Effectiveness and complications of percutaneous needle tenotomy with a large gauge needle for muscle contractures: a cadaver study.
Ms Camille CHESNELa, Prof François GENETa, Dr Waleed ALMANGOURa, Dr Philippe DENORMANDIEa, Prof Bernard PARRATTEb, Dr Alexis SCHNITZLERa
a Service de médecine physique et réadaptation, Hôpital Raymond Poincarré, AP-HP, Garches, Université Versailles Saint Quentin en Yvelines, b Service de médecine physique et réadaptation, Laboratoire d’anatomie, hôpital Jean Minjoz, Université de Franche-Comté, Besançon
22% of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Micro-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.
Thirty-two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.
Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4(1%) in tendons or muscles, 3(0.7%) in nerves and 1 (0.2%) in a vessel.
Percutaneous needle tenotomy is an effective, low risk technique. Although this study was carried out on cadavers, the results suggest that it is safe to carry out on patients.
Keywords : Contractures, Tenotomy, Needle, Cadaver