Name of the Procedure:

Tendon Lengthening, Upper Arm or Elbow (Tenotomy, Surgical Lengthening)

Summary

Tendon lengthening of the upper arm or elbow is a surgical procedure aimed at increasing the length of a tendon. This operation helps to improve the range of motion and flexibility in joints that have become restricted due to tight or shortened tendons.

Purpose

The procedure addresses problems like muscle contractures and tendon tightness, which can result from conditions such as cerebral palsy, muscular dystrophy, or injuries. The primary goal is to ease movement restrictions, alleviate pain, and enhance the functional use of the upper arm or elbow.

Indications

• Limited range of motion of the elbow or upper arm
• Muscle contractures
• Pain due to tendon tightness
• Spasticity in conditions like cerebral palsy
• Injury-related tendon restrictions

Preparation

• Fasting for 6-8 hours before the surgery
• Temporary discontinuation of certain medications as advised by the surgeon
• Pre-operative physical examination and possibly imaging tests like X-rays or MRI
• Blood tests to ensure no underlying issues will complicate the surgery

Procedure Description

1. The patient is given general anesthesia or regional block anesthesia.
2. A small incision is made over the affected tendon.
3. The tendon is carefully identified and isolated.
4. The tendon is lengthened using surgical techniques, such as Z-lengthening or fractional lengthening, allowing more flexibility.
5. The incision is then closed with sutures, and a dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This procedure is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon or specialized hand surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection at the incision site
• Excessive bleeding
• Scarring
• Damage to surrounding nerves or tissues
• Blood clots
• Post-surgical stiffness or weakness

Benefits

• Improved range of motion and flexibility
• Decreased pain and discomfort
• Enhanced functional use of the arm or elbow
• Better ability to perform daily activities Improvements can generally be observed within a few weeks to months after the procedure.

Recovery

• Keeping the arm elevated to reduce swelling
• Pain management with prescribed medication
• Physical therapy to regain strength and flexibility
• Avoiding strenuous activities for several weeks
• Follow-up appointments to monitor progress

Alternatives

• Physical therapy alone for less severe cases
• Orthotic devices to manage tendon tightness
• Medication for managing pain and inflammation
• Minimally invasive procedures like steroid injections
• Pros and Cons: Non-surgical methods may offer short-term relief and are less invasive but may not provide long-term improvements like surgery.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operation, there may be mild to moderate pain, managed with medication. Swelling and initial discomfort are common but can be managed with rest and proper care. Physical therapy plays a crucial role in recovery, and adhering to prescribed exercises will help regain maximum functionality.