Tenolysis of flexor tendons

Overview

• Flexor tendon tenolysis is a difficult procedure, in which it is frequently more challenging to obtain a good outcome than primary tendon repair, and should not be taken lightly without ensuring patient cooperation. Patient selection plays an important role in successful tenolysis.

• If both flexor and extensor tenolysis and joint releases are needed, the procedures should be performed in two stages. The first stage begins with the dorsal side, followed by aggressive postoperative rehabilitation. Release of flexion contractures and flexor tenolysis should be done at a second stage, again followed by aggressive postoperative rehabilitation.

Indications

• In patients without radiographic joint abnormalities, range of motion (ROM) limitation can be attributable to joint contracture or tendon adhesions. If joint contracture exists, both active and passive ROM are limited but equal. Tendon adhesions are suspected when the patient shows greater limitation in active ROM (tendon excursion is curtailed) than passive ROM (joint is freely mobile; i.e., there is an active-passive discrepancy).

• Tenolysis is recommended after failure to improve active motion or plateau in active motion without improvement for at least 6 weeks with aggressive therapy.

• Tenolysis is performed at least 6 months after primary tendon repair. This minimum time allows for scar maturation, stabilization of the initial inflammatory process, and resolution of edema and permits healing of tendons so that they are strong enough to endure the removal of adhesions that serve as the extrinsic blood supply. Skin must be soft and pliable before tenolysis. Any operation in an already inflamed tissue bed will further limit digit ROM and decrease the chances of a successful outcome.

Imaging

Radiographs may be indicated to rule out an associated joint abnormality.