CASE 35
A 28-year-old woman presents after flexor tendon repair in zone 2. Despite an aggressive therapy protocol, she has not achieved sufficient active motion. The tendon is intact on palpation.
Which of the following is true regarding tenolysis?
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It should be performed 4 to 6 months after primary repair
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It should be followed by a passive range of motion protocol
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The A2 pulley should be sacrificed if it is densely adherent to the tendon
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Tenolysis is indicated to increase passive range of motion as well as active range of motion
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Postoperative rupture of the tendon is a risk particularly with dense adhesions
Discussion
The correct answer is (E). The tenolysis should be delayed until 6 to 12 months after repair to maximize therapy, minimize risk of tendon rupture, and allow for resolution of inflammation of the digit. Vigorous, active range of motion should be instituted to minimize the risk of postoperative adhesions. Tenolysis will not treat joint contracture, therefore it will not improve passive range of motion of the joints. Postoperative tendon rupture is a known risk of tenolysis. Healing of the tendon to the surrounding structures can indicate weakness of the laceration repair.
Objectives: Did you learn...?
Identify the appropriate time period to perform tenolysis?
