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Clinical Example: Digital Extensor Tenolysis
| Stiffness of the fingers is a common
problem following either closed or open injury. The moving parts of fingers
are often glued together by scar tissue following injury, and if movement
can not be recovered through therapy and time, and if all other conditions
are favorable (wound maturation, patient motivation, available therapy,
absence of infection or mechanical impediment, etc. ), tenolysis may be
helpful. A practical guideline is that the expected final active range
of motion will be halfway between the preoperative active and passive ranges
of motion. These cases illustrate extensor tenolysis at the proximal and
distal interphalangeal joints after open injury. |
| Click on each image
for a larger picture |
Case 1:
This gentleman sustained a laceration of the dorsal finger at the level
of the proximal interphalangeal joint. The treating surgeon repaired the
extensor tendon. After extensive therapy, his finger was still quite stiff: |
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| Posture of the finger with attempted
flexion: minimal movement of the proximal interphalangeal joint, extensor
lag of the distal interphalangeal joint, similar to a stiff swan neck deformity: |
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| At surgery, the patient was found to
have dense extensor tendon adhesions. The nonabsorbable sutures used for
repair were removed. A Fowler swan neck type release was performed, releasing
the central slip attachment to the base of the middle phalanx, removing
the dorsal joint capsule and releasing both collateral ligaments: |
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| This allowed improved range of motion
in the operating room: |
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Several months later, the patient had
improved (although not normal) range of motion.
Extension: |
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| Flexion: |
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| Another option for tenolysis access
is through a proximal window, sliding a Freer and then a Beaver #9081 arthro-loc
end cutting blade from an entry point proximal to the sagittal bands. From
this point, one can free a plane over the entire proximal phalanx out to
the central slip. Because the dorsal lip of the base of the middle phalanx
sits a bit dorsal to the proximal phalanx head, the blade usually
follows the proximal phalanx dorsum, disinserts the proximal joint capsule
attachments and then stops as it abuts the base of the middle phalanx. |
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Case 2:
This gentleman sustained a crush avulsion of the dorsal aspect of the
distal interphalangeal joint. He took this picture with a digital camera
a few days after injury: |
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| Months later, he sought evaluation
because he had neither active nor passive range of motion of his distal
interphalangeal joint: |
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| At surgery, the extensor tendon was
released from the bone and skin, the dorsal joint capsule was excised,
and collateral ligaments were released: |
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| Range of motion in the operating room: |
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| Final active range of motion: |
 |
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