Name of the Procedure:

Synovectomy, tendon sheath, foot; extensor

Summary

A synovectomy of the tendon sheath in the foot involves the surgical removal of the synovial membrane that encases the extensor tendons. This procedure is typically performed to relieve pain and inflammation caused by conditions such as tenosynovitis or rheumatoid arthritis.

Purpose

The primary goal of this procedure is to alleviate pain, reduce inflammation, and prevent further damage to the extensor tendons in the foot. This can improve mobility and quality of life for patients suffering from chronic inflammatory conditions affecting the tendon sheath.

Indications

• Persistent pain and swelling in the foot that has not responded to conservative treatments like medication or physical therapy.
• Diagnosed inflammatory conditions such as rheumatoid arthritis or tenosynovitis.
• Recurrent tendon sheath infections.
• Impairment of foot or toe movement due to inflammation.

Preparation

• The patient may be instructed to fast for several hours before the procedure.
• Medication adjustments, particularly for blood thinners, might be necessary.
• Pre-operative diagnostic tests may include blood tests, imaging studies (such as an MRI or ultrasound), and a full medical evaluation.

Procedure Description

1. The patient is positioned comfortably, and either local or regional anesthesia is administered.
2. A small incision is made over the affected extensor tendon on the foot.
3. The surgeon carefully exposes the tendon sheath and removes the inflamed synovial membrane.
4. The incision is closed with sutures, and the area is bandaged.
5. A sterile dressing is applied to the site to prevent infection.

Tools and equipment used may include scalpels, forceps, and specialized scissors. Anesthesia is generally local or regional, but general anesthesia may be used depending on the patient's condition or preference.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the extent of the surgery required.

Setting

Synovectomy of the tendon sheath in the foot is usually performed in an outpatient surgical center or a hospital operating room.

Personnel

The procedure is conducted by an orthopedic surgeon or a podiatric surgeon. The surgical team also includes nurses and an anesthesiologist or nurse anesthetist.

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to surrounding structures, such as nerves or blood vessels
• Persistent pain or stiffness in the foot
• Recurrence of inflammation or tenosynovitis

Benefits

The expected benefits include relief from pain and inflammation, improved function and mobility of the foot and toes, and prevention of further tendon damage. These benefits can usually be noticed within weeks after the procedure.

Recovery

Post-operative care includes keeping the foot elevated, applying ice, and taking prescribed pain medication. Physical therapy may be recommended to restore full function. The typical recovery time is a few weeks to a couple of months, during which the patient should avoid strenuous activities and follow-up with their surgeon for post-operative visits.

Alternatives

• Non-surgical treatments such as corticosteroid injections, anti-inflammatory medications, and physical therapy.
• Ultrasound-guided drainage of fluid from the tendon sheath.
• The pros of surgery typically include a more permanent solution to inflammation, while cons may include surgical risks and longer recovery time.

Patient Experience

During the procedure, the patient will feel minimal to no pain due to anesthesia. Post-operatively, there may be some discomfort or swelling, which can be managed with pain medication and home care instructions. Mobility may be limited initially, but gradual improvement is expected with adherence to recovery guidelines.