Name of the Procedure:

Synovectomy, Tendon Sheath, Radical (Tenosynovectomy), Flexor Tendon, Palm and/or Finger, Each Tendon

• Common Name(s): Radical Tenosynovectomy
• Medical Terms: Synovectomy, Radical Tenosynovectomy

Summary

In layman's terms:

This procedure involves the surgical removal of the inflamed or damaged lining (synovium) of the sheath surrounding the flexor tendons in the palm and/or fingers. It aims to relieve pain and improve movement.

Purpose

Medical Condition or Problem:

• Addresses: Chronic tenosynovitis, rheumatoid arthritis, or other inflammatory conditions affecting the tendon sheaths.
• Goals: To reduce pain, swelling, and inflammation; improve tendon movement; and prevent further damage to the tendon sheath.

Indications

Specific Symptoms or Conditions:

• Persistent swelling and pain in the palm or fingers.
• Limited finger movement due to inflamed or thickened tendon sheath.
• Failure to respond to non-surgical treatments such as medications or physical therapy.

Patient Criteria:

• Diagnosed with rheumatoid arthritis or chronic tenosynovitis.
• Significant impairment in hand function.
• Inflammation unresponsive to conservative treatments.

Preparation

Pre-procedure Instructions:

• Fasting: Typically required for 6-8 hours before surgery.
• Medication Adjustments: Review and potentially adjust current medications under physician guidance.
• Diagnostic Tests: Blood tests, X-rays, or MRI to assess the extent of inflammation and damage.

Procedure Description

Step-by-Step Explanation:

1. Anesthesia: Administered general anesthesia or regional block to numb the area.
2. Incision: A small incision is made over the affected tendon sheath.
3. Exposure: The tendon sheath is carefully exposed.
4. Synovium Removal: The inflamed synovium is removed from around the tendon.
5. Inspection and Repair: Tendon is inspected for damage; repair is done if necessary.
6. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Tools and Equipment:

• Scalpel, scissors, retractors, irrigation tools, sutures.

Anesthesia:

• General anesthesia or a regional anesthesia block.

Duration

Typical Length:

• The procedure usually takes about 1-2 hours, depending on the extent of inflammation.

Setting

Location:

• Performed in a hospital or outpatient surgical center.

Personnel

Healthcare Professionals:

• Orthopedic or hand surgeon, anesthesiologist, surgical nurses.

Risks and Complications

Common and Rare Risks:

• Common: Infection, bleeding, pain, swelling.
• Rare: Nerve damage, tendon rupture, stiffness, recurrence of symptoms.

Management of Complications:

• Antibiotics for infections, pain medications, physical therapy, possible further surgery.

Benefits

Expected Outcomes:

• Relief from pain and swelling.
• Improved finger movement and function.
• Prevention of further tendon damage.

Realization Time:

• Benefits typically realized within a few weeks post-surgery.

Recovery

Post-procedure Care:

• Keep the surgical area clean and dry.
• Follow doctor’s instructions for wound care.
• Wear a splint if recommended.

Recovery Time:

• Initial recovery in 2-3 weeks, with full recovery taking up to 3 months.
• Physical therapy may be required to regain full function.

Restrictions:

• Limit heavy use of the hand during recovery.
• Attend follow-up appointments to monitor healing.

Alternatives

Other Treatment Options:

• Non-Surgical: Medications (NSAIDs, corticosteroids), physical therapy.
• Minimally Invasive: Steroid injections.

Pros and Cons:

• Non-Surgical: Less invasive, but may not provide lasting relief.
• Minimally Invasive: Quick recovery but potential temporary relief.
• Surgical: More definitive but involves more recovery time.

Patient Experience

During the Procedure:

• Under anesthesia, the patient will not feel pain.

After the Procedure:

• Some pain and swelling as anesthesia wears off.
• Pain managed with prescribed medication.
• Gradual improvement in symptoms over weeks.