Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)
CPT4 code
Name of the Procedure:
Repair, Tendon Sheath, Extensor, Forearm and/or Wrist, with Free Graft (e.g., for Extensor Carpi Ulnaris Subluxation)
Summary
This procedure involves repairing the tendon sheath in the extensor muscle group of the forearm and/or wrist by using a graft taken from another part of the body. It's commonly performed when there is subluxation or displacement of the extensor carpi ulnaris (ECU) tendon.
Purpose
This procedure addresses injuries and conditions affecting the sheath that encases the extensor tendons in the forearm and wrist. The main goal is to restore the normal function and stability of the tendon, reduce pain, and improve the range of motion.
Indications
- Subluxation or dislocation of the extensor carpi ulnaris tendon.
- Chronic pain and instability in the forearm and wrist.
- Tendon sheath rupture or severe tendinitis unresponsive to conservative treatments.
- Traumatic injuries that compromise tendon function.
Preparation
- Patients may need to fast for several hours before the procedure if general anesthesia is used.
- Adjustments in medication, particularly blood thinners, as advised by the healthcare provider.
- Preoperative diagnostic tests might include X-rays, MRI, or ultrasound imaging to assess the extent of the injury.
Procedure Description
- Anesthesia: The procedure is typically performed under regional or general anesthesia.
- Incision: A surgical incision is made over the affected area of the forearm or wrist.
- Repair: The damaged tendon sheath is assessed and repaired using a free graft, which is harvested from another area of the body, commonly the patient's lower leg.
- Graft Placement: The graft is secured around the extensor tendon to restore the sheath's integrity.
- Closure: The incision is closed with sutures, and a sterile dressing is applied.
Duration
The procedure usually takes about 1 to 2 hours, depending on the complexity and extent of the repair needed.
Setting
This surgery is typically performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic surgeon or hand surgeon
- Surgical nurses
- Anesthesiologist or nurse anesthetist
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Scarring
- Nerve damage
- Failure of the graft to take
- Stiffness and prolonged rehabilitation
Benefits
- Restored stability and function of the extensor tendon
- Reduced pain and discomfort
- Improved range of motion and strength in the forearm and wrist
- Enhanced quality of life and ability to perform daily activities
Recovery
- Post-procedure, the patient will need to wear a splint or cast to immobilize the area.
- Physical therapy is crucial for regaining strength and flexibility.
- Recovery time varies but typically ranges from several weeks to a few months.
- Follow-up appointments will be necessary to monitor healing and progress.
Alternatives
- Non-surgical treatments such as physical therapy, bracing, and anti-inflammatory medications.
- Less invasive procedures such as corticosteroid injections.
- Comparing these alternatives depends on the severity of the condition and patient-specific factors.
Patient Experience
- During the procedure, patients under general anesthesia will be asleep and pain-free.
- Post-operatively, discomfort can be managed with pain medication.
- There may be swelling and bruising, which should subside over time.
- Engaging in prescribed physical therapy is key to a smooth recovery, although it might be uncomfortable initially.