Tenolysis is a surgical procedure designed to restore movement in a tendon restricted by surrounding scar tissue. The operation frees the tendon, allowing it to glide smoothly within its natural pathway and improve the range of motion in the affected digit or limb. This intervention is primarily used in the hand and wrist when non-surgical treatments, such as physical therapy, have not succeeded in restoring sufficient function.
What Tenolysis Means
Tenolysis is defined as the surgical freeing of a tendon from surrounding adhesions or scar tissue. Tendons are cord-like structures connecting muscle to bone, and they must be able to slide back and forth within a protective sheath to enable joint movement. The primary objective is to remove the fibrous tissue that has bound the tendon to adjacent structures, preventing necessary gliding motion. When a tendon is stuck, the muscle contracts, but the force is not fully transmitted, resulting in a limited active range of motion. Removing the constricting scar tissue restores the smooth, unhindered movement needed for full function.
Why Tendons Become Restricted
The problem that necessitates tenolysis is the formation of tendon adhesions, which are bands of internal scar tissue. These adhesions typically develop following trauma, such as a deep laceration, a crush injury, or after reconstructive surgery like a previous tendon repair. Any event that causes significant damage to the tissues around the tendon can trigger the body’s natural healing response. In a healthy system, the tendon glides freely within its synovial sheath, which acts like a lubricated tunnel. After an injury, the inflammatory process can cause the healing tissues of the tendon and the sheath to stick together, forming restrictive scar tissue. This binding effectively tethers the tendon to the surrounding structures, preventing the necessary excursion, or distance of travel, required to fully bend or straighten the joint.
How the Surgery is Performed
Tenolysis is typically performed in an operating room as an outpatient procedure, often under regional or general anesthesia. The choice of anesthesia may sometimes allow the patient to remain awake, which permits the surgeon to test the tendon’s motion during the procedure. The surgeon makes an incision, often following the path of a previous scar, to access the affected tendon and its surrounding tissues. The core of the surgery involves meticulously separating the scar tissue from the tendon structure and the tendon sheath. This delicate “lysis” process requires precision to remove the restrictive adhesions without causing damage to the tendon surface. Specialized instruments are used to scrape or cut the fibrous bands away from the gliding surface. To confirm complete release, the surgeon may perform a traction test or ask the awake patient to actively move the digit before closing the incision.
Recovery and Expected Outcome
The success of tenolysis relies heavily on immediate and intensive postoperative rehabilitation, which usually begins within a day of the procedure. This rapid mobilization is designed to prevent the reformation of scar tissue. Physical therapy, often guided by a specialized hand therapist, focuses on active and passive range of motion exercises to encourage the tendon to glide freely in its newly cleared pathway. The recovery timeline ranges from several weeks to a few months, depending on the extent of the initial scarring and the patient’s compliance with the therapy regimen. Consistent movement is the main defense against recurrent adhesions. While the procedure generally leads to significant improvement, a realistic expected outcome involves a substantial gain in active range of motion, though full pre-injury motion may not always be achieved.