The percutaneous needle tenotomy in the treatment of tendon contractures in brain damaged patients: pilot study
Dr Flavia Oana COROIANa, Prof Bertrand COULETa, Prof Isabelle LAFFONTa
a CHU Lapeyronie Montpellier
Assessment of the feasibility and efficacy of percutaneous needle tenotomy in patients with neuro-orthopedic disorders secondary to impairment of the central nervous system.
MATERIAL AND METHOD
Fourteen patients were followed in the Physical medicine and rehabilitation Department from September 2014 to March 2015. The average age was 58.7 years (29-86y). The origin of neuro-orthopedic disorder was stroke (N = 7), parkinsonism (N = 2), head trauma (N = 2), cerebral palsy (N = 1), Little's disease (N = 1) and Alzheimer’s disease (N = 1). The indication of percutaneous needle tenotomy was selected during a medical-surgical consultation. Twenty one goals were identified: hygiene (N = 6), pain (N = 4), sitting (N = 3), standing (N = 4), transfers (N = 1), walking (N = 2), grasping (N = 1). A total of 31 sites were covered: the finger flexors (N = 9), the semitendinosus, biceps femoris and tensor fascia lata (N = 7), the Achilles tendon (N = 5), the biceps and brachioradialis (N = 3), the wrist flexors (N = 2), flexor digitorum longus (7 claw toes) and hip adductors (N=1). In 10 patients the treatment involved several sites. Tenotomy was performed with a 18G needle (1,2X40mm), under local or regional anesthesia. A plaster cast was associated with hamstring tenotomy if the objective was functional. A cast was always associated with Achilles tendon, elbow flexor and wrist flexor tenotomy. The Goal Attainment Scale (GAS) was used to assess the effectiveness of treatment.
The targets were achieved in all cases (GAS≥0). No side effects were noted.
Percutaneous needle tenotomy is a technique which can be used as treatment of some neuro-orthopedic disorders in brain-damaged patients. Percutaneous tenotomy of the Achilles' tendon has already been described by Minkowitz. Our study shows the feasibility and effectiveness of needle tenotomy, sometimes multi-site, performed in this type of patient.
Minkowitz B, Finkelstein BI Bleicher M, Percutaneous tendo-Achilles lengthening with a large gauge needle: modification of the Ponseti technique for correction of idiopathic clubfoot, J Foot Ankle Surg. 2004 Jul-Aug; 43 (4): 263-5
Keywords : Brain damage, tendon contracture, tenotomy, needle