Tenotomy Surgery

Overview

Tenotomy is a surgical procedure to relieve pain in the tendons by dividing the tendons. Tenotomy helps to relieve the tension in the tendon, thus allowing the tendon to rest and heal. The procedure involves loosening the stiffness in your tendons by making holes into them with needles or dividing (cutting) them up and removing pieces of the tendon through incisions on your skin. It is commonly done on the tendons of your shoulder blade, elbows, feet, and ankles.
Both forms of tenotomy are minor procedures done on an outpatient basis. You can go home the same day.
The results of the procedure can last up to three years. A fresh injury to the same tendon, or undue strain on the tendon before it fully recovers, can affect the procedure's outcome, and you may need a repeat tenotomy.

What Is Tenotomy?

A tendon is a strong, flexible tissue that connects the muscle to the bone. Tendons are responsible for the movement of the muscle. High-impact activities like running, jumping, and lifting heavy weights can damage the muscles involved if not for the tendons supporting them. The tendons absorb all the impact from such activities, thus keeping your muscles safe.
Repeated strain on the tendon or injury to the muscle can cause tendonitis, a condition where the tendon is swollen and painful. Tendonitis causes severe pain and restriction of movements of the affected part.
Tenotomy is a surgical procedure that helps relieve the symptoms of tendonitis. This procedure is opted for when the initial treatments of ice packs, rest, and non-steroidal anti-inflammatory products have not been effective.

The tendons do not generally receive a rich blood supply, and the idea behind tenotomy is to bring the body’s attention to the injured tendons. This kickstarts the body’s natural healing mechanism. The body sends fresh, oxygenated blood with lots of plasma proteins to the injured tendon, thus allowing it to heal.

The procedure is done by two methods:

1. Percutaneous Needle Tenotomy:

This is a minor procedure done under local anesthesia. It involves making multiple small holes in the injured tendon with the help of a needle. The procedure is guided by ultrasound imaging. 

• Open Tenotomy:

This surgical procedure is done under general anesthesia. The surgeon makes incisions on the skin and then cuts the injured tendon. Releasing the tendon in this manner helps relieve the tension and pain. This procedure sometimes causes the tendon to regrow longer than before.

Both procedures are done on an outpatient basis. The procedure shows excellent results when used along with PRP (plasma-rich platelet) injections. Recovery takes 6 to 8 weeks. You will be asked to reset the affected part for a few days completely. It is recommended that tendon motions be resumed under the supervision of a physiotherapist.

When Is Tenotomy Recommended?

Tenotomy, as a surgical option, was first used to treat Tennis Elbow, a condition that happens due to overuse of the elbow muscles by repeated movements of the wrist and arms. Tenotomy is now used for a variety of conditions that affect tendons.

• Rotator cuff injuries- These affect the tendons of the muscles that move your shoulders.
• Plantar Fasciitis- This is the painful swelling of the thick band of the tendon that supports the arch of your foot.
• Patellar Tendonitis- This condition affects the patellar tendon, the tendon that keeps the knee cap attached to the shin bone. This is commonly seen due to running, skipping rope, and vigorous jumping.
• Hip Tendonitis- This is a condition where the hip tendons are painful and swollen.
• Achilles Tendonitis- A condition where the Achilles tendon is swollen. This tendon connects the calf muscles to the heel.
• Club foot- This is a congenital disorder that affects the baby’s feet and ankles.
• Hammertoes- A condition in which the joint is stuck in an upward position, leading to pain while walking.
• People with tightened or shortened muscles due to neuromuscular disorders.

How To Prepare For Tenotomy?

Tenotomy is a surgical procedure to relieve the symptoms of tendonitis. 

Conventional (Non-surgical) treatments and Surgical treatments can be used to manage the symptoms of the condition. 

Conventional treatment includes:

• Resting the affected part
• Applying ice packs,
• Physical therapy to improve the strength of the muscle and tendon and to aid recovery.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help with the pain
• Corticosteroid injections to decrease inflammation.

The Surgical option (Tenotomy) is usually used as a last resort. The procedure is a minor one that is performed under anesthesia. It takes about 15 to 20 minutes to complete. Here is how you can prepare for this procedure:

• You can ask your surgeon to explain the details of the procedure along with the outcome and prognosis. You will be asked to sign an informed consent form agreeing to go ahead with the procedure.
• Discuss your medical history with your surgeon and inform him about-
  • All the medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards medicines, if any.
• If you are undergoing open tenotomy, you will be asked to fast for 12 hours before the procedure.
• You will be advised to stop all medications, mainly NSAIDs and corticosteroids, that you are taking for the tendonitis 2 weeks before the procedure.

What Happens During A Tenotomy Procedure?

Tenotomy is a surgical procedure performed on injured tendons that cannot heal effectively on their own. This procedure stimulates healing by stimulating the body to deliver fresh, plasma-rich blood to the tendon.
Tenotomy can be done in two ways. Here is what will happen to you during each type of procedure-

Percutaneous Needle Tenotomy

• This procedure is done under local anesthesia. The surgeon will inject lidocaine into the area of the procedure to numb you to the pain. You might feel a slight pinch when anesthesia is administered.
• Using a needle, the surgeon makes multiple holes in the affected tendon and may also remove any dead tissues found.
• The surgeon uses an ultrasound to guide the procedure.

Open Tenotomy

• This procedure is performed under general anesthesia to numb you to the pain.
• Once you are asleep, the surgeon will make cuts on your skin to expose your tendon.
• Once the tendon is exposed, it is cut through along the length allowing it to stretch. 
• The tendon heals well as the body sends fresh oxygenated blood rich in plasma proteins.
• The incisions are then sutured, and the wound is dressed. 

The procedures last for around 15 to 20 minutes. You can go home immediately or once the effects of general anesthesia wear off, depending on the procedure you underwent.

How Is The Recovery After Tenotomy?

Recovery from a tenotomy takes about 6 to 8 weeks. Most patients experience immediate relief from all their symptoms. Tenotomy helps the patient gain a better posture and improves the range of movement of the affected joint. Here is what you can do to improve the tendon recovery.

• Completely rest the joint for a week or as instructed by the surgeon.
• The pain and discomfort subside gradually. Do not take painkillers or corticosteroid injections for the pain.
• Start with gentle movement of the affected joint.
• You may consult a physiotherapist who can guide you on specific exercises and movements that target the affected tendon.
• Strenuous activities and activities that exert an undue strain on the tendon should be avoided till you are completely healed.

What Are The Benefits And Risks Of Tenotomy?

Tenotomy is a minor procedure done on an outpatient basis. There are both benefits as well as risks to this procedure. Your surgeon will explain both in detail to help you make an informed decision.

Benefits Of Tenotomy

• It is a safe procedure
• You can go home the same day; there is no need to stay in the hospital
• There is immediate relief from the symptoms
• Once you recover fully, you may experience better posture and an improved range of movements of the affected joint

Risks Of Tenotomy

• You may experience cramping at the place where you had the tenotomy. The discomfort subsides gradually over time
• You may develop scar tissue around the tendon that can be very painful
• Injury to a nearby nerve while cutting the tendon is a possibility that can lead to loss of sensation and function
• Infection at the site of tenotomy
• Your symptoms may return sooner than expected, and you may need a repeat procedure. This usually happens if the tendon is injured again due to repeated strain or if you have unduly exerted the tendon before full healing.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!