Name of the Procedure:

Incision and Drainage, Forearm and/or Wrist; Bursa

Summary

Incision and drainage (I&D) of the forearm and/or wrist bursa involves making a surgical cut into the bursa—a small fluid-filled sac that reduces friction between tissues in the forearm or wrist—to drain pus or other fluid buildup. This procedure is typically done to treat an infected or inflamed bursa.

Purpose

The procedure aims to:

• Alleviate pain and discomfort caused by bursa inflammation or infection (bursitis).
• Remove pus, reducing the risk of further infection.
• Promote healing and restore normal function to the affected area.

Indications

• Symptoms like swelling, redness, pain, and reduced movement in the forearm or wrist.
• Diagnosis of bursitis, often due to infection or repetitive injury.
• Failure to respond to conservative treatments such as antibiotics, rest, or anti-inflammatory medications.

Preparation

• Patients may be asked to fast for 6-8 hours before the procedure if general anesthesia is planned.
• Medical history review and physical examination.
• Blood tests or imaging studies (e.g., X-rays, ultrasound) to identify the extent of the infection.
• Discussion of current medications, with adjustments as needed (e.g., stopping blood thinners).

Procedure Description

1. Anesthesia: Local anesthesia to numb the area, or general anesthesia if the infection is extensive.
2. Incision: A small cut is made over the swollen bursa.
3. Drainage: Pus or infected fluid is drained out. The area may be thoroughly cleaned to ensure all infected material is removed.
4. Irrigation: The bursa cavity is rinsed with a saline solution.
5. Closure: In some cases, the incision may be left open to drain naturally, or loosely packed to prevent recurrence of infection.
6. Dressings: The wound is covered with sterile dressings.

Duration

The procedure usually takes about 30 to 60 minutes, depending on the extent of infection and complexity.

Setting

The procedure is generally performed in an outpatient clinic or a hospital's minor surgery room.

Personnel

• Surgeons or physicians specialized in hand surgery or orthopedics.
• Nurses or surgical assistants.
• Anesthesiologist or anesthesia nurse, if sedation is required.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Injury to surrounding tissues or structures.
• Recurrence of bursitis or chronic bursa damage.
• Scarring or delayed wound healing.

Benefits

• Relief from pain and the resolution of infection.
• Reduced swelling and restored movement of the forearm or wrist.
• Prevention of further complications associated with infected bursae.

Recovery

• Keeping the wound clean and dry.
• Following prescribed antibiotics to prevent further infection.
• Possible restrictions on arm movement for a few days.
• Follow-up appointments to monitor healing.
• Stitches, if used, may be removed in about 7-14 days.
• Full recovery can take several weeks, depending on the severity of the initial infection and individual healing rates.

Alternatives

• Oral or intravenous antibiotics without drainage (less effective if an abscess is present).
• Aspiration of the bursa using a needle (less invasive but may not adequately drain infected fluid).
• Corticosteroid injections to reduce inflammation (typically for non-infectious bursitis).

Patient Experience

• Mild discomfort or pressure during the procedure under local anesthesia.
• Pain management with oral painkillers post-procedure.
• Some swelling and bruising may occur, but should decrease over several days.
• Instructions for home care, including wound care and activity modifications, will be provided for a smoother recovery.