Name of the Procedure:

Synovectomy, Metacarpophalangeal Joint, including Intrinsic Release and Extensor Hood Reconstruction, Each Digit

Summary

In this procedure, the surgeon removes inflamed or diseased synovial tissue from the metacarpophalangeal (MCP) joints, releases intrinsic hand muscles, and repairs the extensor hood. The MCP joints are where the fingers meet the hand. This can alleviate pain, improve movement, and correct deformities in the fingers.

Purpose

This procedure primarily addresses conditions such as rheumatoid arthritis, and other inflammatory or degenerative joint diseases affecting the MCP joints. The goals are to reduce pain, minimize joint swelling, improve finger function, and prevent further joint damage or deformities.

Indications

• Chronic pain or swelling in the MCP joints
• Decreased range of motion or finger function due to synovitis
• Joint deformities caused by inflammatory or degenerative joint diseases
• Failed conservative treatments such as medications or physical therapy

Preparation

• Fasting usually required for 8-12 hours before the procedure
• Adjustments or temporary discontinuation of certain medications, especially blood thinners
• Preoperative diagnostic tests may include blood work and imaging studies such as X-rays or MRI

Procedure Description

1. The patient is administered regional or general anesthesia.
2. A small incision is made over the affected MCP joint(s).
3. Surgeons remove inflamed synovial tissue from the joint.
4. Intrinsic muscles are released to relieve tension and improve flexibility.
5. The extensor hood is reconstructed to ensure proper tendon function.
6. The incision is closed with sutures, and a sterile dressing is applied.

Tools and equipment include scalpel, forceps, scissors, and specialized surgical instruments for joint reconstruction. Imaging guidance may be used as necessary.

Duration

The procedure typically takes 1-2 hours per digit, depending on the extent of the surgery.

Setting

Performed in a hospital operating room or a specialized outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Nerve or tendon damage
• Stiffness or decreased range of motion
• Adverse reactions to anesthesia
• Scar formation

Benefits

• Relief from chronic joint pain
• Increased range of motion and improved finger function
• Reduction of joint swelling
• Prevention of further joint damage or deformities
• Improved quality of life

Recovery

• Patients may require immobilization of the hand for a few weeks.
• Pain management typically includes medications and ice application.
• Physical therapy is often necessary to restore joint function and strength.
• Recovery time ranges from several weeks to a few months depending on the individual case and extent of surgery.
• Follow-up appointments are essential to monitor progress and manage any complications.

Alternatives

• Conservative treatments (e.g., medication, corticosteroid injections, physical therapy)
• Joint fusion surgery (arthrodesis)
• Total joint replacement (arthroplasty)

Each alternative comes with its own set of risks and benefits. Conservative treatments might not provide lasting relief for severe conditions, while more invasive procedures like joint replacement might offer more definitive solutions but with longer recovery times.

Patient Experience

During the procedure, the patient will be under anesthesia and feel no pain. Postoperatively, there may be discomfort or pain managed with medications. Swelling, bruising, and stiffness are common initially. Pain relief and functional improvement are usually noticed within weeks but can continue to improve over months with proper rehabilitation.