nsteinhauser
Expert
Debridement of the peroneal tendons has been discussed in this forum before but there are varying answers. There was no tear. Pre and post diagnosis was right peroneal tendinitis.
Op note: "There were many crossing veins. I did open the peroneal tendon sheath. The 2 tendons were in separate sheaths inferior to the fibula. The peroneal brevis was found to be intact within its tendon sheath, but did have inflammation and tenosynovitis around it. This was debrided with tenotomies. It was intact through the groove. The peroneal longus was sitting inferior to the brevis. It was very tight as it came through the inferior peroneal retinaculum. The retinaculum was opened and released distally as far as possible. There was a large peroneal tubercle that seemed to be rubbing on the peroneal longus. It was removed with a rongeur. I did leave some of the periosteum intact to be repaired at the end of the case. Peroneal longus was also intact with tenosynovitis, but no split tear."
There was no repair except the periosteum; retinaculum was opened but not repaired so 28200 doesn't seem correct. Would tenolysis be appropriate even though there aren't any named "adhesions"? And does tenolysis (28220 + 28222) include tenosynovectomy and the debridement? The lay description for 28086 includes synovectomy and debriding tenosynovial tissue. Is the 28086 appropriate?
Would appreciate any help.
Thanks!
Op note: "There were many crossing veins. I did open the peroneal tendon sheath. The 2 tendons were in separate sheaths inferior to the fibula. The peroneal brevis was found to be intact within its tendon sheath, but did have inflammation and tenosynovitis around it. This was debrided with tenotomies. It was intact through the groove. The peroneal longus was sitting inferior to the brevis. It was very tight as it came through the inferior peroneal retinaculum. The retinaculum was opened and released distally as far as possible. There was a large peroneal tubercle that seemed to be rubbing on the peroneal longus. It was removed with a rongeur. I did leave some of the periosteum intact to be repaired at the end of the case. Peroneal longus was also intact with tenosynovitis, but no split tear."
There was no repair except the periosteum; retinaculum was opened but not repaired so 28200 doesn't seem correct. Would tenolysis be appropriate even though there aren't any named "adhesions"? And does tenolysis (28220 + 28222) include tenosynovectomy and the debridement? The lay description for 28086 includes synovectomy and debriding tenosynovial tissue. Is the 28086 appropriate?
Would appreciate any help.
Thanks!