Understanding Hand Surgery for Carpal Tunnel, Trigger Finger, De Quervain’s Tendonitis, and Lacertus Syndrome: A Patient Guide

By Dr. James Clarkson, MD, Plastic and Hand Surgeon at Heritage Hand and Plastic Surgery

If you’re struggling with hand pain, numbness, tingling, or fingers that lock up, you might be dealing with conditions like Carpal Tunnel Syndrome, Trigger Finger, De Quervain’s Tendonitis, or the more recently recognized Lacertus Syndrome. These issues seem more common today than decades ago, though the exact reasons for this increase aren’t fully understood. Factors like rising diabetes rates, repetitive activities (e.g., typing or smartphone use), and longer lifespans may contribute, but the full picture remains unclear. As a hand surgeon and direct descendant of Sir William Arbuthnot Lane—whose pioneering surgical works are displayed in my waiting room at Heritage Hand and Plastic Surgery, established in 2025 following 14 years of research at Michigan State University—I’m here to explain these conditions, their treatments, and how modern technology is making surgery simpler and safer for patients like you.

What Are These Conditions?

These conditions often involve swelling or pressure in the synovium, the tissue around your hand’s tendons, or related structures:

Carpal Tunnel Syndrome: Pressure on the median nerve in your wrist causes pain, numbness, or tingling, often worse at night.

Trigger Finger: A finger “locks” or catches when bent, due to swollen tendon linings.

De Quervain’s Tendonitis: Pain at the thumb’s base, often called “mommy thumb,” from tendon inflammation, common in new parents or repetitive tasks.

Lacertus Syndrome: A newer diagnosis since my grandfather Patrick Clarkson’s time (he wrote a hand surgery textbook in 1962). This condition involves compression of the median nerve at the elbow by the lacertus fibrosus, a fibrous band. It’s often a component of Carpal Tunnel Syndrome and is linked to numbness and tingling after muscular activity, like lifting or gripping.

These conditions can disrupt sleep, work, and daily tasks.

How Are They Treated?

A steroid injection can often reduce swelling and relieve pain for Carpal Tunnel, Trigger Finger, and De Quervain’s Tendonitis. For Carpal Tunnel or Lacertus Syndrome, I may recommend a nerve conduction study to assess nerve damage and guide treatment. While injections help about half of Trigger Finger and De Quervain’s cases, some patients need a minor surgical procedure to release the tight tendon or nerve.

Lacertus Syndrome, like Carpal Tunnel, can be treated with a simple lacertus fibrosis decompression, which releases the fibrous band compressing the nerve at the elbow. At Heritage Hand and Plastic Surgery, we perform these surgeries—Carpal Tunnel release, Trigger Finger release, De Quervain’s release, and lacertus fibrosis decompression—in the office using local anesthesia, similar to a dental visit. This means:

No fasting or long hospital visits.

Diabetics can stick to their usual diet and medication.

A faster, more convenient experience.

A Legacy of Surgical Innovation

My great-grandfather, Sir William Arbuthnot Lane, transformed surgery in the early 20th century with sterile techniques and drapes, alongside pioneers like William Halstead. His works, displayed in my waiting room at Heritage Hand and Plastic Surgery, laid the foundation for modern surgery. However, Lane likely never imagined that minor procedures like Carpal Tunnel or lacertus fibrosis decompression would rely on general anesthesia, which became standard but isn’t always ideal. General anesthesia can cause confusion or cognitive decline, especially in older patients, with up to 40% not fully recovering. As patients today are older and often frailer, we prioritize safer options.

How Technology Is Transforming Surgery

To make hand surgery more comfortable without sedation, we use Virtual Reality (VR) during procedures. VR headsets distract you, reduce anxiety, and can make surgery enjoyable. In a study I conducted during my time at Michigan State University, 80% of patients using VR had fun during surgery, compared to none without it. VR also helps needle-phobic patients by easing the discomfort of local anesthesia injections.

This technology wasn’t available to Lane or my grandfather Patrick Clarkson, who noted Carpal Tunnel, Trigger Finger, and De Quervain’s Tendonitis in just one page of his 1962 textbook—Lacertus Syndrome wasn’t even identified then! I believe Lane would have embraced tools like VR to improve patient care, just as we do at Heritage Hand and Plastic Surgery.

What to Expect

If you’re considering treatment:

Diagnosis: A simple exam can pinpoint the issue. Steroid injections may confirm the diagnosis and provide relief for Carpal Tunnel, Trigger Finger, or De Quervain’s. Lacertus Syndrome may be suspected if numbness worsens after activity.

Testing: A nerve conduction study helps assess nerve damage for Carpal Tunnel or Lacertus Syndrome.

Treatment: Injections may suffice, but if surgery is needed (for Carpal Tunnel, Trigger Finger, De Quervain’s, or Lacertus Syndrome), it’s quick, done in the office, and uses local anesthesia.

Comfort: VR keeps you relaxed and may make the experience fun.

Final Thoughts

Hand pain, numbness, or locking fingers don’t have to control your life. Whether it’s Carpal Tunnel Syndrome, Trigger Finger, De Quervain’s Tendonitis, or the newly recognized Lacertus Syndrome, effective treatments are available. While we don’t fully know why these conditions are becoming more common, we can treat them effectively. Inspired by my great-grandfather Sir William Arbuthnot Lane’s legacy, showcased in my waiting room at Heritage Hand and Plastic Surgery, established in 2025 following 14 years of research at Michigan State University, I combine time-tested techniques with innovations like VR to provide safe, comfortable care. My grandfather Patrick Clarkson’s era didn’t know about Lacertus Syndrome, but today, we can treat it as easily as Carpal Tunnel with a simple office procedure.

For more information or to schedule a consultation, contact our team at Heritage Hand and Plastic Surgery. We’re here to help you live pain-free!