Learn all about tenosynovectomy definition, surgery, procedure and recovery.
Tenosynovectomy can be performed to restore tendon function anywhere in the body. Typically used to treat patients that have developed tenosynovitis, this procedure will reduce joint inflammation and pain if anti-inflammatory medications or compression aren’t successful.
Tendons are contained in sheaths that are lined with synovial tissue like joints and filled with synovial fluid. In RA, these sheaths can become inflamed and swollen. This condition is called tenosynovitis, the symptoms of which include pain, swelling, and stiffness and difficulty of movement where the inflammation occurs. This condition can cause a finger to get stuck in a flexed (bent) position, a condition sometimes called “trigger finger”.
Prophylactic surgery, such as tenosynovectomy, to manage tenosynovitis can prevent rupture of tendons and avoid the necessity of more involved reconstructive surgery.
The operation we recommend for the finger with rheumatoid tenosynovitis is a tenosynovectomy, but with maintainence of the pulley system and resection of one slip of the superficialis in order to decompress the digital theca.
What is Tenosynovectomy?
Tenosynovectomy is a procedure performed to surgically excise the tendon sheath (a layer of membrane surrounding the tendon).
Tenosynovectomy is the excision or resection of a tendon sheath. Tenosynovitis is inflammation of a tendon and its sheath. Most acute cases of flexor tenosynovitis (FT), which involves disruption of normal flexor tendon function in the hand, are the result of infection. However, FT also can develop secondary to acute or chronic inflammation from a noninfectious cause, such as diabetes, overuse, or arthritis.
A tenosynovectomy is surgery to treat tendon problems such as ‘trigger finger’ or tenosynovitis of the wrist. These conditions can restrict the free movement of a tendon within its sheath causing, in the case of trigger finger, a joint to get stuck in a bent position. A tenosynovectomy may be recommended to treat the condition in order to prevent the tendon rupturing and to avoid more complex reconstructive surgery.
After a brief recovery period, the patient will be free to go home on the same day as the surgery.
After surgery, patients begin a recovery process in the days and weeks that follow. Most patients experience relief from pain and other symptoms after 6 to 12 weeks of recovery.
A tenosynovectomy is usually carried out under a local anaesthetic (so you’ll stay awake but you won’t feel anything). It takes around half an hour and you should be able to go home on the same day.
The procedure involves removing any abnormal, inflamed or thickened tissue from around the tendon and its sheath to allow the tendon to move smoothly again. During the procedure, the patient will generally lie down on the back with the arm out to the side. The surgeon will apply a tourniquet to the patient’s arm.
After sterilizing the hand and wrist, injections numb the wrist, hand, and surgical area. The patient remains awake, as general anesthesia is rarely used for this procedure.
After the area has been numbed, the surgeon makes a small incision at the base of the thumb and locates the band of fascia that runs across the top of the tendons (the extensor retinaculum). Some surgeons also perform this procedure endoscopically, using smaller incisions and an endoscope to view the surgical area.
The surgeon releases the extensor retinaculum by severing it, taking care not to damage the tendons underneath or nearby radial nerve.
The surgical instruments are removed and the incision in closed with stitches. The surgical site is then bandaged.
Tenosynovectomy recovery takes 3 to 6 months. Within three months, restoration and pain is diminished. Most normal activities can resume in about six months and even earlier for some patients. Strength recovery takes 3-6 months and improves depending upon the amount of weakness prior to surgery and the intensity of the strengthening exercises. Surgery may initially cause some pain or soreness. Doctors may recommend over-the-counter painkillers for relief.
Immediately after surgery, a person should be able to move their finger or thumb. Be gentle with movements at first; full movement can be expected to return in 1 to 2 weeks.
People should keep a dressing on their finger for a few days following open surgery. After this, they must keep the wound clean, using mild soap and water.
If a person has stitches, a medical professional may need to remove them after 2 to 3 weeks. Dissolvable stitches will dissolve within 3 weeks.
A person should ask their doctor about when they can resume everyday activities, such as driving or using a computer. Recovery time may be longer for someone who has had trigger finger surgery on more than one finger or thumb.
Some people may need to do finger exercises or undertake hand therapy to return full movement to the affected digit.