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Can someone help me with this one?
Vickie
Chronic extensor tendon tenosynovitis, index and middle finger,
dorsum right hand.
PROCEDURES: Biopsy and tenosynovectomy, extensor tendon, index and middle
finger, and tenoplasty, extensor digitorum communis, index finger.
INDICATIONS FOR PROCEDURE: This is a 50-year-old lady who presents to me for
recent swelling and pain over the extensor tendon of the index and middle
finger, just distal to the extensor retinaculum at the wrist. She is here for
an excisional biopsy today. She was first diagnosed with a ganglion cyst, but
clinically, it is not a ganglion cyst, it moves with the tendon.
DESCRIPTION OF PROCEDURE: The patient under general anesthesia, prepping and
draping of her right upper extremity. Tourniquet up at 250 millimeters of
mercury. I made a Z-incision on top of the swelling, and I dissect the soft
tissue carefully. I went down to the extensor tendon of the index and middle
finger, and there is a typical chronic tenosynovitis surrounding both extensor
tendons of the index finger, as well as the middle finger, just distal to the
extensor retinaculum of the wrist. So, I clean all of that out under loupe
magnification, and I send that to pathology. I make sure that all 3 tendons are
clean. There is no evidence of synovitis around the ring and little finger. I
did not open the extensor retinaculum, but I could not see the extensor
pollicis longus, that seems to be intact microscopically. The extensor communis
of the index finger presents an intratendinous knot, about 1 centimeter, the
tendon is enlarged. I open it longitudinally with the scalpel to discover some
synovium material inside the tendon, like we see with rheumatoid patients. I
debrided it carefully, and then I clean the wound with normal saline. I close
the subcutaneous with Monocryl 3-0, and the skin with Prolene 4-0. I use local
anesthesia for pain management postop. I left a small drain inside the wound,
and I made a sterile compressive dressing. Tourniquet down. Good capillary
refill. The procedure was well tolerated.
Vickie
Chronic extensor tendon tenosynovitis, index and middle finger,
dorsum right hand.
PROCEDURES: Biopsy and tenosynovectomy, extensor tendon, index and middle
finger, and tenoplasty, extensor digitorum communis, index finger.
INDICATIONS FOR PROCEDURE: This is a 50-year-old lady who presents to me for
recent swelling and pain over the extensor tendon of the index and middle
finger, just distal to the extensor retinaculum at the wrist. She is here for
an excisional biopsy today. She was first diagnosed with a ganglion cyst, but
clinically, it is not a ganglion cyst, it moves with the tendon.
DESCRIPTION OF PROCEDURE: The patient under general anesthesia, prepping and
draping of her right upper extremity. Tourniquet up at 250 millimeters of
mercury. I made a Z-incision on top of the swelling, and I dissect the soft
tissue carefully. I went down to the extensor tendon of the index and middle
finger, and there is a typical chronic tenosynovitis surrounding both extensor
tendons of the index finger, as well as the middle finger, just distal to the
extensor retinaculum of the wrist. So, I clean all of that out under loupe
magnification, and I send that to pathology. I make sure that all 3 tendons are
clean. There is no evidence of synovitis around the ring and little finger. I
did not open the extensor retinaculum, but I could not see the extensor
pollicis longus, that seems to be intact microscopically. The extensor communis
of the index finger presents an intratendinous knot, about 1 centimeter, the
tendon is enlarged. I open it longitudinally with the scalpel to discover some
synovium material inside the tendon, like we see with rheumatoid patients. I
debrided it carefully, and then I clean the wound with normal saline. I close
the subcutaneous with Monocryl 3-0, and the skin with Prolene 4-0. I use local
anesthesia for pain management postop. I left a small drain inside the wound,
and I made a sterile compressive dressing. Tourniquet down. Good capillary
refill. The procedure was well tolerated.