Incision, extensor tendon sheath, wrist (eg, de Quervains disease)
CPT4 code
Name of the Procedure:
Incision of the Extensor Tendon Sheath in the Wrist (e.g., for de Quervain's Disease)
Summary
This surgical procedure involves making an incision in the sheath (covering) of the tendons in the wrist that are responsible for extending the thumb. It is performed to relieve pressure and inflammation of these tendons, which can alleviate pain and improve function for those affected by de Quervain’s disease.
Purpose
This procedure addresses de Quervain's disease, a condition characterized by pain and swelling near the base of the thumb due to inflammation of the tendons in the wrist. The goal of the surgery is to release the constricted tendon sheath, reduce pain, and restore normal thumb and wrist movements.
Indications
- Chronic pain at the base of the thumb and wrist
- Swelling over the affected area
- Difficulty or pain when moving the thumb or wrist
- Symptoms not relieved by non-surgical treatments such as splinting, anti-inflammatory medications, or corticosteroid injections
Preparation
- Patients may be advised to fast for a certain period before the procedure.
- Medication adjustments, especially blood thinners, as per the surgeon's guidance.
- Pre-operative diagnostic tests such as X-rays or ultrasound to assess the condition of the tendons.
Procedure Description
- The patient is given local anesthesia to numb the area, and sometimes, mild sedation to help them relax.
- A small incision is made over the affected area of the wrist.
- The surgeon carefully cuts the sheath surrounding the inflamed tendons to release pressure.
- The incision is closed with sutures and bandaged.
Duration
The procedure typically takes about 30 to 45 minutes.
Setting
This surgery is usually performed in an outpatient clinic or surgical center.
Personnel
- Orthopedic Surgeon or Hand Surgeon
- Surgical Nurse
- Anesthesiologist or Nurse Anesthetist (if sedation is used)
Risks and Complications
- Infection
- Nerve damage leading to numbness or tingling
- Scarring
- Incomplete relief of symptoms
- Temporary stiffness or weakness in the wrist or thumb
Benefits
- Significant pain relief
- Improved thumb and wrist function
- Quick recovery time, with many patients returning to normal activities within a few weeks
Recovery
- Keep the wrist elevated and apply ice to reduce swelling.
- Take prescribed pain medications and antibiotics if needed.
- Follow-up appointments to remove sutures and monitor healing.
- Engage in prescribed physical therapy exercises to restore movement and strength.
- Avoid excessive wrist movements or heavy lifting until fully healed.
Alternatives
- Non-surgical treatments like splinting, anti-inflammatory medications, and corticosteroid injections.
- Physical therapy and ergonomic adjustments.
- Pros: Non-invasive and avoids surgical risks. Cons: May provide only temporary relief and not as effective as surgery for severe cases.
Patient Experience
During the procedure, patients might feel some pressure or pulling but should not feel pain due to local anesthesia. Post-surgery, mild discomfort or soreness can be managed with pain relievers. Most patients experience significant relief from symptoms within a few weeks as they recover.