Preoperative Diagnosis: Right middle finger extensor contrac…

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Case 15
Preoperative Diagnosis: Right middle finger extensor contracture.
Postoperative Diagnosis: Same
Operative Procedure: Right middle finger extensor tenolysis and partial collateral ligament incision metacarpophalangeal joint.
Indications For Procedure: This is a 25-year-old right dominant painter, who complains of right middle finger pain at the MP joint. He originally underwent a bone grafting of a giant cell tumor in the metacarpal approximately two years ago. Since then, he has had considerable discomfort in the MP joint, with difficulty extending and flexing the finger. He has had extensive therapy without relief of his symptoms.
His physical examination shows flexion to approximately 75 degrees, without full active extension.
Procedure: After adequate median, dorsal, radial, and ulnar sensory nerve blocks with Lidocaine 2% and Marcaine 0.5%, equal volumes, 20 cc total, the right upper extremity was prepped and draped in the usual sterile fashion. The arm was exsanguinated and forearm tourniquet inflated to 250 mm of mercury.
A pre-existing longitudinal surgical scar over the MP joint was extended proximally the distance of 1 cm. This dissection was carried down through the skin and subcutaneous tissues. An extensive amount of scar tissue was encountered just above the sagittal bends. This was resected, and sent to pathology. The extensor tendon was then identified, firmly adherent to the sagittal band. Tenolysis was begun at this level, which was slightly proximal to the MP joint. A combination of blunt and sharp dissection was used. Primarily scissors were used to free up the sagittal band in the tunnel through which the tendon could pass. At the completion of the tenolysis, the MP joint could be passively and fully extended by placing pressure on the tendon. Passive flexion was achievable to approximately 80 degrees. It was felt to be improved, but not completely resolved.
It was, therefore, elected to perform a partial resection of the collateral ligament. Sharp dissection was placed through the sagittal bands, down to the capsule. A mini-arthrotomy measuring about 4 mm, was extended over the insertion of the collateral ligament, and using a #69 beaver blade, they were resected. The flexion was then improved to approximately 90 degrees. Hyperflexion to 100 degrees was not achievable with this procedure. However, it was felt to be sufficient so that he would have a functional range of motion and a good grip.
 
The wound was thoroughly irrigated. The tourniquet was released, and hemostasis was achieved after five minutes of digital pressure. The skin was reapproximated with Ethilon 4-0 suture, using the horizontal mattress technique. A light dressing with Coban was applied. The patient tolerated the procedure well, and was taken to the recovery room in stable condition.
 
ICD-10-CM Code: 
 
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