25320 Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability

Name of the Procedure:

Capsulorrhaphy or Reconstruction, Wrist, Open (e.g., Capsulodesis, Ligament Repair, Tendon Transfer or Graft)

Summary

In this surgical procedure, a surgeon stabilizes the wrist joint for patients with carpal instability by repairing or reconstructing ligaments and tendons. This may involve tightening the joint capsule, using grafts, or transferring tendons to support the wrist properly.

Purpose

Carpal instability occurs when the ligaments that hold the wrist bones together become injured or weakened, leading to pain and decreased wrist function. The goals of this procedure are to reduce pain, restore stability, and improve wrist function.

Indications

• Chronic wrist pain and instability due to ligament injuries.
• Symptoms such as a clicking or popping sound in the wrist, swelling, and decreased range of motion.
• Failure of non-surgical treatments like physical therapy and splinting.
• Diagnostic imaging (e.g., X-ray, MRI) confirming ligament damage.

Preparation

• Patients may be advised to fast for several hours prior to the surgery.
• Medication adjustments, such as pausing blood thinners, may be necessary.
• Preoperative tests might include blood work, EKG, and imaging studies to assess the extent of ligament damage.

Procedure Description

1. Anesthesia: The patient will be placed under general anesthesia or regional anesthesia.
2. Incision: An incision is made over the wrist to access the joint.
3. Evaluation: The surgeon examines the wrist structures, identifying damaged ligaments and tendons.
4. Repair/Reconstruction: Capsulodesis or ligament repair is performed, possibly involving tendon transfers or grafts to reinforce stability.
5. Synovectomy and Capsulotomy: Any inflamed synovium is removed, and the joint capsule is adjusted as needed.
6. Closure: The incision is closed with sutures, and the wrist is bandaged.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or specialized surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Nerve or blood vessel damage
• Persistent pain or stiffness
• Difficulty in regaining full wrist function
• Adverse reactions to anesthesia

Benefits

• Reduction in wrist pain
• Improved wrist stability and function
• Enhanced ability to perform daily activities and physical tasks
• Reduced risk of long-term joint damage

Recovery

• Patients will likely wear a splint or cast for several weeks post-surgery.
• Physical therapy is typically required to regain strength and range of motion.
• Recovery time varies, but many patients return to normal activities within a few months.
• Follow-up appointments are essential to monitor progress and healing.

Alternatives

• Non-surgical treatments, such as physical therapy, wrist braces, and anti-inflammatory medications.
• Minimally invasive procedures, if indicated.
• Pros: Less invasive, quicker recovery.
• Cons: May not be as effective for severe instability.

Patient Experience

• During the procedure, patients will not feel pain due to anesthesia.
• Postoperatively, some pain and swelling are common, managed with pain medications and ice.
• Physical therapy can be challenging but is crucial for optimal recovery.
• Patients should expect gradual improvement in wrist function over several weeks to months.