| ICD-9-CM: |
| 80.7 - | Synovectomy; Resection of Synovial Membrane, Complete or Partial |
| 80.70 - | Synovectomy, Unspecified Site |
| 80.71 - | Synovectomy, Shoulder |
| 80.72 - | Synovectomy, Elbow |
| 80.73 - | Synovectomy, Wrist |
| 80.74 - | Synovectomy, Hand and Finger |
| 80.75 - | Synovectomy, Hip |
| 80.76 - | Synovectomy, Knee |
| 80.77 - | Synovectomy, Ankle |
| 80.78 - | Synovectomy, Foot and Toe |
| 80.79 - | Synovectomy, Other Specified Site, Spine |
| A synovectomy is the surgical removal of the thin membrane lining a joint capsule (synovium). The joint is opened (arthrotomy) and the synovium is cut away. This can be done as an open procedure or be performed by means of arthroscopy, using small incisions around the joint.
Synovectomy is a temporary solution to problems of swollen synovium (synovitis). Joint motion, pain, and swelling are usually improved and cartilage destruction diminished for about 2 years. After that time, further surgery may be required.
Synovitis is part of a disease process, and the need for synovectomy will depend on the course of the underlying condition.
Individuals at risk of synovitis are the most likely candidates for this procedure. This includes those with rheumatoid arthritis, joint infection, joint trauma, exposure to toxins, arthritis secondary to hemophilia (hemophiliac arthritis) and pigmented villonodular synovitis (an idiopathic joint disorder resulting from brownish-colored nodular growth in the villi of the synovium). |
Source: Medical Disability Advisor
| Removal of the thin membrane lining a joint capsule (synovium) is done to reduce the symptoms of pain and swelling due to recurrent or persistent synovial inflammation (synovitis). This procedure usually is performed only if the condition is severely disabling or if the condition has not responded to other, more conservative methods of treatment, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antirheumatic drugs (for rheumatoid arthritis), or the injection of corticosteroid drugs into the joint itself.
Contraindications for synovectomy include significant restriction in joint motion or significant joint degeneration. |
Source: Medical Disability Advisor
| Local, regional, or general anesthesia is used depending on the location of the joint, amount of synovium to be removed, and the technique employed. The procedure can be performed in an outpatient or inpatient setting, depending on the technique.
In an open procedure, the joint capsule is exposed through an incision over the affected joint (arthrotomy). The lining is identified and removed by scraping and cutting. A soft pressure dressing is applied to control swelling. Early limited joint motion is encouraged to prevent scar tissue (adhesions) from forming in the joint that would limit range of motion.
More often, a synovectomy is performed arthroscopically. A thin, fiberoptic surgical and viewing instrument (arthroscope) is inserted into the joint space through a small skin incision to visualize the interior of the joint. Instruments are then inserted into the joint through 4 or 5 other tiny incisions (portals) to cut away the synovium. An irrigation solution is infused into the joint to help clear the area of debris created during the procedure. The arthroscopic approach is generally less invasive and requires only a few small incisions. Consequently, less tissue trauma is associated with arthroscopic surgery than with open surgery, resulting in a shorter hospital stay, reduced postoperative joint stiffness, and a more complete synovectomy. After the surgery, a pressure dressing is applied and the joint is kept mobile to inhibit scarring. |
Source: Medical Disability Advisor
| Temporary relief of pain, swelling, and decreased range of motion is expected. Synovectomy does not remove the cause of synovitis, so relief of symptoms may not be permanent. Ongoing management of the underlying disease process will influence successful outcome. |
Source: Medical Disability Advisor
| Note on research and authorship The goal of rehabilitation after synovectomy is to decrease pain and to restore function. The intensity and duration of rehabilitation depend on the underlying condition, the involved body part, and the preoperative functional status of the individual.
Modalities such as heat and cold are used to control pain and swelling (Braddom). If the lower extremity is involved, assistive devices may be used to promote independent ambulation, although typically weight bearing is not limited. Individuals may be instructed in gentle range of motion and strengthening exercises to be continued independently in order to preserve joint mobility and function.
Limited supervised rehabilitation is indicated in most cases. Prior to discharge from therapy, individuals should be educated in ways to protect the involved joint and in self care, including a home exercise program. If impaired function persists, modifications in lifestyle and the workplace may be recommended by an occupational therapist or ergonomists (Ruddy). |
| FREQUENCY OF REHABILITATION VISITS | | Surgical | |
| Physical or Occupational Therapist | | Up to 20 visits within 8 weeks | |
|
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Possible complications include infection, bleeding into the joint (hemarthrosis), nerve and vessel damage, damage to bone surface (articular cartilage), and no relief of symptoms.
Radionuclide synovectomy is generally associated with fewer hemorrhagic episodes than the arthroscopic or open approaches. However, leakage (extravasation) of the radionuclide substance outside the joint space, causing localized tissue death (necrosis), has been reported as a rare complication of the procedure. |
Source: Medical Disability Advisor
| Limited work loading of the affected joint is an appropriate restriction. This may include no lifting, carrying, gripping, twisting, pushing or pulling, standing, squatting, or kneeling, depending on the joint(s) involved. Periods of rest and time for rehabilitation may be necessary.
Individuals may be required to use devices to assist with ambulation such as crutches, canes, or walkers. Worksite modification may be necessary to accommodate the use of these assistive devices safely.
Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. |
Source: Medical Disability Advisor
| Braddom, Randolph L. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: W.B. Saunders, 2000.Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. 6th ed. Philadelphia: W.B. Saunders, 2001. |
Source: Medical Disability Advisor
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