Chapter 16 Flexor Tenolysis
Surgical Overview
• The tenolysis procedure is performed under local anesthesia that is supplemented with an intravenous sedative drug. This allows for a thorough evaluation of AROM in which the patient is participatory.
• The involved flexor system is approached via a zigzag incision, long enough to expose the adhered tendon.
• The adhesions are excised with all efforts made to preserve the pulley systems, specifically the A2 and A4 pulleys.
• These pulleys are critical in maintaining the correct moment arm for the tendons to function most efficiently and prevent tendon bowstringing. Without the pulleys, more force is required to generate tension to produce full digital flexion.
• Joint contractures, if present, are released through a capsulectomy. During this procedure, the active motion is reevaluated frequently to confirm adequate tissue release.
• The tendon is assessed for gapping at the repair site. A tendon with a large gap that has filled in with scar tissue will be too long, inefficient, and prone to rupture.
Rehabilitation Overview
• Referral information should include the integrity of the lysed tendon, intraoperative AROM and PROM measures, digit vascularity, prognosis for motion, and any concomitant procedures performed, such as a capsulectomy or pulley reconstruction.
• A tendon of good quality, with intact pulleys, requires a more vigorous postoperative therapy program.
• When the quality is poor (also known as frayed tendon) and/or there is pulley reconstruction, a less aggressive approach is used to decrease the demands of the involved structures and reduce the risk of tendon rupture.
• General rehabilitation goals are to achieve and maintain intraoperative AROM/PROM, prevent adhesion formation, maximize tendon glide/excursion, and maximize strength for restoration of normal hand function.
