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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...
Treatment It is critical to begin treating early phases of carpal tunnel syndrome before the damage progresses. A conservative approach to CTS, which may include corticosteroid injections and splinting, is the first step in treating this disorder. The conservative approach is most successful in patients with mild carpal tunnel syndrome. If the initial treatment doesn't improve symptoms in 2 - 7 weeks, another treatment or surgery should be tried. Some patients may start with surgery if there is evidence of nerve damage. Studies suggest that surgery is a better option for severe CTS. Surgery improves function and symptoms better than splinting or anti-inflammatory drugs plus hand therapy over the long term. The improvements last for more than 6 months. Even among patients with mild CTS, there is a high risk of relapse. Some researchers are reporting better results when specific exercises for carpal tunnel syndrome are added to the program of treatments. Limiting Movement. If possible, the ...
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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