CPT® Code 26518

1. Indications

The capsulodesis procedure is indicated for patients presenting with specific deformities of the metacarpophalangeal (MCP) joint. These indications include:

• Flexion Deformity - A condition where the finger is abnormally bent towards the palm, limiting extension and function.
• Extension Deformity - A condition where the finger cannot flex properly, leading to difficulties in grasping and manipulation.

2. Procedure

The capsulodesis procedure involves several critical steps to ensure effective correction of the MCP joint deformity. The steps are as follows:

• Step 1: Incision - The procedure begins with the surgeon making an incision over the affected MCP joint. This incision allows access to the underlying anatomical structures necessary for the correction.
• Step 2: Exposure of the Flexor Pollicis Longus - Once the incision is made, the flexor pollicis longus tendon is carefully exposed. This tendon plays a significant role in finger movement and must be handled with care during the procedure.
• Step 3: Tendon Sheath Excision - A portion of the tendon sheath surrounding the flexor pollicis longus is excised. This step is crucial for providing adequate access to the volar plate and facilitating the correction of the deformity.
• Step 4: Exposure of the Volar Plate - The tendon is retracted to expose the volar plate, which is an important structure that stabilizes the MCP joint. The surgeon then incises the volar plate at its proximal and lateral attachments, effectively dividing the intrinsic muscles while leaving the distal attachment intact.
• Step 5: Positioning the Finger - The finger is positioned in a slightly flexed position. This positioning is essential to maximize the functional outcome of the procedure, allowing for improved movement post-surgery.
• Step 6: Securing the Volar Plate - The volar plate is placed in direct contact with the metacarpal neck. To maintain this position, the bone is drilled, and a Kirschner wire is inserted. This wire holds the volar plate against the metacarpal bone, ensuring that the finger remains in the desired position during the healing process.

3. Post-Procedure

After the capsulodesis procedure, patients can expect a recovery period that may involve immobilization of the finger to allow for proper healing. The Kirschner wire will typically remain in place for a specified duration, during which the patient may need to follow specific care instructions to prevent complications. Rehabilitation exercises may be recommended to restore function and mobility to the finger once healing has progressed. Follow-up appointments will be necessary to monitor the healing process and to determine when it is appropriate to begin more active rehabilitation.