I wanted to develop something that had the convenience of being done in the office, while being safe and having no potential to damage the nerves and tendons in the hand.”

Trigger finger repair with the Trigger Tome works like this: a patient with trigger finger schedules an appointment with Dr. Jurbala.  He confirms the diagnosis and then the patient is walked down the hallway to another room, where they are seated in a comfortable chair (think living room recliner) and their hand is numbed with a local anesthetic using a special vibrating device that lessens most of the pain from the injection. Once the hand is numb, the patient feels virtually no pain.  Dr. Jurbala then makes a small puncture incision, inserts the Trigger Tome, and, using high resolution ultrasound to visualize the instrument and position it, releases the tight tissue and cures the triggering.

“The entire procedure takes five or ten minutes, and I can do as many fingers as necessary in the same sitting,” Dr. Jurbala adds.  “There’s no stitch, and you can use the hand right away.  You can even drive yourself to and from the office visit.”

Patients with private insurance often only have to pay a copay for the office visit, plus a small additional fee for the instrument he uses.  This procedure has resulted in Dr. Jurbala— who is board certified in orthopaedic surgery and holds certificates of added qualifications in hand surgery and sports medicine from the American Board of Orthopaedic Surgery— being a preferred provider for many insurance companies because he is able to perform the procedure so cost-effectively.

All of this came about in response to patient demand.  “I responded to what my patients wanted and produced something that would help them,” Dr. Jurbala shares.

The savings are so significant, his office has become a sort of medical tourism destination, as people from all over the United States have learned about the procedure and opted to travel to Lakeland to have it performed.  It is cheaper for people to travel here for the Trigger Tome procedure than to have the surgical procedure performed in their hometown.  “We’re saving people money,” Dr. Jurbala states.  “That’s what it should be all about— providing solutions that improve care and save money for the patient.”

Retired orthopaedic surgeon Dr. Frank Bertram, age 71, underwent the office procedure on both of his ring fingers in July 2013.  “It was really interesting because during the surgery I could look on the ultrasound screen and see the procedure,” Dr. Bertram explains.  “The recovery was just about what he said it would be.  My finger stayed a little swollen and stiff for a month or two, but in a week or less after the surgery, I started to play golf again.  I could do virtually anything after a couple of days.”  Dr. Jurbala has recently been granted two United States patents for the Trigger Tome device and method of ultrasound guided trigger finger release.



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