In the previous post, we discussed different types of surgeries which are used in patients with rheumatoid arthritis . This week I’d like to talk more about surgeries involving soft-tissue, specifically synovectomy, tendon repair, and carpal tunnel release.
What is a Synovectomy?
The synonium is a membrane surrounded a joint, usually only one or two cell layers thick, which produces synovial fluid to help lubricate the joint. In rheumatoid arthritis, the synovium becomes inflamed and may grow excessively, producing too much synovial fluid containing an enzyme that can eat away at the cartilage on the joint surface. Disease-modifying anti-rheumatic drugs (DMARDs) are used to control the abnormal growth of synovium.
If DMARDs do not work, a patient’s rheumatologist may suggest steroid injections into a joint or a needle aspiration of excess synovial fluid. If these strategies do not work, then the patient may be referred to an orth...
I just saw the following question:
I recently had carpal tunnel surgery on both hands at the beginning of June. It's now late July and my blood sugar levels are still in the 230s. I take Lantus twice a day. What can I do? I have a constant headache, jaw pain, teeth hurt; can this be making my level stay high?
Something doesn’t quite fit together here. As I understand it, you have had elevated blood glucose levels continuously since hand surgery that was done almost two months ago.
Surgery certainly can cause pain, and pain is a stressor that can raise blood sugar levels. Plus, after most surgical procedures, there’s decreased physical activity for a while, which also would contribute to high sugar levels. With that in mind, I think people with diabetes who are on insulin shots or pumps should be given explicit instructions on what target ranges to aim for post-operatively, and how to adjust their insulin to meet these targets.
As the story was unfolding in Part One , I shared that my neurologist had referred me to a hand surgeon to be evaluated for treatment of Carpal Tunnel Syndrome. The hand surgeon injected steroids into each wrist which relieved the swelling, pain, and dysfunction. He stated that when/if the pain returned that my next step would be Carpal Tunnel Release surgery, a procedure I was greatly fearful of and didn’t want to undergo. However, he also referred me to a rheumatologist to be evaluated.
My first appointment with the rheumatologist was exactly two years ago. I brought to the appointment: x-rays of the swollen (and immobile) finger, a note detailing my symptoms and attempted treatments, and a history of blood work. The rheumatologist used a nifty ultrasound machine to detect inflammation around the joints and possible erosion of the bones in the joints due to arthritis. The evidence seen on ultrasound combined with the examination, my hi...
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