Perioperative management - Removal of a tendon sheath hygroma/extensor tendon synovectomy with retinaculum plasty

• Pain and swelling
• Failed conservative treatment attempt over 6 months

• Local or general diseases that contraindicate elective surgery either surgically or anesthesiologically, or that can be improved preoperatively

• Clinical Examination:
  → Inspection/Palpation of a painful thickening along the course of the 4th extensor tendon, which moves with the extensor tendons
• Sonography: Detection of a fluid-filled cavity connected to the extensor tendons
• Possibly MRI in case of unclear findings

• no special preparation of the patient necessary
• generally an outpatient procedure
• clarification of contraindication for bloodlessness (e.g., existing shunt in dialysis)

Information about

• surgical method
• additional procedures such as tendon suture, tendon reconstruction, retinaculum plasty

• general surgical risks
  • wound healing disorder
  • tendon injury
  • functional deficit of wrist/hand
  • CRPS = Sudeck's disease

• specific surgical risks
  • injury to the extensor tendons
  • prolonged scar pain (usually subsides after 6 months)
  • persistent complaints
  • revision surgery
  • two-stage tendon rupture

• intravenous regional anesthesia
• plexus anesthesia
• general anesthesia

• Supine positioning
• Positioning of the hand on a hand table
• Recommended: Application of upper arm tourniquet

• The surgeon should sit on the side where the leading hand points distally with the scissor tip
• Opposite, an assistant may sit
• The instrument nurse positions themselves at the head of the hand table

• It is recommended to establish an upper arm tourniquet
• A hand instrument set is used

Postoperative Analgesia

• Follow the link to PROSPECT (Procedures Specific Postoperative Pain Management).
• Follow the link to the current guideline Treatment of Acute Perioperative and Posttraumatic Pain.
• Possibly apply cold packs as a local physical measure.

Medical Follow-up Treatment

• Regular wound inspection, elastic compression bandage (Caution: constriction!) for 3 weeks
• Suture removal after 14 days
• Possibly recommend fatty ointment for scar care (special scar ointment not necessary)
• Release of load depending on tendon quality

Thrombosis Prophylaxis

• not applicable

Mobilization

• immediate

Physical Therapy:

• Active exercise therapy with possible physiotherapeutic support with full extension and fist closure of the fingers from the 1st postoperative day (prevents hand edema and finger stiffness).
• Specific hand therapeutic measures in advanced findings and risk of two-stage tendon rupture.

Dietary Build-up

• not applicable

Bowel Regulation

• not applicable

Incapacity for Work

• Generally 14-21 days depending on manual activity (maximum 6 weeks).