CPT® Code 25315

1. Indications

The flexor origin slide procedure (CPT® Code 25315) is indicated for patients experiencing flexion contractures of the wrist, hand, and fingers due to specific underlying conditions. The following are the primary indications for this surgical intervention:

• Cerebral Palsy - A neurological condition that affects movement and muscle coordination, often leading to contractures in the extremities.
• Volkmann Contracture - A condition resulting from ischemic injury to the muscles and nerves, causing permanent shortening and tightness of the flexor muscles in the forearm.

2. Procedure

The flexor origin slide procedure involves several critical steps to effectively release the contractures and restore function. The following outlines the procedural steps as described:

• Step 1: Incision - A longitudinal incision is made along the ulnar border of the forearm, extending from the wrist to just above the elbow. This incision provides access to the underlying structures necessary for the procedure.
• Step 2: Identification and Protection of Nerves and Arteries - The ulnar and median nerves, along with the brachial artery, are carefully identified and protected throughout the procedure to prevent any potential damage.
• Step 3: Ulnar Nerve Decompression - The ulnar nerve is decompressed at the point where it enters the cubital tunnel and descends beneath the flexor carpi ulnaris muscle, allowing for improved nerve function.
• Step 4: Muscle Release - The flexor carpi ulnaris and flexor carpi radialis muscles are released from their attachments to the ulna and radius. This step is crucial for enabling the muscles to slide distally along the forearm.
• Step 5: Ulnar Nerve Transposition - The ulnar nerve is transposed anteriorly to facilitate the subsequent steps of the procedure.
• Step 6: Detachment of Additional Muscles - The flexor carpi ulnaris and flexor carpi radialis are detached from their superficial origin on the medial epicondyle of the humerus. Additionally, the flexor pollicis longus and flexor digitorum superficialis are also detached from their origins on the radius, allowing for further distal sliding.
• Step 7: Distal Displacement - The distal displacement of these muscles effectively releases the flexion contractures in the wrist and hand, improving mobility.
• Step 8: Wound Closure and Immobilization - After the surgical site is closed, the wrist and hand are immobilized in an extended position to promote healing and prevent re-contracture.

3. Post-Procedure

Following the flexor origin slide procedure, patients are typically required to undergo a period of immobilization of the wrist and hand in an extended position. This immobilization is crucial for allowing the surgical site to heal properly and for maintaining the newly established range of motion. Patients may also need to participate in a rehabilitation program, which may include physical therapy to strengthen the muscles and improve functionality over time. Regular follow-up appointments are essential to monitor the healing process and to assess the effectiveness of the procedure in alleviating the contractures.