Tenotomy

definition

The word tenotomy comes from the Greek (“tenon” = tendon and “tome” = cut) and means severing the tendon. If there is a severing exactly at the transition between the tendon and the associated muscle, it is called a tenomyotomy ("myo" = muscle). In the case of a fractional tenotomy, however, the muscular part is not touched. Instead, two transverse cuts are made only in the area of ​​the tendon, which should be about 2 cm apart.

You can also differentiate between an open and a closed tenotomy. Offen describes the procedure in which the tendon is first surgically exposed before the tenotomy, as the transection, can be realized. In the case of a closed tenotomy, on the other hand, no two work steps are necessary: ​​the tendon is cut through the skin directly with a stab incision. However, this is only possible if the tendon is superficial. Otherwise the open tenotomy must be performed.

Finally, the “z-shaped tenotomy” has to be defined. As the name suggests, the tendon is cut in a z-shape, i.e. not crosswise as with the other methods, and then sewn together again after the tendons have been lengthened.

Indications for a tenotomy

There are several indications from different medical specialties for performing a tenotomy.

The first example mentioned is a foot deformity from pediatrics, i.e. from pediatrics. The so-called "clubfoot" is a combined misalignment of the forefoot and rearfoot, which must be treated as quickly as possible. On the first day of life, treatment is carried out using a certain procedure named after Ponseti. This includes tenotomy as one of 3 treatment steps to correct the foot deformity. The Achilles tendon is severed under local anesthesia, which leads to a timely improvement in the malalignment of the foot. Another indication is a foot deformity, namely the equinus. In this case, a tenotomy of the Achilles tendon is also performed.

Tenotomy is also a common procedure to alleviate some problems with the long biceps tendon. In addition to the indications that have already been specifically explained, it can generally be said that a tenotomy is always necessary if an increased muscle tone leads to joint misalignments or problems in the joint. The increased muscle tension can be reduced by cutting the associated tendon and thus the symptoms are reduced or even eliminated. A tenotomy is indicated whenever a tendon lengthening is desired for any reason. In addition, a tenotomy is often done when the tendon itself is causing discomfort or is injured.

Long biceps tendon tenotomy

Long biceps tendon complaints that cannot be managed with conservative treatment often require a tenotomy of the long biceps tendon. This also applies to serious injuries for which conservative therapy is not promising. In general, a tenotomy is only necessary to treat complaints of the long biceps tendon, as this runs through the joint space compared to the short biceps tendon. Thus, the likelihood of injury or overuse of the long biceps tendon is much higher than that of the short biceps tendon.

There are several indications for performing a tenotomy on the long biceps tendon. A common reason is the degenerative change in the tendon, which is called tendopathy. The word tendopathy implies that this is not an inflammatory process but that the symptoms are primarily based on degeneration, i.e. wear and tear, and heavy stress. In addition, inflammatory processes or rheumatic diseases can cause pain in the long biceps tendon.

More on this subject: Tendinitis; Rheumatic diseases; Tendonitis from rheumatism

A tenotomy may also be necessary in the so-called “impingement syndrome”. This is a bottleneck syndrome in the area of ​​the roof of the shoulder and the head of the humerus, which can irritate and irritate structures that run through, such as the long biceps tendon. In general, athletes such as volleyball players and climbers are particularly prone to problems with the long biceps tendon. Electricians or painters who work overhead are also predisposed to lesions on the long biceps tendon.

In young patients, the long biceps tendon is usually sutured again in a different location, usually in the capsule area. This procedure is called tenodesis. In older patients, however, the tenotomy remains. The tendon grows together in the form of scarring over time, which is sufficient for the low strength requirements in old age.

Consequences of a tenotomy

In principle, tenotomy is a procedure with few complications and without any significant consequences. Only a limited mobility and a reduction in strength are sometimes complained of by the operated. Since the tenotomy usually has no significant consequences, unrestricted follow-up treatment is also possible. The rehabilitation measure can be carried out well and painlessly. Cosmetic consequences after a tenotomy are also rare. Unless it is a tenotomy of the long biceps tendon, which can result in a Popeye phenomenon. It should be taken into account that a tenotomy is not always a permanent solution to the problem, depending on the reason for the complaints, and the complaints may creep back over time.

Follow a tenotomy of the long biceps tendon

A tenotomy of the long biceps tendon pursues, among other things, the treatment goal of freedom from pain, both at rest and under stress. This is usually achieved. Unfortunately, the procedure can have a few undesirable and less pleasant consequences. This includes, among other things, the reduction in strength through to the loss of strength in the elbow joint, even if the short biceps tendon makes up the greater part. In addition to the reduced strength, there is also a slight restriction in mobility. In addition to the functional consequences, the tenotomy of the long biceps tendon can also lead to visible changes in the upper arm. One speaks of the so-called "popey sign" or in German "Popeye phenomenon". The muscle belly of the biceps slides down through the severing of the long biceps tendon, so that the biceps looks surprisingly voluminous, like with Popeye when he has eaten his spinach. The Popeye phenomenon is associated with a cosmetic problem rather than a loss of strength after a tenotomy of the long biceps tendon. This is because, as I said, the short biceps tendon makes up a large part of the power transmission to the elbow joint. Optically, the Popeye phenomenon is mainly only recognizable in slim patients due to a tenotomy.

Pain after tenotomy

Pain is initially considered an indication for the surgical intervention of a tenotomy. Therefore, freedom from pain is one of the most important treatment goals through the procedure. In most cases this goal is achieved and those affected report a few weeks after the operation that the symptoms have improved and in some cases have even completely subsided. Initial pain that persists immediately after the tenotomy is to some extent normal, harmless and should not be a cause for concern. The surgical scar can be slightly painful while the wound is healing and the surrounding muscle and connective tissue, which may have been held aside with hooks during the operation, can still hurt for a few days. These pains are similar to sore muscles.However, if the pain does not get better or even worse after a tenotomy, a follow-up appointment with the attending physician is inevitable.

Duration

The tenotomy itself is a short and straightforward procedure that takes about 30 minutes. A discharge is usually possible 1-2 days after the operation. The exact duration of the healing process varies depending on the complexity of the procedure or the original complaints that made a tenotomy necessary. You can expect from 4 to 8 weeks.

In general, physiotherapy should be introduced relatively soon to avoid shortening the tendon and stiffening the associated joint. This can often be done 2 days after the operation. It is important, however, that training should only be carried out by trained personnel. These ensure that there is only passive exercise in the affected region. Partial exposure can only begin after a few weeks. A load on the affected region is therefore not allowed. For example, if it is a tenotomy on the long biceps tendon, shoulder loading is prohibited. On the other hand, there is nothing to be said against light jogging if the person concerned feels pain-free. There are fixed follow-up treatment schemes for the respective locations of the tenotomy, on the basis of which the physiotherapy adapts an individual rehabilitation.