Name of the Procedure:

Capsulotomy, wrist (e.g., contracture)

Summary

A capsulotomy of the wrist is a surgical procedure that involves cutting the capsule of the wrist joint to release stiffness or tightness, often due to contracture. By creating more space in the joint, the procedure aims to improve mobility and reduce pain.

Purpose

The procedure addresses stiffness, pain, or limited movement in the wrist joint, often caused by contractures resulting from injury, surgery, or conditions like arthritis. The goal is to enhance joint mobility, alleviate discomfort, and improve the overall function of the wrist.

Indications

• Persistent pain and stiffness in the wrist
• Limited range of motion unresponsive to conservative treatments
• Contractures due to trauma, surgery, or inflammatory conditions
• Impairment in daily activities due to restricted wrist movement

Preparation

• Fasting may be required if general anesthesia is used.
• Adjustment or temporary cessation of certain medications, like blood thinners.
• Pre-operative imaging (e.g., X-rays, MRI) to assess joint condition.
• Discussion about allergies, medical history, and anesthesia risks with the healthcare team.

Procedure Description

1. The patient is positioned, and the wrist is sterilized.
2. Anesthesia is administered (local, regional, or general depending on the case).
3. An incision is made over the wrist joint.
4. The surgeon carefully cuts into the joint capsule to release tight or fibrous tissue.
5. Additional procedures (e.g., debridement, synovectomy) may be performed as needed.
6. The incision is closed with sutures and bandaged.

Tools: Surgical scalpel, retractors, special scissors or surgical instruments for joint capsule cutting.

Duration

The procedure typically takes about 1-2 hours.

Setting

The capsulotomy is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Orthopedic surgeon or hand surgeon
• Nurses assisting during the procedure
• Anesthesiologist or anesthesia provider (if general or regional anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Scarring
• Damage to surrounding tissues or nerves
• Adverse reactions to anesthesia
• Recurrence of contracture

Benefits

• Improved range of motion
• Reduced pain and stiffness
• Enhanced ability to perform daily activities
• Long-term improvement in wrist function

Recovery

• Initial rest and immobilization of the wrist.
• Gradual introduction of physical therapy exercises.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing and progress.
• Full recovery may take several weeks to a few months.

Alternatives

• Physical therapy and occupational therapy
• Non-surgical treatments such as splinting or bracing
• Medications like anti-inflammatory drugs or corticosteroid injections
• Less invasive procedures like wrist arthroscopy

Patient Experience

During the procedure, the patient might experience minimal discomfort due to anesthesia. Post-operatively, mild to moderate pain can be expected, manageable with prescribed pain relief. Swelling and bruising around the wrist are common, gradually decreasing over time. Regular use of ice packs, elevation, and gentle exercises can support the healing process.