Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon
CPT4 code
Name of the Procedure:
Lengthening or Shortening of Flexor or Extensor Tendon, Forearm and/or Wrist, Single, Each Tendon
Common Names: Tendon Lengthening, Tendon Shortening
Technical Terms: Tendonoplasty, Tendon Release
Summary
This surgical procedure involves altering the length of a tendon in the forearm or wrist to improve function and alleviate pain. Tendons connect muscles to bones, and adjusting their length can help in cases of injury or conditions that restrict movement.
Purpose
Conditions Addressed:
- Tendon injuries
- Overuse injuries
- Conditions like Dupuytren's contracture or rheumatoid arthritis
Goals:
- Restore proper tendon function
- Improve range of motion
- Reduce pain
Indications
Symptoms:
- Restricted movement in the wrist or forearm
- Pain during tendon movement
- Visible abnormalities in tendon function
Criteria:
- Non-responsive to conservative treatments like physical therapy or medications
- Diagnosis of conditions such as tendinopathy or tendon contractures
Preparation
Instructions:
- Fasting may be required if general anesthesia is used
- Adjustments in medications, especially blood thinners
- Arrangements for postoperative transportation
Diagnostic Tests:
- MRI or Ultrasound to assess tendon condition
- Preoperative physical examination
Procedure Description
- Anesthesia: Local or general anesthesia is administered.
- Incision: A small incision is made over the affected tendon.
- Exposure: The tendon is carefully exposed.
- Adjustment: The tendon is either lengthened by making small cuts and suturing it in a stretched position, or shortened by removing part of the tendon and rejoining the ends.
- Closure: The incision is closed with sutures.
Tools and Equipment: Scalpels, surgical scissors, sutures, possibly magnification devices.
Duration
Typically, the procedure takes about 30 to 90 minutes, depending on the complexity and number of tendons involved.
Setting
Usually performed in a hospital or outpatient surgical center equipped for orthopedic surgery.
Personnel
- Orthopedic or hand surgeon
- Surgical nurses
- Anesthesiologist or nurse anesthetist
Risks and Complications
Common Risks:
- Infection
- Scarring
- Temporary pain and swelling
Rare Complications:
- Nerve damage
- Blood clots
- Chronic pain or stiffness
Benefits
Expected Benefits:
- Improved tendon function and mobility
- Pain relief
- Enhanced quality of life
Timeline: Benefits may be realized within a few weeks to months as the tendon heals and physical therapy progresses.
Recovery
Post-procedure Care:
- Keep the incision site clean and dry
- Follow prescribed physical therapy exercises
- Pain management with medications as advised
Recovery Time:
- Typically spans 6 to 12 weeks
- May include temporary bracing or splinting
Restrictions and Follow-up:
- Avoid heavy lifting or strenuous activities initially
- Scheduled follow-up appointments for monitoring
Alternatives
Other Options:
- Physical therapy
- Medications like anti-inflammatories
- Corticosteroid injections
Pros and Cons:
- Non-surgical methods have lower immediate risks but may not be as effective long-term
- Surgery offers a more permanent solution but carries surgical risks
Patient Experience
During the Procedure:
- Minimal discomfort if local anesthesia is used
- Sedation or full unconsciousness with general anesthesia
After the Procedure:
- Pain and swelling managed with medications
- Typically some degree of discomfort, which lessens with time and rehabilitation
Pain Management:
- Over-the-counter pain relief or prescribed medications
- Cold compresses and elevation to reduce swelling