Name of the Procedure:

Synovectomy, Extensor Tendon Sheath, Wrist, Single Compartment; with Resection of Distal Ulna

Summary

In layman's terms, a synovectomy for the wrist involves removing inflamed or diseased synovial tissue from the sheath surrounding the extensor tendons of the wrist. This particular procedure also involves the removal of a small portion of the distal ulna, one of the two bones in the forearm, to help alleviate pain and improve function.

Purpose

• Medical Condition: This procedure addresses chronic inflammation and pain in the wrist, often caused by conditions like rheumatoid arthritis or tenosynovitis.
• Goals: The main goals are to reduce pain, improve wrist and hand function, and prevent further joint damage.

Indications

• Persistent swelling, pain, or limited motion in the wrist despite conservative treatments.
• Diagnoses such as rheumatoid arthritis, psoriatic arthritis, or other inflammatory joint diseases.
• Failure of non-surgical treatments like medications, splinting, or injections.

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Medications, especially blood thinners, may need to be adjusted or stopped.
• Preoperative assessments might include blood tests, imaging studies like X-rays or MRIs, and a complete physical examination.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made on the dorsal (back) side of the wrist.
3. Synovectomy: The surgeon carefully removes the inflamed synovial tissue surrounding the extensor tendons.
4. Resection of Distal Ulna: A small portion of the distal ulna is removed to relieve pain and allow for better movement.
5. Closure: The incision is closed with sutures, and a sterile bandage is applied.

Duration

The procedure typically takes about 1-2 hours.

Setting

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

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technologist

Risks and Complications

• Common Risks: Infection, bleeding, and scarring.
• Rare Risks: Damage to surrounding nerves or blood vessels, persistent pain, and reduced range of motion.
• Management plans are in place to handle any arising complications promptly.

Benefits

• Reduction in pain and inflammation.
• Improved range of motion and function in the wrist.
• Benefits are often realized within a few weeks to months post-surgery.

Recovery

• Post-procedure care includes keeping the wrist elevated, applying ice, and taking prescribed pain medications.
• Physical therapy may begin shortly after the procedure to aid in recovery.
• Most patients can expect a recovery period of several weeks to a few months, with follow-up appointments to monitor progress and adjust treatment.

Alternatives

• Non-surgical options like corticosteroid injections, anti-inflammatory medications, and physical therapy.
• Arthroscopic synovectomy, a less invasive option with similar goals.
• Each alternative has its own set of pros and cons, and the best course depends on individual circumstances and the severity of the condition.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel any pain.
• Postoperatively, patients might experience some discomfort, swelling, and stiffness, which will be managed with pain relief measures.
• Following the surgeon's instructions carefully will enhance comfort and speed up recovery.