28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

Name of the Procedure:

Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

Summary

A capsulotomy is a surgical procedure focused on the metatarsophalangeal (MTP) joint, typically of the foot. The surgery involves making an incision in the joint capsule to relieve tension and improve joint function. It can be accompanied by tenorrhaphy, which is the repair of associated tendons.

Purpose

The procedure addresses problems such as stiffness, deformity, or pain in the MTP joint. The primary goal is to enhance joint mobility and alleviate discomfort, enabling patients to walk more comfortably and prevent further joint damage.

Indications

• Pain and stiffness in the MTP joint unresponsive to conservative treatments
• Conditions such as capsulitis or bursitis
• Deformities such as hammertoe or claw toe
• Limited mobility impacting daily activities
• Failed previous interventions

Preparation

• Patients may need to fast for a few hours prior to the procedure.
• Medication adjustments might be necessary, particularly blood thinners.
• Pre-operative diagnostic tests like X-rays or MRIs may be required to assess the joint condition.

Procedure Description

1. The patient is administered local or general anesthesia depending on the case.
2. An incision is made over the MTP joint.
3. The joint capsule is carefully cut to release tight structures.
4. If necessary, tenorrhaphy is performed to repair and reposition tendons.
5. The joint capsule and skin are sutured closed.
6. A dressing is applied to protect the surgical site.

Tools used include scalpels, retractors, sutures, and occasionally surgical drills if bone work is involved.

Duration

Typically, the procedure lasts about 30 to 90 minutes per joint.

Setting

The procedure is usually performed in an outpatient surgical center or a hospital.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Prolonged swelling or stiffness
• Recurrence of the original problem
• Difficulty in wound healing

Benefits

• Reduced pain
• Improved joint mobility
• Correction of deformities
• Enhanced ability to perform daily activities
• Long-term joint function improvement may be noticed within weeks to months post-surgery

Recovery

• Patients will receive instructions on wound care and activity restrictions.
• Use of crutches or walking aids may be advised initially.
• Physical therapy may be recommended to restore joint function.
• Full recovery typically takes several weeks, with follow-up appointments to monitor progress.

Alternatives

• Conservative treatments like physical therapy, orthotics, anti-inflammatory medications, or corticosteroid injections.
• Other surgical options such as arthroplasty or osteotomy might be considered depending on the specific condition.

Patient Experience

• Patients may experience discomfort or mild pain during the initial recovery period, managed by prescribed pain medications.
• Swelling and restricted movement are common but temporary.
• Gradual improvement in symptoms will allow for incremental return to normal activities with adherence to post-operative care instructions.