Tenotomy is the cutting of a tendon. This and related procedures are also called tendon release, tendon lengthening, and heel-cord release (for tenotomy of the Achilles tendon).
Tenotomy is performed in order to lengthen a muscle that has developed improperly, or become shortened and is resistant to stretch.
Club foot is a common developmental deformity in which the foot is turned inward, with shortening of one or more of the muscles controlling the foot and possibly some bone deformity as well.
A muscle can become shortened and resistant to stretch when it remains in a shortened position for many months. When this occurs, the tendon that attaches muscle to bone can shorten, and the muscle itself can develop fibrous tissue within it, preventing it from stretching to its full range of motion. This combination of changes is called contracture.
Contracture commonly occurs in upper motor neuron syndrome following spinal cord injury; traumatic brain injury; stroke; multiple sclerosis; or cerebral palsy. Damage to the nerves controlling muscles lead to an imbalance of opposing muscle forces across a joint, which may allow one muscle to pull harder than another. For instance, excess pull from the biceps, unless opposed by the triceps, can bend the elbow joint. If the shortened bicep remains in this position, it will develop contracture, becoming resistant to stretching. Tenotomy is performed to lengthen the tendon, allowing the muscle to return to its normal length and allowing the joint to straighten.
When one muscle pulls much more strongly than its opposing muscle, it may cause the joint to become partially dislocated, which is called subluxation. Tenotomy is also performed to prevent or correct subluxation, especially of the hip joint in cerebral palsy.
Chronic pain or bone deformity may prevent a person from moving a joint through its full range of motion, leading to contracture.
Contracture also occurs in a variety of neuromuscular diseases, including muscular dystrophies and polio. Degeneration of one muscle can allow the opposing muscle to pull too hard across the joint, shortening the muscle.
Tenotomy is performed in infants with clubfoot, and in older patients who develop contractures or subluxations from neuromuscular disease, the upper motor neuron syndrome, or other disorders.
During a tenotomy, the tendon is cut entirely or partway through, allowing the muscle to be stretched. Tenotomy may be performed through the skin (percutaneous tenotomy) or by surgically exposing the tendon (open tenotomy). The details of the operation differ for each tendon.
During a percutaneous lengthening of the Achilles tendon, a thin blade is inserted through the skin to partially sever the tendon in two or more places. This procedure is called a Z-plasty, and is very rapid, requiring only a few minutes. It may be performed under local anesthesia.
More severe contracture may be treated with an open procedure. In this case, the tendon may be cut lengthwise, and the two pieces joined lengthwise to form a single longer tendon. This procedure takes approximately half an hour. This type of tenotomy is usually performed under general anesthesia.
If multiple joints are to be treated (for example, ankle, knee, and hip), these are often performed at the same time.
Patients requiring tenotomy are those with contracture or developmental deformity leading to muscle shortening that has not responded sufficiently to treatment with casts, splints, stretching exercises, or medication. Tests performed before surgery include determining the range of motion of the joint involved, and possibly x rays to determine if there is a bone deformity impeding movement or subluxation.
Patients undergoing general anesthesia will probably be instructed not to eat anything for up to 12 hours before the procedure.
After tenotomy, the patient may receive pain medication. This may range from over-the-counter aspirin to intravenous morphine, depending on the severity of the pain. Ice packs may also be applied. The patient will usually spend the night in the hospital, especially children with swallowing or seizure disorders, who need to be monitored closely after anesthesia.
Casts are applied to the limb receiving the surgery. Before the cast is applied, the contracted muscle is stretched to its normal or near-normal extension. The cast then holds it in that position while the tendon regrows at its extended length. Braces or splints may also be applied.
After the casts come off (typically two to three weeks), intensive physical therapy is prescribed to strengthen the muscle and keep it stretched out.
Tenotomy carries a small risk of excess bleeding and infection. Tenotomy performed under general anesthesia carries additional risks associated with the anesthesia itself.
Tenotomy allows the muscle to stretch out, proving more complete range of motion to the affected joint. This promotes better posture and movement; and may improve the ability to walk, stand, reach, or perform other activities, depending on the location of the procedure. Pain may be reduced as well. Club foot is usually completely fixed by proper treatment. Contracture and subluxation may be only partially remedied, depending on the degree of muscle shortening and fibrotic changes within the muscle before the procedure.
Properly performed, tenotomy does not carry the risk of mortality. It may cause temporary pain and bleeding, but these are usually easily managed.
Tenotomy is usually recommended only after other treatments have failed, or when the rate and severity of contracture or subluxation progression indicates no other more conservative treatment is likely to be effective. Aggressive stretching programs can sometimes prevent or delay development of contracture.
See also Rhizotomy .
Robinson, R. "Fight Against Contractures." Quest Magazine (1996). http://www.mdausa.org/publications/Quest/q34contrc.html .
Muscular Dystrophy Association. 3300 E. Sunrise Dr. Tucson, AZ 85718. (800) 572-1717. http://www.mdausa.org .
Richard Robinson
Tenotomy is performed by an orthopedic surgeon. It is performed in a hospital.
Thank you,
Darcy Figurel
I am a 35 yr old male with Mild CP, primarily affecting 1 side. My Achilles tendon is very tight leads to significant foot pain as I walk incorrectly on my toes. I am a very active individual. I work out 3 times a week and hike as much as I can. Currently this is preventing me from even going to the gym as I limp so badly from now foot, knee, hip pain. I stretch my tendon as much as I can, but in a short time it will become very tight. I would like any and all information on a tendon release as an adult who is active and any details on it's success/failures. Thank you very much,
Ken
Thanks!
Lorri
Long way to the well for this quesion - at my age, would surgery be of benefit?
kind regards
julie
Looking for information.
When you cut tendons, there is virtually always at least moderate pain involved for some time...the length of time depending on the procedure, location, any manipulation performed post-surgery, etc. Physical therapy will also likely be required in order to stretch those tendons that need lengthening. After the procedure(s), pain management will be necessary probably for a number of days (usually through the use of oral opoid pain meds...hydrocodone is commonly prescribed along with prescription strength ibuprofen in case the pain is manageable with a non-steroid analgesic). Ice packs are also helpful to control swelling.
Bottom line is that it does definitely hurt. However, especially with someone with special needs, physical therapy is crucial to a successful outcome. It won't be a lot of fun, but stick with it. Do everything the therapist requests, and when it hurts, treat accordingly. Good luck!
All of my toes are curled and flexable except the great toe.
I am due,to have,an ACJ excision and right Shoulder Tenotomy and just wanted to know,what do they attach the tendon to when its,cut?
who will take care of me and extend my disability till my condition improves for me to return to full hard duty? I am a commercial truck driver (mixer truck) my whole job requires 2 healthy feet to say the least. I told my P.A. I would not be able to take any of my prescriptions if I am to return to my work , nor will I be able to attend therapy,pain management, or doctor visits or get a night sleep without some type of assistance for the pain. My work wants me back but only on a full duty back to work basis. They will not cater to me being in this condition. My foot will nt work for me in my job duties currently. I can not have any of these current meds in my system, it is illegal in Ca. commercial driving law. SO I am stuck in ruff spot and quite frankly I did not see this coming either. What is right or wrong here ? And what can I do?
caroline greengrass 18
I had flexor tenotomies to my 2nd toe and it was one of the worst mistake of my life,
Joyce 24
I had a bunion surgery 4 weeks ago and the doctor also lengthened my big toe tendon. Now my toe will not raise at all and the tip is floppy. I am so depressed about this. Can the tendon be shortened again to fix this?
Thank you