25115 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors

Name of the Procedure:

Radical Excision of Bursa, Synovia of Wrist, or Forearm Tendon Sheaths (e.g., tenosynovitis, fungal infection, tuberculosis, other granulomas, rheumatoid arthritis); Flexors

Summary

This procedure involves the surgical removal of the inflamed or infected bursa, synovial tissue, or tendon sheaths in the wrist or forearm's flexor tendons. It is typically performed to address persistent pain, swelling, or dysfunction that has not responded to other treatments.

Purpose

The procedure aims to relieve pain, reduce inflammation, and restore function in patients suffering from chronic synovitis, tenosynovitis (inflammation of the tendon sheath), infections like tuberculosis or fungal infections, or conditions such as rheumatoid arthritis that affect the wrist or forearm tendons.

Indications

• Chronic pain and swelling in the wrist or forearm
• Restricted movement or dysfunction of the flexor tendons
• Infections (e.g., fungal, tuberculosis)
• Inflammatory conditions like rheumatoid arthritis
• Presence of granulomas or other abnormal tissue growth

Preparation

• Fasting may be required for a certain period before the surgery.
• Adjustments to current medications, especially blood thinners.
• Preoperative blood tests, imaging studies like X-rays or MRIs, and a thorough medical evaluation.

Procedure Description

1. The patient is positioned and anesthetized, typically using general or regional anesthesia.
2. An incision is made over the affected area.
3. The surgeon carefully removes the inflamed or infected bursa, synovial tissue, or tendon sheaths.
4. The area is thoroughly cleaned and irrigated to remove any remaining debris or infection.
5. The incision is closed with sutures, and a sterile dressing is applied.
6. The patient is monitored during recovery from anesthesia.

Duration

The procedure typically takes between 1 to 2 hours, depending on the extent of tissue removal required.

Setting

The procedure is usually performed in a hospital's operating room or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or technologists
• Possibly an infectious disease specialist if an infection is present

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Stiffness or reduced range of motion
• Recurrence of the condition
• Adverse reactions to anesthesia

Benefits

• Relief from chronic pain and swelling
• Improved movement and function of the wrist or forearm
• Elimination of infection or inflammatory tissue

Recovery

• Follow post-operative care instructions, including wound care and medication regimen.
• Physical therapy may be recommended to restore strength and flexibility.
• Recovery time can range from a few weeks to several months, with activity restrictions as advised by the surgeon.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Non-surgical treatments like medication, physical therapy, or corticosteroid injections.
• Less invasive surgical options if suitable.
• The pros and cons of alternatives should be discussed with the healthcare provider.

Patient Experience

• Initial discomfort and pain managed with prescribed pain medications.
• Temporary limitations in hand and wrist movement.
• Periodic follow-up visits for progress assessment.
• With proper care, most patients experience significant pain relief and improved function within a few months.