| A tendon is a tough band of fibrous tissue that connects muscle to bone. Tendons are surrounded by specialized tissues (tendon sheath) that protect and help to nourish the tendons. Sometimes, the sheath can cause pressure on the tendon, limiting movement or causing pain.
Incision of a tendon sheath is a surgical procedure in which the tissue surrounding a tendon (tendon sheath or epitenon) is cut. Often, this is necessary to relieve pressure or constriction around a tendon. The tendon itself may be normal, but if the sheath around it is too tight, it can prevent the normal gliding function of the tendon. Incision of the sheath restores function by allowing the tendon to move more freely. Tenolysis is a surgical procedure that removes adhesions that impair normal tendon movement within the sheath.
For example, tendons that control movement of the fingers pass from the forearm to the wrist and into the hand through a series of "tunnels" that help hold the tendon close to the bone. These tunnels act just like the metal eyelets on a fishing rod that help to hold the fishing line in place. If adhesions develop, it can prevent free movement of the tendon, just like a knot in the fishing line.
A tendon sheath incision may be necessary in the treatment of inflammatory disorders, entrapment disorders, cumulative trauma disorders like lateral epicondylitis, changes resulting from fractures and dislocations, or other conditions that lead to formation of scar tissue along the tendon. Surgery may be indicated when conservative treatment has not led to improvement, or when decreased function and pain interfere with the activities of daily living (ADLs).
Incision of the tendon sheath can be required anywhere in the body a tendon is affected. In inflammatory disorders like rheumatoid arthritis, the procedure is most often done in the feet and hands. Entrapment disorders like carpal tunnel syndrome and stenosing tenosynovitis occur mostly in the hands and wrists. |
Source: Medical Disability Advisor
| This procedure is used to restore tendon function and to relieve symptoms of loss of function and pain caused by entrapment or compression of the tendon.
Tendons that slide through tight compartments or tunnels are most prone to problems with the tendon sheath. Conditions that cause tenosynovitis, such as inflammatory diseases, cumulative trauma disorders, or changes resulting from fractures and dislocations, could result in the need for tendon release. |
Source: Medical Disability Advisor
| Local, regional, or general anesthesia may be required, depending on the location of the involved tendon. The surgery may be performed either endoscopically (using a special operating microscope and miniature instruments) or through an open incision. An incision is made over the tendon. The sheath and the tendon are explored, isolating and protecting nerve and blood vessel branches. The sheath is then either cut away (excised) entirely or loosened (released) by making a cut on one side along its length. Tendon function is evaluated with passive motion, and the wound is closed with sutures. |
Source: Medical Disability Advisor
| Successful outcome depends on the underlying reason for the procedure. Restoration of tendon function is usually possible, along with relief of pain and swelling. If there are no other complications (e.g., joint contractures, muscle or nerve damage), the procedure should restore normal function. There is the possibility of repeated procedures caused by recurrence of the underlying disease process.
Between 59% and 90% of individuals undergoing flexor tenolysis of the hand experience improvement in joint range of motion. From 5% to 33% of individuals undergoing this surgery find no improvement, and 8% of individuals experience worsening of symptoms. Tendon rupture occurs in 8% to 15% of individuals (Gorum). |
Source: Medical Disability Advisor
| Note on research and authorship Common clinical practice indicates that therapy after a tendon sheath incision includes exercises and activities specific for the location, degree of injury, and the functional limitations. In most cases, a full recovery can be expected (Schneider).
Range of motion exercises should be started on the adjacent joints as soon as possible, unless contraindicated. The first part of therapy is to control swelling using elevation, and follow wound care and scar management protocols. Pain may be controlled using modalities, such as cold packs, as needed. Hand splinting and the prescribed passive and active range of motion protocols are also initiated (Gerard). Therapy is directed towards restoring full hand function and achieving safe independence in activities of daily living (Schneider).
Return to normal function may take up to 3 months. Depending on the location and extent of injury, an ergonomist may be called upon to assess working conditions and possible modifications. |
| FREQUENCY OF REHABILITATION VISITS | | Surgical | |
| Physical, Occupational or Hand Therapist | | Up to 15 visits within 6 weeks | |
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| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Laceration could occur to the tendon, nerves, or blood vessels during surgery. Some authors suggest that there is a higher risk of nerve injury or symptom recurrence in endoscopic carpal tunnel tendon sheath incision (Fuller). Generally, endoscopic repairs have a much shorter healing time because the surgery is less invasive and there is less tissue damage. Infection, bleeding, worsening of symptoms, the formation of postoperative scar tissues including additional tendon adhesions, and the development of reflex sympathetic dystrophy are all potential complications. |
Source: Medical Disability Advisor
| Work restrictions and accommodations will depend on the tendon(s) involved and the underlying condition necessitating the procedure. Several days are required for the wounds to heal, during which time the area must be kept clean and dry. Initially, any activity that places tension or stress on the tendon will be limited. If there is risk of tendon rupture while any swelling or irritation resolves, use of the affected body part will be restricted for a few weeks. Temporary or permanent reassignment may be required to allow adequate healing and to prevent recurrence. Individuals who perform heavy or very heavy work may require additional lifting restrictions. Those whose duties require fine motor skills, especially in the wrists and hands, may benefit from implementation of ergonomic principles and work station adaptations (JAN). |
Source: Medical Disability Advisor
| Job Accommodation Network (JAN). U.S. Department of Health and Human Services. 29 Dec. 2008 <http://www.jan.wvu.edu/soar/motor/4_keyboarding.html>.Fuller, David A. "Carpal Tunnel Syndrome." eMedicine. Eds. Michael S. Clarke, et al. 12 Aug. 2008. Medscape. 29 Dec. 2008 <http://emedicine.medscape.com/article/1243192-overview>. Gerard, F., et al. "Immediate Active Mobilisation After Flexor Tendon Repairs in Verdan's Zones I and II. A Prospective Study of 20 Cases." Chirurgie de la Main 17 2 (1998): 127-132. National Center for Biotechnology Information. National Library of Medicine. 9 Dec. 2008 <PMID: 10855278>. Gorum, Jay W., and Cato T. Laurencin. "Flexor Tenolysis." eMedicine. Eds. Michael S. Clarke, et al. 8 Apr. 2008. Medscape. 29 Dec. 2008 <http://emedicine.com/orthoped/topic96.htm>. Schneider, L. H., and S. B. Feldscher. "Tenolysis: Dynamic Approach to Surgery and Therapy." Hunter - Mackin - Callahan Rehabilitation of the Hand and Upper Extremity. Eds. E. J. Mackin, et al. 5th ed. Philadelphia: Mosby, Inc., 2002. |
Source: Medical Disability Advisor
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