Name of the Procedure:

Synovectomy, carpometacarpal joint
Common names: Synovectomy of the thumb, Carpometacarpal joint synovectomy

Summary

A synovectomy of the carpometacarpal (CMC) joint involves surgically removing the inflamed synovial tissue around the base of the thumb to relieve pain and improve joint function.

Purpose

This procedure addresses chronic inflammation of the synovial membrane in the CMC joint, commonly due to rheumatoid arthritis or other inflammatory conditions. The goals are to reduce pain, improve joint mobility, and prevent further joint damage.

Indications

• Persistent pain and swelling in the thumb joint that does not respond to non-surgical treatments
• Rheumatoid arthritis causing inflammation and degeneration of the CMC joint
• Decreased thumb function affecting daily activities

Preparation

• Patients may need to undergo imaging studies such as X-rays or MRIs.
• Pre-procedure fasting for 6-8 hours if general anesthesia is used.
• Adjustment of medications, particularly blood thinners, as advised by the doctor.

Procedure Description

1. The patient is given appropriate anesthesia (local, regional, or general).
2. An incision is made over the base of the thumb.
3. The surgeon carefully removes the inflamed synovial tissue from the CMC joint.
4. The incision is closed with sutures, and a bandage or splint is applied.
5. The thumb and wrist are typically immobilized to promote healing.

Tools used may include surgical scissors, scalpels, and specialized instruments for joint tissue removal.

Duration

The procedure typically takes around 45 minutes to 1 hour.

Setting

Synovectomy of the CMC joint is usually performed in an outpatient surgical center or hospital operating room.

Personnel

• Orthopedic or hand surgeon
• Nurse or surgical technologist
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Damage to the surrounding tendons, nerves, or blood vessels
• Stiffness or reduced thumb mobility
• Need for further surgery if symptoms persist or recur

Benefits

• Relief from chronic thumb pain
• Improved joint function and range of motion
• Enhanced ability to perform daily tasks

Recovery

• Patients will receive instructions on wound care and activity restrictions.
• Pain management may include medications and ice therapy.
• Physical therapy may be recommended to restore mobility.
• Recovery time varies; most patients return to normal activities within 4-6 weeks, though full recovery may take several months.

Alternatives

• Non-surgical treatments such as medications, corticosteroid injections, or physical therapy
• Arthroscopic synovectomy as a less invasive option
• Joint fusion or replacement in severe cases Each alternative has its own set of benefits and limitations, with varying degrees of invasiveness, recovery time, and effectiveness.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Postoperatively, mild to moderate pain is typical, managed with prescribed painkillers and ice. Some swelling and stiffness are expected. The patient will likely need to avoid heavy use of the thumb for several weeks and follow specific rehabilitation exercises to regain full function. Regular follow-up appointments ensure proper healing and address any concerns.