DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Left wrist radiocarpal arthritis.
2. Left wrist extensor pollicis longus tenosynovitis.
POSTOPERATIVE DIAGNOSES:
1. Left wrist radiocarpal arthritis.
2. Left wrist extensor pollicis longus tenosynovitis.
3. Possible crystalline tenosynovitis of the wrist.
OPERATIONS PERFORMED:
1. Tenosynovectomy of left EPL tendon.
2. Limited wrist radiocarpal tenosynovectomy.
SURGEON: John Doe, MD
ANESTHESIA: General plus regional block.
COMPLICATIONS: None.
SPECIMENS REMOVED:
1. Synovial biopsy to pathology.
2. Synovial biopsy for AFB, atypical mycobacteria, and fungus.
3. Joint synovium for crystal.
ESTIMATED BLOOD LOSS: Less than 5 mL.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female with a long history of wrist pain. She was seen and evaluated in the clinic and noted to have mild arthritis on x-rays, as well as mid dorsal radial wrist swelling, which was painful to palpation. Preoperative x-rays demonstrated increase of the radiocarpal arthritis, as well as appearance of a new onset of significant ligament disruption and slack wrist. She was also complaining of some numbness in her fingertips with positive median nerve compression test. However, no electrodiagnostic studies were performed, and she had intact two-point discrimination through all her fingertips. It was felt that the pain was likely related to her wrist pathology and not to carpal tunnel syndrome or carpal ligament compression. It was felt that she would benefit from further evaluation with electrodiagnostic studies to confirm or rule out the presence of a carpal tunnel syndrome.
DESCRIPTION OF OPERATION: The patient was brought back to the operating room and placed supine on the operating table with her left arm on the arm table. She was prepped and draped in the usual standard sterile fashion. She had a nonsterile brachial tourniquet placed, and the tourniquet was inflated after the arm was exsanguinated with an Esmarch. The incision was carried down over the dorsal aspect of the swelling in her wrist, approximately 4 cm long, in an oblique fashion. It was carried down sharply through the skin and then using blunt dissection down to the tendon sheath of the EPL tendon. The dorsal branch of the radial nerve was isolated and protected and retracted radially during the dissection.
Once the EPL tendon sheath was incised, a large amount of synovium and joint fluid was noted to egress from the wound. The joint fluid appeared to be benign, as well as the synovium appeared to be benign and non-markedly inflammatory. The tendon was dissected both proximally and distally and proximally extended to the extensor retinaculum distally towards the MP crease, and the entire EPL tenosynovium was dissected en masse and sent for pathology.
Attention was then turned, and dissection was carried deeper into the interval between the ECRL and ECRB tendons. The synovium was dissected out into the dorsal wrist capsule. A portion of the wrist capsule was removed in order to have the appearance of crystalline deposits in the joint. This was felt to be a degenerated ligament. However, it was noted to be throughout the wrist joint and wrist capsule. Therefore, the joint capsule was sent to pathology for a crystalline analysis as well.
A limited wrist synovectomy was performed, and the radioscaphoid joint was explored and noted to have severe arthritis and deterioration of the wrist joint. The wounds were then irrigated copiously and closed with interrupted 5-0 nylon sutures on the dorsum of the wrist. The patient was then placed and had 10 mL of local anesthesia infiltrated to augment the block, and bacitracin, Adaptic gauze, dry gauze, and a well-padded thumb spica splint were placed on the patient. The patient was then awakened and brought to the PACU in stable condition.
