Name of the Procedure:

Radical Excision of Bursa and Synovia of Wrist or Forearm Tendon Sheaths (e.g., Tenosynovitis, Fungus, Tuberculosis, Other Granulomas, Rheumatoid Arthritis); Extensors, with or without Transposition of Dorsal Retinaculum

Summary

Radical excision of the bursa and synovia of wrist or forearm tendon sheaths is a surgical procedure performed to remove inflamed or infected tissue around the tendons of the wrist and forearm. The surgery might involve the transposition of the dorsal retinaculum if necessary.

Purpose

This procedure addresses conditions like tenosynovitis, fungal infections, tuberculosis, other granulomas, and rheumatoid arthritis. The aim is to relieve pain, reduce inflammation, and restore function and mobility to the wrist and forearm.

Indications

• Persistent swelling or pain in the wrist or forearm not relieved by conservative treatments.
• Radiographic or clinical evidence of infection (fungal, tuberculosis) or granulomas.
• Diagnosed tenosynovitis or rheumatoid arthritis affecting tendon sheaths.
• Inflammatory symptoms impacting daily activities and quality of life.

Preparation

• Patients may be instructed to fast for 6-8 hours prior to the procedure.
• Adjustments to certain medications, particularly blood thinners, may be necessary.
• Pre-procedure diagnostic tests might include blood tests and imaging studies (X-ray, MRI) of the wrist and forearm.

Procedure Description

1. The patient is brought to the operating room and administered local or general anesthesia depending on the extent of the surgery.
2. An incision is made over the affected area to access the inflamed or infected bursa and synovia.
3. The surgeon carefully excises the diseased tissue while preserving surrounding structures.
4. If required, the dorsal retinaculum is transposed to improve tendon function.
5. The incision is then closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and extent of the excision.

Setting

This surgery is usually performed in a hospital or surgical center.

Personnel

The procedure involves:

• A surgeon specialized in hand and upper limb surgery.
• An anesthesiologist to manage anesthesia and monitor the patient.
• Surgical nurses and technicians to assist during the operation.

Risks and Complications

• Common risks include infection, bleeding, and scarring.
• Rare risks might include damage to surrounding nerves or tendons, prolonged stiffness, or recurrence of the condition.
• Complications are managed with appropriate medical interventions and follow-up care.

Benefits

• Relief from pain and inflammation.
• Improved wrist and forearm function and mobility.
• Reduced risk of recurrence with the radical excision approach.

Recovery

• Post-procedure instructions usually include keeping the surgical area clean and dry, managing pain with prescribed medications, and limiting wrist and forearm movements.
• The recovery period ranges from a few weeks to several months, depending on the extent of surgery.
• Follow-up appointments are essential to monitor healing and begin physical therapy if needed.

Alternatives

• Non-surgical treatments such as steroid injections, physical therapy, or nonsteroidal anti-inflammatory drugs (NSAIDs).

Pros:

• Non-invasive with lower immediate risks.

Cons:

• May not provide lasting relief or address severe cases.

Patient Experience

• During the procedure, if under local anesthesia, the patient might feel slight pressure but no pain. General anesthesia will ensure they are unconscious.
• Post-procedure, pain and swelling are managed with medications.
• Patients should expect some temporary discomfort and limited mobility, gradually improving with recovery.