get rid

Video - surgical excision of a rheumatoid nodule

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you

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you

a rheumatoid nodule is a local swelling

usually quite firm to the touch a little

bit like it on right fruit it curves

almost exclusively in association with

rheumatoid arthritis and is usually

subcutaneous especially over a bony

prominence such as underneath the

metatarsal phalangeal joints or the

electron on of the elbow

patron coming up is a delightful ladies

have rheumatoid arthritis for over 20

years she's been on anti TNF switch

incidentally she stopped for the surgery

and she's got a swelling about the size

of a kidney bean some the first

metatarsal phalangeal joint over the

tibial sesamoid where it's really quite

sore so the plan is to remove we will of

course then don't center histo for

confirmation and this is karen doing the

skin prep and we're in theater now so

here is our lesion it's about the size

of a 2 DB underneath the first

metatarsal phalangeal joint patient is

rheumatoid so rheumatoid 90 would be my

go-to thought for diagnosis I'm gonna

come just on the side of it rather than

going directly over it

kind of wants to come out sooner or

later some smidley scissors please -

he's a lot of stuff

got the skin looks please account

how's my favorite scrub nose to work

with because she's got the same sense of

humor as I have

so Karen had a patient this morning had

to do a prostate exam on him and he said

there where should I put my trousers mr.

lile I said I'll put on the back of the

chair next to mine so he knows normally

this is done with the scrub nurse who's

not like who is that it might deploy

this surely buggy moments

so what I'm trying to do Luke is blood

bisect as much as possible there's a bit

more attention to spitting sharp on the

top side so to speak yes

so I'll try to stick close to the region

and so if war comes out so rather than

doing that that court they have almost

we've just kind of stroking it there's a

reason it's a decent-sized caveat for

sanctions yet so what feels good now

what I can feel there which is the

tibial sesamoid I'm just right on it

there it's the smoothest there so you do

lose a little bit of pattern there

sometimes when you get these these

modules you take them out you do lose a

bit of the padding that they've created

so we can get a bit of metatarsalgia

afterwards but that's it

okay we're gonna go there we go straight

to skip it's it's really forcing thank

you sister

yes

Oh awesome

yeah to count Pete - great

Joss Joss and that's it done

I saw the sample goes off to his still

all soft tissue samples Katya stone will

dress it now stitch from stain two weeks

and we hopefully out the histone result

for the patient we imagined would be my

my best guess for that so my patient was

back at two weeks the stitches out the

wound was progressing very well sutures

were removed nothing abnormal with the

wound at all she was progressing very

nicely indeed by that stage I'd had the

histone report it was indeed a

rheumatoid nodule so we're now happy to

start her back on the anti TNF typically

I'll keep the patients in the bandage

for two to four weeks just to make sure

that wound really heals and I do a

six-month long term with you but this is

a just a short example of the surgical

technique for removal thank

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