Sheri B Feldscher | PubMed Health

PubMed2002

Flexor tenolysis.

Tenolysis is a well-established salvage procedure, which can be applied when non-gliding adhesions form along the surface of a tendon after injury or repair and prevent gliding of the tendon in the performance of its intended function.(8,15,17,29,30,39,40,44,49) Tendon adhesions will occur whenever the surface of a tendon is damaged either through the injury itself, be it laceration or crush, or by surgical manipulation.(18) At any point on the surface of a tendon where violation occurs, an adhesion will form in the healing period.(20,26) When these adhesions cannot be mobilised by an adequate course of hand therapy, tenolysis should be considered. This procedure is as difficult or more so than tendon repair itself and should not be undertaken lightly. It represents another surgical incursion into an area of previous trauma and surgery. If the procedure is not successful, the patient's hand may show no improvement or even be worse. The risk of further decreasing the circulatory supply and innervation to an already deprived finger is a real one. Rupture of the lysed tendon, a disastrous complication, is the major hazard of tenolysis.

Contracture↗

PubMedDate not supplied

Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.

The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days. On postoperative day 8, hand therapy was initiated. Many challenges were encountered. Insurance constraints required the patient to change therapists. The device frame cracked. The patient developed a PIP joint contracture with extensor lag. Despite these obstacles, the patient achieved a successful outcome, returning to normal pain-free use with grip strength at 87% of that of the uninvolved hand. At discharge, active range of motion was 12 degrees/100 degrees at the PIP joint and 0 degrees/40 degrees at the DIP joint. Passive extension was 0 degrees. At 6 months postoperatively, active range of motion was 0 degrees/105 degrees at the PIP joint and 0 degrees/60 degrees at the DIP joint. This case demonstrates the need for closely supervised postoperative therapy that includes good communication between providers, ongoing patient education, and close monitoring of range of motion.

Chronic Disease↗