Tenolysis Protocols

Tenolysis is the surgical release of a tendon from adhesions, typically in the hand or wrist. Adhesions, fibrous bands of scar tissue that form between tissues and join them together, are made up of blood vessels and connective tissue cells. While adhesions have an initial positive benefit on healing and help prevent the spread of infection, sometimes they cause tissues to grow together that lead to inflammatory problems. Symptoms of adhesions are pain and dysfunction. Tenolysis protocols depend in large part on the condition of the tendon after surgical correction. Surgeons assess the quality of the tendon as well as the range of motion achieved during surgical correction to determine the health of the repaired tendon.

Healthy Tendon Protocol

• This protocol is recommended for a tendon that is in good condition at the end of tenolysis with no fraying. Day 1 to 2: Remove the postoperative dressing and assess for edema, swelling from excessive fluid in tissues, as well as signs of infection. Elevate the repaired tendon. Apply a clean dressing. Initiate active and passive range of motion exercises and differential glide exercises two to four times a day as outlined by the surgical team. Between exercises and at night, apply a gutter splint that has been fitted in full extension. Day 3 to 5: Increase differential glide exercises to 15 minutes per hour. Add dynamic extension split or a foam piece if recommended by the surgical team. Initiate functional electrical stimulation as needed to help with tendon excursion. Continue this protocol until six weeks postoperatively. Week 6: Begin working with foam or putty to increase grip strength. Week 12: Resume activity as prior to surgery.

Frayed Tendon Protocol

• This protocol is recommended when the postoperative tendon shows suboptimal quality. In this case, an altered protocol is used to reduce the chances of tendon rupture. However, tendon rupture can still occur with a weak or frayed tendon. Day 1: Remove the postoperative dressing and assess for edema and signs of infection. Elevate the repaired tendon. Apply a clean dressing. Initiate an exercise program in which the digit is passively moved toward the freed tendon, then contract the muscle. Release the digit and return to a neutral position. This exercise routine is performed two to four times a day. Do not move the wrist and digits together. Between exercises and at night, apply a dynamic flexion splint. Follow this protocol daily until instructed otherwise by the surgical team.

Alterations to Protocols

• Factors such as poor circulation, infection, severe edema, joint stiffness or poor quality or severely frayed tendons can require alterations in tenolysis protocol. Check with your surgical team before beginning any postoperative protocol after tenolysis.