• Tenolysis

    (Tendolysis)

    Definition

    Tenolysis is surgery to release a tendon affected by adhesions. A tendon is a type of tissue that connects muscle to bone. An adhesion happens when scar tissue forms and binds tendons to surrounding tissue. This can make it difficult for the affected body part to work correctly. For example, adhesion in the fingers can cause the tendons to become stuck. This prevents the fingers from being able to move properly.
    This surgery is often done on hands and wrists.
    Tendons in Finger
    Finger Tendon
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    You may have tendon adhesions if you had an injury to the area or if you had surgery that affected the tendon. Tenolysis is done when other therapies, like physical therapy, are unsuccessful.
    In addition to tenolysis, the doctor may need to do other procedures. The goal is to have full movement of the affected body part.

    Possible Complications

    Complications are rare. But no procedure is completely free of risk. If you are planning to have a tenolysis, your doctor will review a list of possible complications:
    • Damage to nerves or other nearby structures
    • Inability to have full movement of the affected body part
    • Pain and stiffness
    • Infection
    • Amputation
    Factors that may increase the risk of complications include:
    Discuss these risks with your doctor before surgery.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam—The doctor may check the range of motion of the affected body part by asking you to do different exercises and motions.
    • Blood and urine tests
    • MRI scan —This test uses magnetic waves to make pictures of structures inside the body.
    • Talk to you about your medicines—You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners (eg, warfarin , clopidogrel )
    Before the procedure:
    • Arrange for a ride to and from the hospital.
    • If general anesthesia will be used, do not eat or drink anything six hours before the surgery.

    Anesthesia

    Anesthesia will prevent pain during the procedure. Local anesthesia will be injected under your skin. It may also be given as a nerve block. This is an injection of anesthetic into the area where the nerves run. Depending on your condition, general anesthesia may be used instead.

    Description of the Procedure

    A tourniquet will be tied near the area where the surgery will occur. This will prevent blood flow to that area. The doctor will make an incision in the skin to expose the tendon and surrounding tissue. The tissue will be cut to release the tendon. During surgery, the doctor will check your ability to move the affected body part. Based on your abilities, the doctor can assess if the procedure is working or if additional procedures need to be done. This may include reconstructing the tendon. The incision will be closed with stitches.

    Immediately After Procedure

    You will have heavy bandages on the incision area. These bandages will be replaced with lighter ones later so that you can work with a therapist on regaining movement of the affected body part. Depending on the location of the surgery, you may also need a splint.

    How Long Will It Take?

    This depends on which tendon is affected and how bad the adhesions are. For example, if you injured the flexor tendon in your finger, it can take 45-60 minutes to repair.

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Pain or soreness during recovery will be managed with pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 1-2 days. If you have any problems, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    You will work with the staff on exercises to regain movement of the affected body part.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Your stitches will be removed 2-3 weeks after surgery. You will be able to return to light activities once your stitches are removed. Avoid strenuous activities for at least four weeks.
    • You will continue physical therapy once you are home. The physical therapist will work with you on exercises to help you regain motion and strength. This will start the day after surgery.
    • If you are wearing a splint, your doctor will let you know how long you should wear it (usually three weeks).
    • Do not drive until your doctor tells you it is safe (about 3-4 weeks).
    • Be sure to follow your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • You are unable to control pain with the medicine given
    • You develop signs of infection, such as fever or chills
    • Signs of infection near the surgical area (increased pain, heat, throbbing, swelling, redness, discharge of pus)
    • Any other concerns
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Society for Surgery of the Hand http://www.assh.org/

    CANADIAN RESOURCES

    The Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Feldscher SB, Schneider LH. Flexor tenolysis. Hand Surg. 2002;7(1):61-74.

    Schneider LH. Tenolysis and capsulectomy after hand fractures. Clin Orthop Relat Res. 1996;(327):72-78.

    Tendon repair. Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 10, 2010. Accessed November 30, 2010.

    Tenolysis. Pulvertaft Hand Centre website. Available at: http://www.pulvertafthandcentre.org.uk/files/Tenolysis%5F2.doc . Accessed November 30, 2010.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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