Certain medical situations can lead to a tenotomy, a partial or total section of a tendon. In what context does this surgery take place? The explanations of Dr Régis Guinand and Dr François Lintz, orthopedic surgeons.
Certain situations can lead to partial or total severing of a tendon. Tenotomies of the foot and long biceps (often associated with tendinitis of the rotator cuff) are the most common. What are the indications for such a section (instability, osteoarthritis, etc.)? Does this surgery lead to a reduction in mobility and function in the operated area? All the answers with Dr. François Lintz, orthopedic surgeon of the lower limbs.
Tenotomy: what are we talking about?
Made up of connective tissue, tendons serve as a transmission belt between muscles and bones. When the tendons cause significant pain, a tenotomy, partial or total, can sometimes be considered. It is even sometimes the only possible surgical treatment.
Etymologically, a tenotomy (Teno, tendon; Tomie: to cut) is a surgical intervention which consists of cutting a tendon. A tenotomy can involve all the tendons and different joints: the shoulder, the hip, the ankle, the foot, etc. “However, the most frequent tenotomies concern surgery of the long biceps in the event of tendonitis in the shoulder as well as tenotomies of the foot”, emphasizes Dr. François Lintz, orthopedic surgeon of the lower limbs.
Tendinitis, motor disabilities and neurological pathologies
More specifically, when a muscle located behind the calf, for example, retracts, muscle or tendon tension and pain will appear. “Partially cutting the tendon will reduce tension and pain in the muscle and tendon chain”, continues the orthopedic surgeon.
At the level of the muscular chain located between the calf and the Achilles tendon, tendinitis is frequent in the event of muscular retraction. “We will then make an opening just behind the knee and incise the tendon of the internal gastrocnemius. This will relieve tendonitis located at the level of the Achilles tendon”explains Dr François Lintz.
Apart from tendinitis, which is a source of pain, other causes may justify treatment by tenotomy. Thus, a neurological pathology such as a CVA (cerebrovascular accident), for example, or a situation of motor infirmity since birth, can cause retractions, therefore deformations in all the limbs. Sequelae of paralysis also represent a reason for surgical intervention for these patients. “Severing certain tendons will then be necessary to free the limbs”explains the surgeon.
The most common cases of tenotomies in the lower limbs remain toe deformities, which are more frequent with advancing age. These deformations are favored by narrow, rigid footwear with heels. “A tenotomy is sometimes the only effective solution in this type of situation”, continues Dr François Lintz. This type of intervention is performed under local or loco-regional anesthesia and is quite fast. “The operation is performed by percutaneous surgery. It leaves few sequelae, provided that the post-surgical rehabilitation phase is rigorously followed. adds the orthopedic surgeon. Generally, walking is possible from the intervention thanks to orthopedic post-operative shoes and rehabilitation can begin quickly after the intervention.
With regard to the upper limbs, the tenotomy at the level of the shoulder, which generally concerns the tendon of the long biceps, is a relatively frequent operation.
“It is one of the surgical treatments for shoulder tendon pain, also known as rotator cuff tendonitis. Tenotomy involves cutting the tendon that passes through the shoulder. explains Dr Régis Guinand, upper limb orthopedic surgeon. This intervention is generally carried out when the other therapeutic solutions have not worked (rest, medication, infiltrations, physiotherapy) and the pain has become disabling on a daily basis. “Regarding the long biceps, there remains the solution of tenotomy which consists in cutting this tendon, which is not essential for the proper functioning of the shoulder., continues the surgeon. If everyone can be affected by this problem, certain professions, in particular those which mobilize a lot of arms and shoulders, such as in the building trades, are more at risk.
As with the Achilles tendon tenotomy, the shoulder tenotomy is an intervention performed under arthroscopy. On the other hand, the intervention is frequently done under general anesthesia. In some cases, tenotomy is combined with tenodesis. This tenodesis is a surgery that consists of fixing the severed tendon to another place, or connecting it to another tendon.
If this surgery gives good results, it can however be delicate in patients who are a little old and/or fragile. Some complications are always possible. In some cases, cramps and deformities of the biceps may appear, such as a lump in the shoulder. “This is called the muscle or Popeye syndrome which can have consequences on the aesthetic appearance of the muscle”, explains Dr. Régis Guinand. After surgery, shoulder recovery can take 6 to 12 weeks.
Apart from the shoulder tenotomy, certain much rarer medical situations, of handicap, can lead to cutting tendons in order to restore a form of mobility, at the level of a hand or a wrist, for example.