Percutaneous needle tenotomy in the treatment of neuro-orthopedic complications of upper limb related to central nervous system impairment: Open study on 12 patients

Abstract

The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle. The patients were older than 18 years, had a history of central neurological disease, and had a musculotendinous retraction regarding a superficial tendon of upper limb. The primary endpoint was the Goal Attainment Scale (GAS). Secondary outcomes were pain, the pulp-palm distance and range of motion gain. The evaluation was conducted in pre-tenotomy, immediately post-tenotomy, 3 months and 6 months. Twelve patients (8 women) were included in our study. The mean age was 62.91 years (28–87). Neuro-orthopedic disorders were related to a stroke ( n = 4), head trauma ( n = 2), to Parkinsonian syndrome ( n = 3) at a cerebral palsy ( n = 3). The objectives identified were nursing ( n = 12), pain ( n = 11), the skin condition ( n = 5), gripping ( n = 2), posture ( n = 1) and dressing ( n = 1). The targets were achieved in all cases. The average score GAS per patient ranged from 0 to 2. GAS score was unchanged at 3 months and 6 months. Our experience confirms the locations already described for percutaneous needle tenotomy of the flexor of the fingers. We also report the effectiveness of percutaneous tenotomy in the wrist and elbow flexors without vascular and nerve injury elbow.