Ultrasound-Guided Percutaneous Tenotomies of the Upper Limb

In the context of fixed upper-limb deformities, percutaneous tendon lengthening procedures are particularly relevant when the limb is non-functional. The therapeutic goals will be to relieve pain and improve passive mobility, thereby facilitating nursing care. While these procedures can easily be performed using simple anatomical landmarks on superficial tendons, ultrasound guidance is necessary for deeper muscles. Among the various muscles targeted, we detail the ultrasound-guided technique for sectioning the subscapularis and brachialis tendons. Deep tenotomies are performed in the operating room under general or regional anesthesia, whereas simple tenotomies can be performed using the WALANT (Wide Awake Local Anesthesia No Tourniquet) technique in a dedicated suite, predominantly on an outpatient basis. They have the advantage of simplifying the management of postoperative care for patients-often in institutional settings-who have cognitive impairments.