Name of the Procedure:

Synovectomy, extensor tendon sheath, wrist, single compartment Common name: Wrist Synovectomy

Summary

A synovectomy involves the surgical removal of the synovial membrane, which lines the joint and tendon sheaths. This specific procedure targets the extensor tendon sheath in a single compartment of the wrist.

Purpose

This procedure addresses conditions such as chronic inflammation, pain, or joint dysfunction due to synovitis (inflammation of the synovial membrane). The goal is to reduce pain, improve joint function, and prevent further damage to the tendons and joint.

Indications

• Persistent wrist pain due to inflammation
• Rheumatoid arthritis
• Synovial cysts
• Non-responsive to conservative treatments (e.g., medication, physical therapy)
• Swelling or decreased range of motion in the wrist

Preparation

• Fasting for 6-8 hours prior to the procedure
• Adjusting medications as advised by the doctor (e.g., stopping blood thinners)
• Pre-operative diagnostic tests such as MRI or ultrasound to assess the extent of the inflammation

Procedure Description

1. Anesthesia: Local or regional anesthesia is administered to numb the wrist.
2. Incision: A small incision is made over the affected extensor tendon sheath.
3. Synovial Membrane Removal: The surgeon carefully removes the inflamed synovial tissue while preserving surrounding structures.
4. Closure: The incision is closed with sutures or surgical staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in an outpatient surgical center or hospital operating room.

Personnel

• Orthopedic or hand surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist
• Surgical assistant

Risks and Complications

• Infection
• Bleeding
• Stiffness or decreased range of motion
• Nerve damage
• Recurrence of synovitis
• Adverse reactions to anesthesia

Benefits

• Relief from pain and inflammation
• Improved wrist function and mobility
• Reduced risk of tendon damage
• Symptoms may improve within a few weeks to months

Recovery

• Immediate post-procedure care includes keeping the wrist elevated and applying ice to reduce swelling.
• Pain management with prescribed medications.
• Physical therapy may be recommended to restore strength and mobility.
• Return to normal activities generally expected within 4 to 6 weeks.

Alternatives

• Non-surgical treatments: Corticosteroid injections, anti-inflammatory medications, physical therapy
• Other surgical options: Tenosynovectomy (more extensive removal of tendon sheath inflammation)
• Pros and Cons: Non-surgical options may offer temporary relief but may not be sufficient for severe cases. More extensive surgery may offer longer-lasting results but carries higher risks.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Mild to moderate pain and discomfort may be felt post-procedure, managed with medication.
• Swelling and stiffness are common and typically resolve with appropriate post-operative care.

By understanding these crucial details, patients can make informed decisions about their healthcare and what to expect during the synovectomy procedure.