Name of the Procedure:

Capsulectomy or Capsulotomy; Metacarpophalangeal Joint, Each Joint

Summary

A capsulectomy or capsulotomy procedure involves the surgical removal (capsulectomy) or incision (capsulotomy) of the capsule that surrounds the metacarpophalangeal joints of the fingers, which are the joints at the base of your fingers.

Purpose

The main purpose of this procedure is to address issues such as joint stiffness, limited range of motion, or deformities that can't be managed by non-surgical methods. The goal is to restore functional mobility and reduce pain in the affected joints.

Indications

• Chronic pain or stiffness in the metacarpophalangeal joints
• Joint deformities or contractures
• Lack of improvement with conservative treatments like physical therapy or medication
• Impairment in daily activities due to limited finger movements

Preparation

• Fasting for at least 6-8 hours before the procedure if general anesthesia is used.
• Adjusting or discontinuing certain medications as advised by the doctor.
• Preoperative assessments such as X-rays or MRI scans to evaluate joint condition.

Procedure Description

1. The patient is given either local anesthesia with sedation or general anesthesia.
2. An incision is made over the affected metacarpophalangeal joint.
3. The surgeon either removes (capsulectomy) or incises (capsulotomy) the joint capsule to relieve tension.
4. Any corrective measures, such as release of contractures, are performed.
5. The incision is then closed with sutures.
6. A splint or a bandage may be applied to immobilize the joint temporarily.

Duration

The procedure typically takes about 1 to 2 hours depending on the complexity and the number of joints being treated.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Possibly physical therapists for post-operative guidance

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve injury leading to numbness or loss of function
• Scar tissue formation
• Recurrent stiffness or need for further surgery

Benefits

• Enhanced mobility and range of motion in the fingers
• Reduction or elimination of pain
• Improved ability to perform daily tasks
• Enhanced quality of life

Recovery

• Keep the surgical area clean and dry.
• Follow instructions regarding the use of splints or braces.
• Physical therapy may be recommended to improve joint function.
• Recovery time varies; light activities can usually be resumed within a few weeks, while full recovery may take several months.

Alternatives

• Non-surgical treatments such as physical therapy, medications, or steroid injections
• Alternative surgeries, including arthroscopy or joint replacement in severe cases

Patient Experience

• During the procedure, patients under local anesthesia might feel pressure but should not feel pain. Under general anesthesia, they will be unconscious.
• Post-procedure, patients might experience discomfort or pain, which can be managed with prescribed pain medications.
• Swelling and stiffness are common but should gradually improve with proper care and physical therapy.