Tendon Release Surgery

Tendon release surgery: Dallas Fort Worth Hand Surgeons Review Tendonitis and De Quervain’s Tenosynovitis.

Dr. David and Solomon Azouz review Tendonitis and Tendon release surgery: symptoms, surgical and non-surgical treatment, cost, insurance, and recovery.

What is Tendonitis? What is De Quervain’s Tenosynovitis?

Tendon release surgery treats Tendonitis, which refers to inflammation of the tendon and/or tendon sheath. De Quervain’s tenosynovitis is a painful case of tendonitis where the tendons affecting the thumb on the side of the wrist are painful and swollen.

Tendonitis can be caused by repetitive movement over time. However, some patients do develop tendonitis after a sudden injury. Many people develop tendonitis due to repetitive work injury however, musicians, pregnant women, women with new babies, and woodworkers are also at higher risk.

Symptoms of tendonitis:

An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) that stresses soft-tissue structures
Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, and thyroid disorders.
Overuse of the tendon.
Occasionally an infection can cause tendinitis

Any muscle/tendon unit can develop tendonitis however Dequervains Tendosynovitis is one of the most common and symptoms include:

Pain near the base of the thumb
swelling near the base of the thumb
pain and limited range of motion when moving the wrist while holding the thumb
the feeling of “sticking” when moving the thumb
pain when pushing on the tendons of the wrist connecting to the thumb

Surgical Management of Tendonitis

There are many tendons throughout the body that travel in compartments. The first dorsal compartment of the wrist is a common location where the tendons to the thumb become constricted, leading to pain, swelling, and loss of function. A first dorsal compartment release allows the tendons to be free of a point of constriction. Patients who have failed medical management, have a loss of function, and have severe pain are candidates for compartment release.

During tendon release surgery, Dr. Azouz utilizes local, regional, and sedation for patients undergoing hand surgery. In the majority of cases, this is not performed with general anesthesia and intubation. This means the patient is “asleep” but breathing without the use of a ventilator. Anesthesia terminology can be confusing and definitions can be seen below.

Local anesthesia: The area where the operation is numbed with medication to make the area pain-free. Local anesthesia typically lasts between six to eight hours.
Regional anesthesia: The surrounding area and the area where the surgery is numbed with medication to make the area pain-free. Regional anesthesia typically lasts between twelve and twenty-four hours.
Axillary block: an axillary block is a specialized form of regional anesthesia where the upper extremity is numbed to prevent pain during and after surgery. An axillary block can last for up to twenty-four hours or longer.
Sedation: sedation is twilight anesthesia where the patient is in a dream state and does not typically remember the surgery. Sedation can be made more or less sleepy according to their preference. This is sometimes referred to as deep or light sedation.
General anesthesia and intubation: The patient is unconscious (asleep), and a machine is used to breathe for the patient by placing a tube past the vocal cords into the airway.

During tendon release surgery, Dr. Azouz will mark his incisions and the extremity to be operated on on the day of surgery. The hand, wrist, and upper extremities are numbed. The patient is sedated and often does not remember the surgery. Dr. Azouz protects the nerves and tendons during surgery. The offending compartment is released. In the case of de Quervain’s tenosynovitis, the first dorsal compartment of the wrist is released. The patient is sent home the same day from surgery and typically does not have any pain for many hours after the surgery. Patients are given a prescription for pain medication which serves to treat pain after the numbing medication wears off. Patients are placed in a specialized elevation pillow and splint. Patients are followed up for suture removal in the office and may begin hand therapy if necessary.