title: An alternative treatment for contractures of the elderly institutionalized persons: Microinvasive percutaneous needle tenotomy of the finger flexors.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  Large-needle tenotomy seems safe and effective for treating claw hand in fragile older patients.
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France. Electronic address: alexis.schnitzler@rpc.aphp.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Schnitzler
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Diebold
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Parratte
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Tliba
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Genêt
authors.affiliation: Hôpital R.-Poincaré, 104, boulevard R.-Poincaré, 92280 Garches, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003286:Contracture / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010347:Patient Care Planning; D012189:Retrospective Studies; D058971:Tenotomy / Q000009:adverse effects / Q000379:methods*; D013933:Thumb / Q000601:surgery
keywords: Contractures; Finger flexors; Needle; Tenotomy