25110 Excision, lesion of tendon sheath, forearm and/or wrist

Name of the Procedure:

Excision, lesion of tendon sheath, forearm and/or wrist (Commonly known as tendon sheath lesion removal)

Summary

This surgical procedure involves the removal of abnormal tissue or growths (lesions) within the tendon sheath of the forearm or wrist. It is done to alleviate pain, restore movement, and prevent further damage to the tendon.

Purpose

The procedure addresses tendon sheath lesions that can cause pain, swelling, and restricted movement. The goal is to relieve symptoms, restore normal tendon function, and prevent further complications.

Indications

• Persistent pain in the forearm or wrist that does not respond to non-surgical treatments.
• Swelling or a palpable lump in the forearm or wrist.
• Decreased range of motion or difficulty using the hand/wrist.
• Diagnosis of benign or malignant lesions within the tendon sheath.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Medication adjustments may be required, especially if the patient is on blood thinners.
• Preoperative diagnostic tests such as MRI or ultrasound may be conducted to visualize the lesion.

Procedure Description

1. The patient is positioned and the surgical area is sterilized.
2. Local or general anesthesia is administered to ensure comfort.
3. An incision is made over the affected area of the forearm or wrist.
4. The surgeon carefully identifies and isolates the tendon sheath lesion.
5. The lesion is excised (surgically removed) from the tendon sheath.
6. The incision is then closed with stitches, and a sterile bandage is applied.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity and size of the lesion.

Setting

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

Personnel

• Orthopedic surgeon or hand surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is required)

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Tendon or nerve damage
• Scar tissue formation
• Recurrence of the lesion
• Adverse reactions to anesthesia

Benefits

• Relief from pain and swelling
• Improved range of motion and function in the forearm/wrist
• Prevention of further damage to the tendons
• Typically, benefits are realized within a few weeks post-surgery.

Recovery

• Patients may need to wear a splint or brace to immobilize the wrist/forearm.
• Pain medication and ice packs can help manage discomfort.
• Physical therapy may be recommended to restore strength and flexibility.
• Full recovery can take several weeks, with gradual resumption of activities.
• Follow-up appointments are necessary to monitor healing.

Alternatives

• Non-surgical treatments such as corticosteroid injections, physical therapy, and anti-inflammatory medications.
• Minimally invasive procedures like needle aspiration if the lesion is fluid-filled.
• Pros and cons of alternatives depend on the lesion’s nature, with surgery offering definitive removal but involving recovery time.

Patient Experience

• During the procedure, patients with local anesthesia may feel pressure but should not feel pain.
• Post-procedure, there may be some pain and swelling, managed with prescribed medications.
• Patients are advised to keep the surgical area clean and dry, and to follow instructions regarding activity limitations to ensure proper healing.