Percutaneous needle tenotomy for the treatment of muscle and tendon contractures in adults with brain damage: results and complications

Publication date: Available online 18 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Flavia Coroian, Claire Jourdan, Jérome Froger, Claire Anquetil, Olivier Choquet, Bertand Coulet, Isabelle Laffont
ObjectiveTo study the results and complications of percutaneous needle tenotomy (PNT) of superficial retracted tendons in brain damaged patients. Muscle and tendon contractures are common in this population and can lead to severe functional impairment. Care management is commonly based on open surgical tenotomy. PNT is a mini-invasive surgical procedure suspected to be safer among frail patients.DesignProspective observational studySettingUniversity Hospital Physical Medicine and Rehabilitation (PM&R) and Orthopedic Surgery Departments.ParticipantsThirty-eight patients with severe brain damage (60.7 years [24-93]; 21 women) requiring surgical management of contractures and eligible for PNT were enrolled between February 2015 and February 2016.InterventionsThe PNT gesture was performed by a PM&R physician trained by an orthopedic surgeon, under local or loco-regional anesthesia. Treated tendons varied among patients.Main Outcome MeasuresAll patients were evaluated at 1, 3 and 6 months to assess surgical outcomes (joint range of motion [ROM], pain, and functional improvement) while screening for complications.ResultsImprovements on ROM (37/38) and contractures-related pain (12/12) were satisfactory. Functional results were satisfactory (Goal Attainment Scale≥0) for most patients (37/38): nursing (12), putting shoes on (8), getting in bed or sitting on a chair (6), verticalization (7), transfers and gait (8), grip (2).Five patients had complications related to the surgical gesture: 2 cast-related complications, 2 hand hematoma and one cutaneous necrosis of the Achilles tendon in a patient with previous obliterative arteriopathy of the lower limbs.ConclusionPNT yields good results in the management of selected superficial muscle and tendon contractures. The complications rate is very low and this treatment can be an alternative to conventional surgery in frail neurological patients.



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