Author(s): 1,5Shalamar Medical College, Lahore; 2Christine Kleinert institute, Taiwan; 3Schenectady, New York, United States; 4Karolinska institute Sweden
Revised: 06/01/2024 | Pages: 16-19 | DOI: https://doi.org/10.5455/pjps.249-1686290393
Background: Hand trauma invariably leads to stiffness and reduced range of motion which may be attributed to adhesions and fibrosis. Flexor tenolysis involves resection of all adhesive tissue around the tendon inside and outside the tendon sheath. Many methods have been described in the literature for tenolysis, and all have their pros and cons.
Objective: This study seeks to present findings from employing our approach to treat stiff fingers, which involves tenolysis of both flexor and extensor tendons in patients under local anesthesia whereby patients can actively move their digits to facilitate complete release.
Methodology: A retrospective analysis was done of the charts of all the patients who underwent tenolysis with this method during the 4-year study period. All demographic and clinical data was recorded, including the initial trauma mechanism. The pre-operative and post-operative total active motion (TAM), and flexion lag, were noted and compared. Any complications were also documented.
Results: 34 hands (in 30 patients) were operated upon in the given period. Average age was 41 years. 19 patients were males, 11 were females. Average pre-operative TAM was 102o and average post-operative TAM was 2100. This result was statistically significant (p<0.05). There were no surgical complications seen.
Conclusion: complete removal of all adhesions around the flexor and extensor tendons greatly improves the active range of motion of involved digits. Moreover, performing the procedure under local anesthesia allows thepatient to vigorouslymovetheirfingersper-operatively, whichfacilitatesacompleteandeffective release.
Keywords | finger stiffness, tenolysis, hand trauma, total active motion
1.Coonrad RW, Pohlman MH. Impacted fractures in the proximal portion of the proximal phalanx of the finger. J Bone Joint Surg Am. 1969;51(7):1291-6.
2.Agee J. Treatment principles for proximal and middle phalangeal fractures. Orthop Clin North Am. 1992; 23(1):35-40.
3. Barton NJ. Fractures of the hand. J Bone Joint Surg Br. 1984;66(2):159-67.
4.Yamazaki H, Kato H, Uchiyama S, Ohmoto H, Minami A. Results of tenolysis for flexor tendon adhesion after phalangeal fracture. J Hand Surg Eur Vol. 2008; 33(5): 557-60.
5.Fetrow KO. Tenolysis in the hand and wrist. A clinical evaluation of two hundred and twenty flexor and exten- sor tenolyses. J Bone Joint Surg Am. 1967;49(4):667- 85.
6.Libberecht K, Lafaire C, Van Hee R. Evaluation and functional assessment of flexor tendon repair in the hand. Acta Chir Belg. 2006;106(5):560-5.
7.Kulkarni M, Harris SB, Elliot D. The significance of extensor tendon tethering and dorsal joint capsule tightening after injury to the hand. J Hand Surg Br. 2006;31(1):52-60.
8.Tang JB, Gong KT, Xing SG, Yi L, Xu JH. Wide-Awake Hand Surgery in Two Centers in China: Experience in Nantong and Tianjin with 12,000 patients. Hand Clin. 2019;35(1):7-12. doi: 10.1016/j.hcl.2018.08.011.
9.Ahmad F, Fitch A, Obioha OA, Fernandez JJ, Cohen MS, Simcock X, Wysocki RW. Traction Tenolysis for Flexor Tendon Adhesions: Outcomes in 97 Patients. J Hand Surg Am. 2024;49(1):65.e1-65.e6.
10. Schneider LH. Tenolysis and capsulectomy after hand fractures. Clin Orthop Relat Res. 1996;(327):72-8.
11.Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: Acomparison of immo- bilization and controlled passive motion techniques. J Hand Surg Am. 1980;5(6):537-43.
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