26500 Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)

Name of the Procedure:

Reconstruction of Tendon Pulley, Each Tendon; with Local Tissues (Separate Procedure) Common name: Tendon Pulley Repair.

Summary

Tendon pulley reconstruction is a surgical procedure to repair and restore the function of the structures that hold the tendons close to the bones in the fingers. This helps in maintaining the smooth gliding motion of the tendons crucial for finger movement.

Purpose

This procedure addresses damage or rupture of the tendon pulleys which can impair finger movement, cause pain, and limit hand function. The goal is to restore normal tendon function, alleviate pain, and improve hand strength and flexibility.

Indications

Indications include:

• Tendon pulley injuries due to trauma or overuse (e.g., rock climbing).
• Symptoms like finger pain, weakness, or inability to bend or straighten fingers.
• Diagnosis of conditions such as trigger finger or pulley rupture.

Preparation

Patients may need to:

• Undergo a physical examination and imaging tests like X-rays or MRI.
• Discuss medication adjustments with their doctor, especially if they are taking blood thinners.
• Fast for a certain period before the surgery if general anesthesia is to be used.

Procedure Description

1. The patient is administered anesthesia (local, regional, or general).
2. An incision is made over the affected tendon pulley.
3. The surgeon identifies the damaged pulley and repairs or reconstructs it using local tissues from the surrounding area.
4. The wound is closed with sutures, and a bandage is applied.
5. A splint may be used to immobilize the finger during initial healing.

Duration

The procedure typically takes 1-2 hours, depending on the complexity and the number of tendons involved.

Setting

This surgery is typically performed in an outpatient surgical center or hospital.

Personnel

The following healthcare professionals are involved:

• An orthopedic or plastic surgeon specialized in hand surgery.
• Surgical nurses.
• An anesthesiologist or nurse anesthetist.

Risks and Complications

Common risks include:

• Infection.
• Bleeding.
• Scarring.
• Stiffness or reduced range of motion. Rare complications:
• Nerve damage.
• Failure of the repair, necessitating additional surgery.

Benefits

The primary benefits are pain relief, restored finger movement, and improved hand function. Most patients see improvements within a few weeks to months as they recover.

Recovery

• Patients may need to wear a splint and engage in physical therapy.
• Pain medication and anti-inflammatory drugs may be prescribed.
• Follow-up appointments to monitor healing.
• Complete recovery and return to normal activities typically occur within 6-12 weeks.

Alternatives

Alternative treatments include:

• Non-surgical treatments like rest, splinting, and physical therapy.
• Corticosteroid injections to reduce inflammation. Pros and cons:
• Non-surgical treatments may be less invasive but may not fully address severe pulley damage.

Patient Experience

During the procedure:

• Patients will not feel pain if anesthesia is effective. After the procedure:
• Patients might experience pain, swelling, and stiffness initially.
• Pain is usually managed with medications.
• Comfort measures include ice application and hand elevation to reduce swelling.