Preoperative Patient Care A Outpatient Evaluation and Management 1 Obtain focused history and performs focused exam concomitant and associated orthopaedic injuries 2 Prescribes and manages nonoperative treatment attempts trial of physical therapy orders appropriate orthosis 3 Makes informed decision to proceed with operative treatment documents failure of nonoperative management describes accepted indications and contraindications for surgical intervention 4 Provides postoperative management and rehabilitation 1 week postoperative visit remove splint diagnose and management of early complications start range of motion exercises start scar massage by 2 weeks B Advanced Evaluation and Management 1 Provides post-op management and rehabilitation gradually increase range of motion C Preoperative H & P 1 Perform basic medical and orthopaedic history and physical check neurovascular status check range of motion 2 Perform operative consent describe complications of surgery including wound complications neurovascular injury stiffness Operative Techniques E Preoperative Plan 1 Execute surgical walkthrough describe the steps of the procedure verbally prior to the start of the case 2 Description of potential complications and steps to avoid them F Room Preparation 1 Surgical Instrumentation loupe magnification 2 Room setup and Equipment standard operating table hand table 3 Patient Positioning patient placed in the supine position with hand on hand table place tourniquet high on the affected extremity G Transverse Incision 1 Identify ganglion cyst the cyst is typically dorsal to the scapholunate ligament the scapholunate ligament is typically distal to Lister`s tubercle in the third and fourth compartment interval 2 Mark the transverse incision mark the incision over the scapholunate ligament and entire cyst 3 Make transverse incision be sure to include the scapholunate ligament in the incision H Deep Dissection 1 Dissect through subcutaneous tissue use blunt dissection 2 Identify and protect neurovascular stuctures protect and preserve any branches of the dorsal radial and ulnar sensory nerves 3 Incise the extensor retinaculum in a transverse fashion I Cyst Visualization 1 Identify the cyst the cyst is usually between the third and fourth extensor compartments 2 Visualize the entire cyst retract the tendons of the second and third compartment radially retract the tendons of the fourth compartment ulnarly J Cyst Excision 1 Identify stalk of the cyst incise the dorsal wrist capsule transversely trace the cyst down to the stalk the stalk usually arises from the dorsal aspect of the scapholunate interosseous membrane 2 Excise the cyst at the base of the stalk 3 Send the specimen to pathology 4 Cauterize the site of origin use bipolar cautery K Joint Inspection 1 Inspect the joint for any abnormalities 2 Allow the capsular tissues and tendons to return to their anatomic position avoid closure of the capsule to prevent joint stiffness L Wound Closure 1 Irrigation and hemostasis copiously irrigate the wound 2 Superficial closure use running subcuticular nonabsorbable monofilament suture 3 Dressing and immediate immobilization dress with antibiotic ointment place a bulky hand dressing and a plaster palmar splint in the neutral position Postoperative Patient Care O Perioperative Inpatient Management 1 Write comprehensive postoperative orders remove splint in one week pain management 2 Discharges patient appropriately write for pain meds schedule follow up appointment in 1 week R Complex Patient Care 1 Comprehensive pre-op planning/alternatives. 2 Modify and adjust post-op plan as needed
A Outpatient Evaluation and Management 1 Obtain focused history and performs focused exam concomitant and associated orthopaedic injuries 2 Prescribes and manages nonoperative treatment attempts trial of physical therapy orders appropriate orthosis 3 Makes informed decision to proceed with operative treatment documents failure of nonoperative management describes accepted indications and contraindications for surgical intervention 4 Provides postoperative management and rehabilitation 1 week postoperative visit remove splint diagnose and management of early complications start range of motion exercises start scar massage by 2 weeks B Advanced Evaluation and Management 1 Provides post-op management and rehabilitation gradually increase range of motion C Preoperative H & P 1 Perform basic medical and orthopaedic history and physical check neurovascular status check range of motion 2 Perform operative consent describe complications of surgery including wound complications neurovascular injury stiffness
E Preoperative Plan 1 Execute surgical walkthrough describe the steps of the procedure verbally prior to the start of the case 2 Description of potential complications and steps to avoid them F Room Preparation 1 Surgical Instrumentation loupe magnification 2 Room setup and Equipment standard operating table hand table 3 Patient Positioning patient placed in the supine position with hand on hand table place tourniquet high on the affected extremity G Transverse Incision 1 Identify ganglion cyst the cyst is typically dorsal to the scapholunate ligament the scapholunate ligament is typically distal to Lister`s tubercle in the third and fourth compartment interval 2 Mark the transverse incision mark the incision over the scapholunate ligament and entire cyst 3 Make transverse incision be sure to include the scapholunate ligament in the incision H Deep Dissection 1 Dissect through subcutaneous tissue use blunt dissection 2 Identify and protect neurovascular stuctures protect and preserve any branches of the dorsal radial and ulnar sensory nerves 3 Incise the extensor retinaculum in a transverse fashion I Cyst Visualization 1 Identify the cyst the cyst is usually between the third and fourth extensor compartments 2 Visualize the entire cyst retract the tendons of the second and third compartment radially retract the tendons of the fourth compartment ulnarly J Cyst Excision 1 Identify stalk of the cyst incise the dorsal wrist capsule transversely trace the cyst down to the stalk the stalk usually arises from the dorsal aspect of the scapholunate interosseous membrane 2 Excise the cyst at the base of the stalk 3 Send the specimen to pathology 4 Cauterize the site of origin use bipolar cautery K Joint Inspection 1 Inspect the joint for any abnormalities 2 Allow the capsular tissues and tendons to return to their anatomic position avoid closure of the capsule to prevent joint stiffness L Wound Closure 1 Irrigation and hemostasis copiously irrigate the wound 2 Superficial closure use running subcuticular nonabsorbable monofilament suture 3 Dressing and immediate immobilization dress with antibiotic ointment place a bulky hand dressing and a plaster palmar splint in the neutral position
O Perioperative Inpatient Management 1 Write comprehensive postoperative orders remove splint in one week pain management 2 Discharges patient appropriately write for pain meds schedule follow up appointment in 1 week R Complex Patient Care 1 Comprehensive pre-op planning/alternatives. 2 Modify and adjust post-op plan as needed