Name of the Procedure:

Tenodesis at wrist; extensors of fingers

Summary

Tenodesis at the wrist for the extensors of the fingers is a surgical procedure where the tendons of the finger extensors are surgically anchored to the bones in the wrist. This procedure is often performed to improve hand function in patients who have lost the ability to extend their fingers due to nerve or muscle damage.

Purpose

This procedure targets medical conditions or injuries that result in the inability to properly extend the fingers. The primary goal is to restore some degree of hand function, allowing better grasp and release abilities, which can significantly enhance the patient's quality of life.

Indications

• Inability to extend the fingers due to nerve injury (e.g., radial nerve palsy)
• Severe tendon injury or rupture that affects finger extension
• Certain neuromuscular disorders
• Patients who have undergone surgery or trauma leading to loss of finger extension

Preparation

• Patients may be required to fast for 6-12 hours before the procedure.
• A pre-operative assessment including blood tests and imaging studies (e.g., X-rays, MRI) may be necessary.
• Patients should inform their physician about any medications they are taking, as some may need to be adjusted.

Procedure Description

1. The patient is typically given regional or general anesthesia.
2. An incision is made over the wrist area to expose the extensor tendons.
3. The tendons are detached from their original insertion points and re-routed, then securely anchored to the wrist bones.
4. The incision is closed with sutures, and a sterile bandage is applied.
5. The hand and wrist are immobilized in a splint or cast to facilitate healing.

Duration

The procedure usually takes about 1-2 hours, depending on the complexity and the specific situation of the patient.

Setting

Tenodesis at the wrist is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technologists

Risks and Complications

• Infection
• Bleeding
• Nerve injury
• Reduced range of motion or stiffness
• Scar formation
• Need for additional surgery

Benefits

• Improved hand function and ability to extend fingers
• Enhanced quality of life and ability to perform daily activities
• Reduced pain in some cases

Recovery

• Initial immobilization in a splint or cast for several weeks
• Hand therapy or physical therapy for several months to regain strength and flexibility
• Follow-up appointments to monitor healing
• Generally, a full recovery can take several months

Alternatives

• Non-surgical management like physical therapy and splinting
• Tendon transfer surgeries
• Use of external devices to aid finger extension
• Each alternative has its own pros and cons, varying in invasiveness, recovery time, and effectiveness.

Patient Experience

• Patients will likely experience some pain and swelling immediately following the procedure, managed with pain medications.
• There may be some discomfort during early rehabilitation stages, but this typically diminishes over time.
• Adherence to physical therapy is crucial for optimal recovery and achieving the best functional outcomes.