Name of the Procedure:

Arthrotomy, with Exploration, Drainage, or Removal of Loose or Foreign Body; Carpometacarpal Joint

Summary

An arthrotomy is a surgical procedure where an incision is made into a joint. Specifically, this procedure targets the carpometacarpal joint in the hand to explore the area, drain any fluid, or remove loose or foreign bodies.

Purpose

Arthrotomy addresses issues such as pain, restricted movement, or inflammation within the carpometacarpal joint, often due to infections, trauma, or degenerative conditions. The aim is to relieve symptoms, improve joint function, and prevent further joint damage.

Indications

• Persistent joint pain or swelling not responding to medication or physical therapy
• Presence of loose bodies (e.g., bone fragments) or foreign objects in the joint
• Infections causing joint effusion (fluid buildup)
• Degenerative joint diseases such as osteoarthritis

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments might be necessary, particularly blood thinners.
• Prior to surgery, diagnostic tests such as X-rays or MRIs are conducted to assess the joint.

Procedure Description

1. The patient is positioned, and anesthesia is administered, usually general or regional.
2. An incision is made over the carpometacarpal joint.
3. The surgeon explores the joint, draining any fluid or removing loose/foreign bodies.
4. The joint is irrigated to ensure cleanliness.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.
6. In some cases, a splint or cast may be placed to immobilize the joint during initial recovery.

Tools, Equipment, or Technology Used

• Surgical scalpel
• Retractors
• Suction and irrigation systems
• Forceps
• Sutures or staples
• Imaging tools for guided precision (if needed)

Anesthesia or Sedation

General or regional anesthesia.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Joint stiffness or reduced range of motion
• Adverse reactions to anesthesia
• Recurrence of symptoms

Benefits

• Relief from pain and inflammation
• Enhanced joint mobility
• Removal of obstructions within the joint
• Prevention of further joint damage
• Benefits are typically realized within a few weeks post-operation.

Recovery

• Post-procedure, the patient may need to keep the joint elevated to reduce swelling.
• Pain management includes medications and ice application.
• Physical therapy may be recommended to restore movement and strength.
• Full recovery may take several weeks to months, with follow-up appointments to monitor progress.
• Restrictions on heavy lifting or using the operated hand may be advised initially.

Alternatives

• Non-surgical treatments like medication, physical therapy, or corticosteroid injections
• Minimally invasive arthroscopic procedures
• Pros and cons include less invasive treatments having fewer immediate risks but possibly providing less relief or delaying necessary surgical intervention.

Patient Experience

During the procedure, the patient is under anesthesia and should feel no pain. Post-procedure discomfort can be managed with pain medication and rest. The patient might experience swelling and limited joint mobility initially but can expect gradual improvement with adherence to recovery guidelines.