24149 Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)

Name of the Procedure:

Radical Resection of Capsule, Soft Tissue, and Heterotopic Bone, Elbow, with Contracture Release (Separate Procedure)

Summary

This surgical procedure involves removing abnormal bone growths and scar tissues around the elbow joint. It aims to release contractures (tight areas) to restore movement and function to the elbow.

Purpose

This procedure addresses conditions such as joint stiffness, restricted movement, and pain caused by heterotopic ossification (abnormal bone formation) and capsule contracture in the elbow. The goal is to improve the range of motion and reduce discomfort.

Indications

• Severe elbow stiffness and limited range of motion due to heterotopic ossification.
• Pain and dysfunction in the elbow resulting from tissue contracture.
• Failed conservative treatments, such as physical therapy and medications.
• Presence of functional impairment affecting daily activities.

Preparation

• Patients may be required to fast for a certain period before surgery.
• Adjustments to current medications, especially blood thinners, may be advised.
• Pre-operative imaging studies, such as X-rays or CT scans, to assess the extent of heterotopic bone.
• Pre-surgical evaluation, including blood tests and a physical exam.

Procedure Description

1. Administration of general anesthesia or regional block anesthesia to ensure the patient is pain-free.
2. An incision is made on the elbow to access the joint and surrounding tissue.
3. Removal of heterotopic bone and scar tissue to free up the joint.
4. Release tight joint capsule and other soft tissues to improve flexibility.
5. Closure of the incision with sutures or staples.
6. Application of a sterile dressing to protect the surgical site.

Duration

Typically, the procedure takes about 2 to 3 hours, depending on the extent of heterotopic bone and tissue involvement.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon or a specialized elbow surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and possibly a surgical technician.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve damage leading to numbness or weakness.
• Recurrence of heterotopic bone formation.
• Blood clots (deep vein thrombosis).

Benefits

• Improved range of motion and function in the elbow.
• Reduction in pain and swelling.
• Enhanced quality of life and ability to perform daily activities.
• Benefits typically realized within weeks to months with appropriate rehabilitation.

Recovery

• Postoperative pain management with medications.
• Physical therapy to restore strength and mobility.
• Avoidance of heavy lifting or strenuous activities for several weeks.
• Follow-up appointments for monitoring recovery and removing sutures or staples.
• Full recovery may take a few months, depending on the extent of surgery and adherence to rehabilitation.

Alternatives

• Non-surgical management including physical therapy, medications, and splinting.
• Less invasive procedures like arthroscopic release.
• Each alternative has its own set of benefits and limitations in restoring elbow function and pain relief.

Patient Experience

• Discomfort and soreness at the surgical site can be expected but managed with pain relievers.
• Swelling and bruising around the elbow which subsides over time.
• Gradual improvement in mobility with physical therapy, with initial restrictions on activity as healing occurs.