Tenolysis of Flexor Tendons

- See: Technique of Free Tendon Grafting

- Discussion:
    - indications for tenolysis include failure to improve ROM after 3 months;
    - if patient has had previous flexor tendon repair, surgery should be delayed until 6 months post op (inorder to avoid tendon rupture);
    - consider using a wrist block and propofol anesthesia, so that the patient can demonstrate active motion in the operating room (indicating whether the tenolysis has been successful);
    - surgical statedgy involves creating small windows in the flexor tendon sheath,  and using a periosteal elevator to elevate adhesions off the tendon;
           - in order to avoid having to make multiple incisions, loop a 24 gauge wire around the tendon  and push it along the tendon sheath (along the volar and dorsal sides);
                  - the wire will either break up adhesions, or will direct the surgeon to where resistant adhesions are located;
    - vigorous postoperative ROM is a must;
    - if tenolysis does not achieve sufficient ROM, repeated tenolysis is not indicated;
          - tenolysis should not take place before than 6 months after repair, because it may lead to tendon rupture;
          - outcome is not always consistent;
    - if tenolysis does not appear possible, the surgeon should move on to staged flexor tendon repair;

- Complications:
    - rupture of tendon repair;
    - edema;
    - neurovascular injury;
    - rupture of flexor pulleys

Flexor tenolysis

Tenolysis and capsulectomy after hand fractures

Complications in phalangeal and metacarpal fracture management. Results of tenolysis

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 31, 2012 1:50 pm