Name of the Procedure:

Tenotomy, open, elbow to shoulder, each tendon
Common Name(s): Open Tenotomy of the Upper Arm, Surgical Tendon Release

Summary

Open tenotomy of the upper arm is a surgical procedure involving the incision and cutting of a tendon between the elbow and shoulder. This helps release tight or shortened tendons that affect movement and cause pain.

Purpose

This procedure addresses conditions like tendon contractures, chronic tendinitis, or severe cases of tennis elbow. The goal is to relieve pain, improve range of motion, and restore functional use of the affected arm.

Indications

• Chronic or severe pain in the upper arm tendons not responding to conservative treatments
• Restricted movement due to tendon contracture
• Conditions like tendinitis or tennis elbow
• Patients with significant functional impairment due to tendon issues

Preparation

• Fasting may be required if general anesthesia is used.
• Patients might need to stop certain medications like blood thinners a few days before the procedure.
• Pre-operative imaging such as MRI or ultrasound to assess the tendon condition.
• Routine blood tests and physical examination.

Procedure Description

1. The patient is given anesthesia (local or general) based on the case specifics.
2. The surgeon makes a small incision over the targeted tendon.
3. The tendon is carefully located and incised to relieve tension.
4. The incision is closed with sutures or staples.
5. A sterile dressing is applied to the surgical site.

Duration

The procedure typically takes 30 minutes to 1 hour, depending on the complexity and number of tendons involved.

Setting

Performed in an outpatient clinic or hospital surgical center.

Personnel

• Orthopedic Surgeon or specialized General Surgeon
• Surgical Nurse
• Anesthesiologist or Nurse Anesthetist
• Operating Room Technician

Risks and Complications

• Common: Infection, bleeding, pain at incision site
• Rare: Nerve damage, delayed healing, incomplete release of the tendon
• Complications can generally be managed with medication, physical therapy, or additional surgical intervention.

Benefits

• Relief from chronic pain
• Improved range of motion and functionality of the arm
• Benefits typically noticed within a few weeks post-surgery

Recovery

• Patients may go home the same day or stay overnight in some cases.
• Rest and limited use of the surgical arm for several days.
• Physical therapy usually starts within a week to promote healing and regain function.
• Full recovery can take 6-8 weeks, with periodic follow-up appointments.

Alternatives

• Non-surgical treatments: Physical therapy, corticosteroid injections, NSAIDs, or orthotic devices
• Less invasive procedures: Percutaneous (needle) tenotomy
• Pros and Cons: Non-surgical options have lower immediate risks but may be less effective; less invasive surgeries offer quicker recovery but might not be suitable for severe cases

Patient Experience

During the procedure, the patient may experience no pain due to anesthesia but might feel pressure or movement. Post-procedure, there could be discomfort or mild pain controlled with prescribed medications. Keeping the arm elevated and applying ice can help reduce swelling.