Article

Almost 10% of older adults in nursing homes have a fixed flexion
deformity of the fingers (claw hand). Such contractures have important functional
consequences, often leading to hygiene difficulties. Medical treatment (such as
botulinum toxin injections, physiotherapy or positioning) is not always effective
and surgery is often not possible in such fragile patients. Microinvasive
tenotomy with a large needle could be a useful alternative because it can be
carried out in an ambulatory setting under local anaesthesia. METHODS: A single
center, retrospective study involving the 2012-2014 database from the
day-hospital unit of a neuro-orthopaedic department in France. All patients who
underwent percutaneous needle tenotomy of the finger or thumb flexors were
included. Outcomes included Goal Attainment Scaling (GAS) and the distance in
centimeters between the palm and the pulp of the most flexed digit (PPD).
RESULTS: Eighteen patients underwent tenotomy (13 women; mean age: 76+/-14
years); all patients lived in a nursing home. The limb to be treated was
nonfunctional in all patients. The principal goal was determined by consensus
with the patients and their health-care teams and was most often to facilitate
hand hygiene. Eight patients had at least one secondary goal. In total, 10
patients underwent microinvasive tenotomy for 4 fingers, 5 patients 1 to 4
fingers and 3 patients only the thumb. At 3 months after treatment, goals were
achieved for 11 patients, 5 patients progressed toward the goal without attaining
it, and for 2 patients, scores were worse. The T-scores of the GAS and the PPD
were significantly increased at 3 months (P=0.0326 and P=0.0002, respectively).
No serious adverse events occurred. CONCLUSION: Large-needle tenotomy seems safe
and effective for treating claw hand in fragile older patients.
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Langue : ANGLAIS