Name of the Procedure:

Capsulotomy; Interphalangeal Joint, Each Joint (Separate Procedure)

Summary

A capsulotomy is a surgical procedure involving the interphalangeal joints of the fingers or toes. The surgery involves cutting into the joint capsule to release tension, alleviate pain, and improve range of motion in the affected joint.

Purpose

This procedure addresses issues like stiffness, pain, or limited movement in the interphalangeal joints due to conditions such as arthritis, scar tissue formation, or contractures. The goals are to relieve discomfort, enhance joint mobility, and improve the overall function of the affected finger or toe.

Indications

• Chronic pain in the interphalangeal joint(s)
• Persistent joint stiffness or limited range of motion
• Non-responsive to conservative treatments like physical therapy or medications
• Conditions like rheumatoid arthritis, osteoarthritis, or Dupuytren's contracture

Preparation

• Fasting for 6-8 hours prior to the procedure if general anesthesia is used
• Adjustments or discontinuation of certain medications as directed by the physician
• Pre-operative diagnostic tests such as X-rays or MRI scans to assess the joint condition

Procedure Description

1. The patient is positioned and the surgical site is sterilized.
2. An anesthetic (local, regional, or general) is administered.
3. A small incision is made over the affected joint.
4. The surgeon carefully cuts into the joint capsule to relieve tension.
5. Any scar tissue or adhesions are removed.
6. The incision is closed with sutures, and a sterile bandage is applied.

Tools and equipment used may include scalpels, scissors, forceps, and fine suturing materials. Anesthesia type varies based on the patient's condition and surgeon's preference.

Duration

The procedure typically lasts between 30 minutes to 1 hour per joint.

Setting

The capsulotomy is usually performed in an outpatient clinic, surgical center, or hospital.

Personnel

The healthcare team typically includes:

• An orthopedic or hand surgeon
• Surgical nurses
• An anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Adverse reaction to anesthesia
• Joint instability or dislocation
• Nerve damage
• Stiffness or decreased range of motion
• Pain that persists or worsens

Benefits

The expected benefits include reduced pain, improved joint movement, and better functionality of the affected finger or toe. These benefits can usually be noticed within a few weeks post-surgery.

Recovery

• Keep the surgical site clean and dry.
• Follow any prescribed physical therapy regimen.
• Avoid heavy lifting or strenuous activities involving the affected joint.
• Follow-up appointments to monitor healing and progress.
• Full recovery typically takes around 6-8 weeks.

Alternatives

• Physical therapy and exercise
• Anti-inflammatory medications or corticosteroid injections
• Splinting or bracing
• Alternative surgical procedures like joint replacement or arthroplasty

Each alternative has its own set of benefits and drawbacks, and the best option varies based on the individual's condition and health status.

Patient Experience

Patients may experience mild to moderate discomfort during the initial recovery, managed with pain medications prescribed by the doctor. Swelling, bruising, and stiffness in the operated area are common but typically decrease over time. Regular follow-up and proactive care significantly contribute to a positive outcome and recovery.