Name of the Procedure:

Tenotomy, percutaneous, adductor or hamstring; multiple tendons

Summary

A percutaneous tenotomy is a minimally invasive surgical procedure where small incisions or needle punctures are made through the skin to cut one or more tendons in the adductor or hamstring muscles. This procedure is usually performed to relieve muscle tightness or contractures.

Purpose

The primary aim of a tenotomy is to address muscle tightness or contractures that restrict movement, often due to conditions like cerebral palsy, muscular dystrophy, or after an injury. The goal is to improve mobility, reduce pain, and enhance the function of the affected limb.

Indications

• Persistent muscle tightness or spasms in the adductors or hamstrings
• Limited range of motion affecting daily activities
• Chronic pain associated with tight tendons
• Failure of conservative treatments like physical therapy or medications

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medication adjustments may be necessary, especially for blood thinners or anticoagulants.
• Preoperative physical examination and imaging studies, like an MRI or ultrasound, to assess the tendons and surrounding tissues.

Procedure Description

1. The patient is placed in an appropriate position for access to the adductors or hamstrings.
2. Local anesthesia is usually administered to numb the area.
3. A small needle or scalpel is inserted through the skin to reach the targeted tendons.
4. The tendons are carefully cut to release tension and lengthen the muscles.
5. The small incisions or puncture sites are closed, often with minimal or no sutures.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Tenotomy is often performed in an outpatient clinic, surgical center, or hospital.

Personnel

• Orthopedic surgeon or specialized physician
• Surgical nurse
• Anesthesiologist or nurse anesthetist (if anesthesia is more than local)

Risks and Complications

• Common risks: minor bleeding, infection at the incision site, temporary soreness
• Rare risks: nerve damage, excessive bleeding, incomplete relief of symptoms
• Complications are usually managed with antibiotics, pain relievers, or corrective surgery if necessary.

Benefits

• Improved range of motion and flexibility
• Relief from chronic pain
• Enhanced ability to perform daily activities
• Benefits might be realized within a few weeks following the procedure.

Recovery

• Post-procedure care includes rest, ice application, and pain management.
• Physical therapy is often recommended to maximize mobility gains.
• Full recovery and return to normal activities usually take a few weeks to a few months.
• Follow-up appointments to monitor progress and address any concerns.

Alternatives

• Physical therapy and stretching exercises
• Oral or injected medications for muscle relaxation
• Botulinum toxin (Botox) injections to reduce muscle spasms
• Pros and cons: Non-surgical options are less invasive but may provide temporary or limited relief compared to tenotomy.

Patient Experience

• During the procedure, patients typically feel minimal discomfort due to anesthesia.
• Post-procedure, patients may experience minor soreness or swelling at the incision sites.
• Pain is usually managed with over-the-counter pain relievers.
• Physical therapy will be essential for optimizing recovery and function.