CPT® Code 29901

1. Indications

The procedure is indicated for patients experiencing conditions that affect the metacarpophalangeal joint, particularly those that lead to pain, inflammation, and impaired function. The following are specific indications for performing arthroscopy with debridement:

• Arthritis - This includes osteoarthritis and rheumatoid arthritis, which can cause joint pain and degeneration.
• Joint Injury - Trauma to the MCP joint that results in damage to the cartilage or surrounding structures.
• Loose Bodies - Presence of loose fragments of bone or cartilage within the joint that can cause pain and limit movement.
• Synovitis - Inflammation of the synovial membrane that can lead to swelling and discomfort in the joint.

2. Procedure

The procedure involves several key steps to ensure effective treatment of the metacarpophalangeal joint. Each step is crucial for achieving the desired outcome.

• Step 1: Portal Incision - The surgeon begins by making small incisions, known as portals, on the dorsal side of the hand, specifically at the dorsal-ulnar and dorsal-radial aspects of the metacarpophalangeal joint. These incisions provide access to the joint while minimizing tissue damage.
• Step 2: Blunt Dissection - Using a small hemostat, the surgeon performs blunt dissection to carefully navigate through the soft tissues until reaching the joint capsule. This technique helps to preserve surrounding structures while allowing access to the joint.
• Step 3: Joint Access - Once the joint capsule is reached, the hemostat is utilized to gently spread the capsule, creating an entry point into the joint space. This step is critical for introducing the arthroscope.
• Step 4: Arthroscope Introduction - The arthroscope, equipped with a camera and light source, is inserted through one of the portals. This allows the surgeon to visualize the interior of the joint on a monitor, facilitating inspection for any signs of injury, disease, or infection.
• Step 5: Debridement - A motorized shaver is employed to remove redundant cartilage, inflamed tissue, and bone spurs (osteophytes) from the joint surfaces. This debridement process is essential for smoothing the joint surfaces and alleviating symptoms.
• Step 6: Removal of Loose Fragments - Any loose fragments of bone or cartilage identified during the inspection are carefully removed to prevent further irritation and improve joint function.
• Step 7: Joint Flushing - After debridement, the joint is flushed with saline solution to clear away any remaining debris, ensuring a clean environment for healing.
• Step 8: Closure - Upon completion of the procedure, the arthroscope and surgical tools are withdrawn, and the portal incisions are closed, typically with sutures or adhesive strips.

3. Post-Procedure

Following the arthroscopy and debridement of the metacarpophalangeal joint, patients can expect a recovery period that may vary based on individual circumstances and the extent of the procedure. Post-procedure care typically includes rest, ice application to reduce swelling, and elevation of the hand to promote healing. Patients may be advised to engage in physical therapy to restore range of motion and strength in the joint. Follow-up appointments are essential to monitor healing and assess the need for any additional interventions. It is important for patients to adhere to their healthcare provider's instructions regarding activity restrictions and rehabilitation exercises to ensure optimal recovery.