A tenotomy is a type of surgery that involves cutting a tendon that is too tight to allow for greater range of motion or proper position of a part of the body. This surgery is generally only performed after other less invasive treatments have failed to give the desired result. Tenotomy is used in many different situations such as in cases of strabismus, hammer toe, and cerebral palsy. Tendons that are too short for comfortable movement may be present at birth, but many conditions can cause tendons and muscles to shorten. The way the surgery is performed varies depending on the specific tendon being lengthened, but aftercare and physical therapy follow roughly the same course.
When a skeletal muscle is kept in a strongly contracted position for a long period of time, the muscle can shorten and lead the related tendon to shorten as well. This may eventually encourage fibrous tissue to grow among the muscle fibers and make it hard for the muscle to stretch; this is called contracture. In many cases, other treatments such as medication, casts, splints, and stretching exercises are used to attempt to correct the contracture before tenotomy is recommended. The tendon may be cut all the way through or only through a portion of its width; sometimes a tendon is divided lengthwise and connected end to end to add length.
Strabismus, i.e., lazy eye, may be present at birth but may also develop later in life. It involves a short tendon on one side of the eye pulling the eye out of alignment; tenotomy is one of many possible surgeries to correct strabismus. Hammer toe is due to a shortening of the tendon on the underside of the toe that causes it to stay in a curled position. Patients with cerebral palsy often have a symptom called spasticity which leads to contracted muscles and requires tenotomy in extreme cases. Damage in the upper arm and shoulder area due to strain, overuse, traumatic injury, or deterioration can lead to problems like long head biceps tendinopathy or slap tears that may require tenotomy.
Many tenotomy surgeries now are performed by arthroscopy, but those that include dividing the tendon and reconnecting it end to end must be open surgeries. After a tenotomy to correct limb contracture, the limb is stretched into a normal position and put in a cast to hold it in place while the tendon reattaches or regrows. Rigorous physical therapy is recommended after the cast comes off to keep the muscle and tendon strong and flexible.