Having a hard time coming up with codes, any input would be great.

1. Explore the flexor carpi radialis tendon sheath.

2. Excision tuberosity scaphoid and trapezium.

3. Resection distal surface of the scaphoid.

4. Interposition with palmaris longus tendon.

A curvilinear incision was made along the base of the thumb along with thenar of eminece and wrist flexion crease. Soft tissue flaps were elevated. The flexor tendon sheath of the flexor carpi radialis tendon was incised. The palmar cutaneous branch of the median nerve was identified and located medial to the are of incision. Futher exposure we released the tuberosity of the scaphoid and trapezium exploring the flexor carpi radialis tendon throughout its length. There was a partial rupture of the tendon. There was heterotopic bone and osteophytes coming from the scapghtrapezial joint. There was loss of articular cartilage involving the distal scaphoid and base of the thumb . Using an osteotome we resected the articular surface of the scaphoid. The defect that remained was filled with tendon into the position using a palmaris longus tendon that was rolled on itself and placed into the interval between the thumb trapezium and distal scaphoid. The soft tissue that had been elevated off the trapesium scaphoid was the sewn over the area which is capsular tissue with 4-0 Vicryl to hold the tendonin place. The plamaris tendon was harvasted proximally through a seperate insicion and divided at the musculatendinous juction then delivered distally and then sewn onto istself for the tendon into position.