# dorsal capsulotomy and release of collateral ligament, thumb



## laurabee (Aug 11, 2009)

The release of collateral ligament part is what I'm having difficulty with. Op note as follows:
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PREOPERATIVE DIAGNOSES:	1.	Late effect of tendon injury of left thumb.
2.	Stiff interphalangeal joint, left thumb.

POSTOPERATIVE DIAGNOSES:	1.	Late effect of tendon injury of left thumb.
2.	Stiff interphalangeal joint, left thumb.

PROCEDURES PERFORMED:	1.	Tenolysis of flexor pollicis longus tendon, left thumb.
2.	Dorsal capsulotomy and release of collateral ligament, left thumb.

ANESTHESIA:	

ANESTHESIOLOGIST:	

INDICATION:  The patient is a 25-year-old male who sustained a SPL injury to his left thumb.  This was repaired.  Postoperatively, he received therapy.  The patient has developed flexion contracture of the IP joint at 45 degrees.  He is now nine months status post surgery.  The patient complains of inability to completely extend the digit and pain on pulp pinch.  He had tenolysis of the tendon and possible dorsal capsulotomy.  The risks and complications were discussed.

OPERATIVE PROCEDURE:  IV sedation was given.  A 0.25% Sensorcaine was given as a digital block.  The hand was prepped and draped in the usual sterile manner.  Incision was made to the previous surgical scar.  The patient had extensive scarring from his earlier surgery.  Using tenotomy scissors and scalpel, the scar tissue was lysed.  Dissection was carried down to the tendon.  The tendon was identified.  There was a strong repair of the tendon.  The tendon was adherent to the surrounding tissue and all the adhesions were lysed.  Proximally, the tendon was also explored in the A1 pulley area and all the adhesions were lysed.  Distally, the adhesion present in the volar plate was also lysed.  I did inset part of the volar plate.  However, the patient had limited extension.  I therefore decided to approach the joint dorsally.  A curvilinear incision was made on the dorsal aspect and dissection was carried down to the capsule.  The collateral bands on either side were incised and I was partially able to extend some of the digits.  Still, I was not able to get 100% extension.  I decided not to proceed with additional division of the ligament causing instability.  At this time, the upper arm tourniquet was released.  Hemostasis was obtained with bipolar cautery.  The procedure was performed under MAC anesthesia.  The patient was able to actively extend and flex the digit during the procedure.

The wound was closed with 4-0 nylon for the volar skin and 5-0 nylon for the dorsal skin after ensuring hemostasis. 




 The wound was dressed with Xeroform and bulky dressing.  The patient tolerated the procedure and was transferred to the recovery room in satisfactory condition.
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I came up with 26440 for the tenolysis and 26525 for the capsulotomy. Any sugestions on the release of collateral ligament of the thumb? Thanks in advance for taking a look.


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## laurabee (Aug 11, 2009)

After some lengthy research it looks like the release of the collateral ligament may be included in the capsulotomy? Anyone agree/disagree?


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## michellelgrd (Aug 20, 2009)

it is included in the 26525 code:


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