Percutaneous needle tenotomy: Technique and first results
Dr Alexis SCHNITZLERa, Dr Aurélie DIEBOLDa, Dr Francois GENÊTa, Dr Philippe DENORMANDIEa
a Hôpital R.poincaré
Introduction: after central nervous system injuries or dementia, loss of muscle elasticity is common. This can major the difficulties for installation (to bed or chair) or for the nursing of severely disabled patients. To take no anesthetic and surgical risk in frail patients we have developed a technique of percutaneous muscle lengthening with a large Gauge needle.
Method: Retrospective study of the years 2012 to 2014.
Percutaneous tenotomy under local anesthetic was performed with a 16G needle (1.6x40 mm). Tendon locating was performed by palpating the subcutaneous rope. Tenotomy was done 3 to 5cm upstream of their distal insertions, the insertion depth of the needle did not exceed 1 cm. The tolerance of the procedure was assessed by visual analog scale (VAS) when it was possible for the patient. The functional purpose, valued at three months by the GAS (goal attainment scaling), denoted by -2 (much worse) to 2 (exceeded target) was determined with the patient and his family.
Statistics: Comparison of T-scores of GAS without weighting of objectives (p = 0.3), Wilcoxon test.
Results: One hundred and thirty six tenotomies (21% of the toes, 27% of knee, 13% of hip, 28% of the fingers, other 21%) were performed to treat 67 patients. The mean age was 71 years, 31% of patients had a history of stroke and 26% dementia. Seventy four main objectives were determined (mostly nursing objectives) and 20 patients had at least a secondary objective. The pain could be evaluated for 43 patients, EVA average was 1.61 (min = 0 max = 8). The t-score GAS median was 40 before the procedure and 50 to 3 months (p <0.001). Three complications have been reported resolute without treatment.
Conclusion: This new technique, simple and minimally invasive, significantly improves the functional consequences of muscle stiffness for severely disabled and frail patients
Keywords : tenotomy, muscle contracture, needle