Sometimes we have a nagging pain in different parts of our body, especially in places like shoulders, elbows, and heels, right? Maybe you are a sportsperson. Or maybe you are someone who does the same type of work all the time. The cause of this pain could be a problem with one of your tendons. Today, we are going to talk about a special treatment method that doctors recommend in such cases.
What is a tenotomy? Simply put...
Okay, first let's look at what tendons are. Simply put, they are strong, cord-like bands that connect our muscles to our bones. These tendons help us move, run, and jump. So when one of these tendons gets damaged or swollen, the pain can be quite unbearable.
Tenotomy is a treatment for a damaged, painful tendon. It involves 'dividing' or 'cutting' the tendon. This can be done in one of two ways:
1. Needle method: The doctor inserts a needle through your skin and treats the damaged tendon.
2. Surgical method: A small incision is made in the skin and the affected part of the tendon is surgically removed.
Although this treatment can be performed on any tendon in the body, it is most commonly performed on the following areas:
- The tendon that connects the biceps muscle in your arm to your shoulder.
- The tendon in the elbow.
- Tendons in the feet and ankles.
Let's find out exactly what the difference is between these treatments?
There are other treatments with similar names to tenotomy. Many people confuse these. Let's see what the difference is.
| Treatment method | Simply put, what happens? | Often used |
|---|---|---|
| Biceps Tenotomy | To reduce pain, the biceps tendon is completely cut and released. The muscle is then moved down the arm a little. | Severe pain in the biceps tendon of the shoulder. |
| Tenodesis | The biceps tendon is cut from the shoulder and reattached to a new location on the upper arm bone. | This is for biceps tendon injuries. People who are very active and don't want their arms to look different choose this. |
| Tenolysis | When a tendon is stuck and won't move, the sheath around it is cut to free the tendon. The tendon is not damaged. | For conditions where the fingers get stuck, such as trigger finger or trigger thumb. |
As you may have noticed, although all of these are treatments for tendons, the methods and goals are different. Your doctor will discuss with you what treatment is best for you.
What conditions require tenotomy treatment?
Tenotomy is often used to treat long-standing tendon pain that has not responded to other treatments. Here are some examples:
- Biceps tendinitis: Shoulder pain caused by inflammation of the tendon of the biceps muscle.
- Shoulder calcific tendinitis: Severe pain caused by calcium deposits in the tendons of the shoulder.
- Tennis elbow or Golfer's elbow: Pain on the outside or inside of the elbow.
- Plantar fasciitis: Unbearable pain in the bottom of the heel when you wake up in the morning.
- Club foot: This is a condition where some babies are born with their feet bent. This treatment is also used to correct this.
- Hammertoes: A condition in which the toes are bent in the middle and look like a 'hammer'.
- Patellar tendinitis: Pain in the kneecap tendon. Also called "runner's knee" or "jumper's knee."
- Achilles tendon injuries: Injuries to the Achilles tendon, the largest tendon in our body, located above the heel.
What does the doctor do before performing a tenotomy?
A doctor will never immediately refer you to a tenotomy. This is usually considered a last resort. Before that, other non-surgical treatments will definitely be tried.
Remember, not all pain requires surgery. It's best to try simple things first.
These are the first things the doctor usually recommends:
- Rest: Staying away from the sport or activity that is causing the pain for a while. This means giving the tendon a break.
- Ice and NSAIDs: Applying ice to the painful area and using an NSAID pain reliever (e.g., ibuprofen) recommended by your doctor can help reduce swelling and pain.
- Physical therapy: This is very important. A physical therapist will teach you exercises to strengthen and stretch the muscles around the injured tendon. This will reduce the pressure on the tendon.
- Corticosteroid injections: If the swelling is very severe, your doctor may inject a steroid injection into the area. This will help reduce the swelling quickly.
If your pain doesn't subside after months of trying all of this, then your doctor may suggest tenotomy treatment.
What actually happens during tenotomy treatment?
As we discussed earlier, this is done in two main ways. The doctor will choose one of these two methods depending on the problem with your tendon.
Percutaneous Needle Tenotomy
The word 'Percutaneous' in this means "through the skin." This is not exactly surgery.
Imagine you have a pain in your elbow. The first thing your doctor does is inject a local anesthetic into the area. Then, using an ultrasound scan, they look closely at your damaged tendon and insert a special needle into it. Then, they use the needle to make small holes in the tendon or remove the damaged parts.
This is an amazing thing. When you cause a small injury like this, the body's natural healing process kicks in. The body thinks there's a new injury there. So, it sends more blood and nutrients to the area. This gives the tendon a chance to grow new tissue and heal itself.
Open Tenotomy
This is a minor surgery. You may be given general anesthesia or local anesthesia.
The surgeon then makes a small incision in the skin and removes the damaged tendon. The tendon is then cut and released. This releases the tendon and relieves the pain. Sometimes, when the tendon is cut in this way, it regrows a little longer and less taut than before.
What are the benefits and risks of this treatment?
As with any medical treatment, there are benefits as well as some minor risks.
What are the advantages?
- Both of these treatments are considered very safe and effective treatments.
- Most of the time, these can be done quickly.
- The needle method is not a surgical procedure, so the risk is very low.
- Even if it is done surgically, it is minimally invasive , so only a small scar, less than a few inches long, is left on the body.
Are there any risks?
These risks don't happen to everyone, but it's good to be aware of them.
- Muscle Cramping: Some people may feel a cramping sensation, especially when performing this treatment on the biceps tendon. However, most people do not even feel this. Even if they do, the discomfort will subside over time.
- Scar tissue: If scar tissue forms inside the treated area, it can cause pain.
- Recurrence of symptoms: Some people may experience pain again years later. This risk is especially high if you overuse your tendons, or if your job or sport involves repetitive motion.
How long does it take to recover after treatment?
This will vary depending on the type of tenotomy you had and the location of the treatment. However, it is very important to not use the tendon for a while after treatment.
Typically, you will need to avoid sports and strenuous exercise for several months . Your doctor or surgeon will give you a specific recovery schedule and instructions. It is important to follow these instructions carefully to ensure a speedy recovery.
When should you see a doctor?
If you have pain or something unusual in your body, don't ignore it. Seek medical advice immediately in the following situations:
| If you have these symptoms, see a doctor. | In this situation, go to ETU immediately. |
|---|---|
|
|
Tenotomy is a safe and effective treatment for a variety of tendon-related conditions and pain. However, your doctor should decide whether this is right for you. So, be open and honest with him about your pain.
Take-Home Message
- Tenotomy is a successful treatment for tendon-related pain that has not responded to other treatments.
- This can be done with a needle or through minor surgery.
- This treatment is used after rest, physical therapy, and medication have failed.
- It is very important to follow your doctor's instructions exactly to ensure a full recovery after treatment.
- If you have tendon-related pain, do not ignore it and seek proper advice from a qualified doctor.
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