[Tenodesis in hand surgery]. / Les ténodèses en chirurgie de la main.

ABSTRACT

Joining tendon's inextensibility with joint's mobility, a tenodesis fixes on the bones the two ends of a tendon on both sides of one or several joints. A "simple" tenodesis overrides only one joint, whereas a "dynamic" tenodesis crosses two or more joints. A "crossed" dynamic tenodesis crosses the line which joins rotation axes. A "direct" dynamic tenodesis is located on the same side of this line. The "tenodesis effect" is normally produced by the movements of the joint on the neighbouring tendons. Anatomical examples are given by the oblique retinacular ligaments (crossed dynamic tenodesis), and by the tenodesis effects linked to the flexion-extension of the wrist on the extrinsic tendons of the fingers (direct tenodesis effect), or to the flexion-extension of the PIP joints on the intrinsic tendons of the fingers (crossed tenodesis effect). Main tenodesis techniques are used for palliative surgery in paralysis of EDC, intrinsic muscles of the fingers, or extrinsic muscles of the thumb (EPL, FPL, APL and EPB).