Name of the Procedure:

Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint

Summary

A synovectomy of the proximal interphalangeal joint is a surgical procedure that involves removing the inflamed synovial lining of the joint to alleviate pain and improve joint function. This procedure includes reconstruction of the extensor mechanism, which helps restore the movement and stability of the finger joint.

Purpose

This procedure addresses conditions like chronic inflammatory arthritis that affect the proximal interphalangeal (PIP) joint of the fingers, leading to pain, swelling, and impaired function. The goals are to reduce pain, improve joint mobility, and prevent further joint damage.

Indications

• Persistent pain and swelling in the PIP joint despite conservative treatments.
• Severe arthritis or inflammation that affects hand function.
• Radiologic evidence of joint degeneration.
• Patients who have not responded to medications or other non-surgical interventions.

Preparation

• Patients are typically instructed to avoid eating or drinking for at least 8 hours before the procedure.
• Medication adjustments might be necessary, especially for blood thinners.
• Pre-operative diagnostic tests may include X-rays, blood tests, and an evaluation of the hand's function.

Procedure Description

1. The patient is typically given regional or general anesthesia.
2. An incision is made over the proximal interphalangeal joint.
3. The inflamed synovial tissue is carefully removed.
4. The extensor tendons are examined and any necessary reconstruction is performed to restore proper function.
5. The joint capsule is repaired and the incision is closed with sutures.
6. A sterile dressing is applied, and sometimes a splint is used to immobilize the joint temporarily.

Duration

The procedure usually takes about 1 to 2 hours, depending on the complexity and extent of the reconstruction needed.

Setting

The procedure is typically performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Stiffness or reduced range of motion
• Recurrence of joint inflammation
• Complications related to anesthesia

Benefits

• Relief from chronic pain
• Improved joint function and mobility
• Enhanced quality of life
• Prevention of further joint damage

Recovery

• Post-operative instructions may include keeping the hand elevated and applying ice to reduce swelling.
• Pain management with prescribed medications.
• Physical therapy may be recommended to restore strength and flexibility.
• Recovery time can vary from a few weeks to several months.
• Follow-up appointments are necessary to monitor progress and remove any stitches or splints.

Alternatives

• Non-surgical management including medication, physical therapy, and steroid injections.
• Joint fusion or arthroplasty as options for severe joint damage.
• Each alternative has its own pros and cons: for example, joint fusion can relieve pain but may reduce mobility.

Patient Experience

Patients may experience discomfort or pain after the procedure, which is managed with medications. Swelling and stiffness are common initially. Physical therapy plays a crucial role in recovery, helping patients regain strength and flexibility over time.