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S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | A U G U S T 2 0 1 4
tient setting. It involves debriding the origin of the extensor carpi radialis brevis
(ECRB) tendon arthroscopically or through a small incision. As with carpal tunnel
release, clinical studies have shown similar outcomes for both techniques.
It should be noted that 80% of tennis elbow cases resolve over time. I'll treat
patients conservatively with physical therapy or injections for 6 months to a year
before resorting to surgery to address lingering discomfort.
• Wrist arthroscopies,
which I perform the overwhelming majority of in the out-
patient setting, involve burrs to remove bony prominences or shavers to debride
other areas before repairing torn structures. For example, the triangular fibrocar-
tilage complex (TFCC) is located on the small finger side of the wrist. Like the
knee's meniscus, it's commonly torn with twisting activities. When torn in its
periphery, it can be repaired arthroscopically. When torn centrally, however,
debridement is typically the best treatment option.
• Trauma fractures
such as distal radius fractures and severe finger fractures are
extremely common repairs. So, too, are fractures of the scaphoid, one of the
wrist's carpal bones. These breaks are often mistaken for severe sprains, but mis-
diagnosis results in high morbidity and can cause problematic non-union — the
failure of a broken bone to heal.
Revving up with regional
A good regional anesthesia program allows
procedures historically performed in a hospital
or inpatient setting to be done in the outpa-
tient arena, including bony complex cases
such as distal fractures, elbow fractures,
osteotomies and partial or total wrist fusions.
Ultrasound-guided blocks for procedures performed on the upper arm, elbow or
wrist involve combinations of interscalene, supraclavicular and axillary. They help
control post-op pain, but in many of these cases they're used as the primary modali-
ty of intraoperative pain control to avoid the need for general anesthesia. That is
U P P E R E X T R E M I T I E S
VISUAL AID Compact C-arms provide intraopera-
tive imaging without limiting surgeon and staff
maneuverability.
Pamela
Bevelhymer,
RN,
BSN
