29845 Arthroscopy, wrist, surgical; synovectomy, complete

Name of the Procedure:

Arthroscopy, wrist, surgical; synovectomy, complete

Summary

Arthroscopy for complete wrist synovectomy is a minimally invasive surgical procedure where a small camera, called an arthroscope, is inserted into the wrist joint to remove inflamed synovial tissue. This procedure aims to alleviate pain and improve joint function.

Purpose

The procedure addresses chronic inflammation of the synovial membrane (synovitis) in the wrist, often seen in conditions like rheumatoid arthritis. The goal is to relieve pain, reduce swelling, and enhance wrist movement and function.

Indications

• Persistent wrist pain and swelling due to synovitis.
• Rheumatoid arthritis or other inflammatory conditions that do not respond to conservative treatments.
• Loss of wrist function or mobility caused by chronic inflammation.
• Diagnostic confirmation of synovitis severity.

Preparation

• Patients may need to fast for 6-8 hours before surgery.
• Adjustments to medications, especially blood thinners, might be necessary.
• Pre-surgical assessments include blood tests, imaging studies (X-rays or MRI), and a comprehensive physical examination.

Procedure Description

1. The patient is positioned, and the wrist is cleansed and sterilized.
2. General or regional anesthesia is administered.
3. Small incisions are made around the wrist to insert the arthroscope and surgical instruments.
4. The surgeon views the wrist joint on a monitor and removes inflamed synovial tissue using specialized instruments.
5. The instruments and arthroscope are removed, and the incisions are closed with sutures.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Arthroscopy for synovectomy is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or hand surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and technicians.

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve or blood vessel injury
• Joint stiffness or reduced mobility
• Adverse reactions to anesthesia
• Recurrence of synovitis

Benefits

• Reduction in wrist pain and swelling.
• Improvement in joint mobility and function.
• Minimally invasive with quicker recovery compared to open surgery.

Recovery

• Patients may go home the same day or the next day.
• Instructions include keeping the wrist elevated, applying ice, and taking prescribed pain medication.
• Physical therapy may be recommended to restore wrist function.
• Full recovery typically takes several weeks, with activity restrictions and follow-up appointments to monitor progress.

Alternatives

• Medication management, including anti-inflammatory drugs and steroids.
• Physical therapy and occupational therapy.
• Open synovectomy, a more invasive surgical option.
• Joint fusion or replacement in severe cases.

Patient Experience

Patients may experience mild discomfort during the procedure due to anesthesia administration. Post-procedure, pain and swelling are managed with medication, ice, and rest. Physical therapy plays a crucial role in regaining full wrist functionality and comfort.