Percutaneous needle tenotomy: Technique and first results

Introductionafter 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.MethodRetrospective study of the years 2012 to 2014.Percutaneous tenotomy under local anesthetic was performed with a 16G needle (1.6×40mm). 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 1cm. 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.StatisticsComparison of T-scores of GAS without weighting of objectives (P=0.3), Wilcoxon test.ResultsOne 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 67patients. The mean age was 71years, 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 43patients, EVA average was 1.61 (min=0 max=8). The t-score GAS median was 40 before the procedure and 50 to 3months (p