BACKGROUND: Biceps tenodesis is a technique frequently performed in shoulder surgeries. Various techniques have been described, but there is no consensus on which technique restores the length-tension relationship. Restoration of the physiologic length-tension relationship has been correlated to better functional outcomes, such as decreased incidence of residual pain or weakness of the biceps. The objective of this study was to measure the anatomic relationship of the origin of the biceps tendon with its zones in the upper extremity. This would provide an anatomic guide or an acceptable placement of the tenodesis to reestablish good biceps tension during surgery METHODS: The study used nine adult cadavers (five males, four females) from the [withheld for blinded review]. Nine shoulder specimens were dissected and markers were placed at five points along each biceps tendon: (1) Labral origin (LO) (2) Superior bicipital groove (SBG) (3) Superior border of the pectoralis tendon (SBPMT) (4) Musculotendinous junction (MTJ) and (5) Inferior border of the pectoralis tendon (IBPMT). Using the origin of the tendon as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle as well as the tendon diameter at the articular surface. RESULTS: The intraclass correlation coefficient was excellent across all measures. A total of nine cadavers were included. Mean age of patients was 66.33 years old, ranging from 52-82 years old. These were composed of five male and four female cadavers. The mean tendon length was 24.83mm ± 4.32 from the origin to the superior border of the bicipital groove, 73.50mm ± 6.96 to the Superior Border Pectoralis Major Tendon, 100.89mm ± 6.88 to the Musculotendinous Junction, and 111.11mm ± 7.45 to the Inferior Border Pectoralis Major Tendon. The mean tendon diameter at the articular origin was 6.44mm ± 1.76. CONCLUSION This study provided measurement guidelines that could restore the natural length-tension relationship during biceps tenodesis using the interference screw technique in Filipinos. A simple method of restoring a normal length-tension relationship is by doing tenodesis close to the articular origin and creating a bone socket of approximately 25mm in depth, using the superior border of the bicipital groove as a landmark.
Tenotomy ; Tenodesis

In 7 patients with "A" pattern strabismus with superior oblique overaction, we performed superior oblique posterior tenotomy and tenectomy(PTT) and horizontal rectus muscle surgery for horizontal strabismus, uni- or bilaterally, and analysed the status in degree of postoperative correction of "A" pattern, horizontal and vertical deviation in the primary position for availability of PTT in correction of superior oblique overaction. The average correction of "A" pattern was 10.4 prism diopter(PD). 6 of 7 patients showed eso- or exotropia under 6 PD in the primary position. Two of four patients in bilateral surgery and 2 of 3 patients in unilateral surgery showed the change of vertical deviation in the primary position but there were no problems cosmetically except one. From these results, we think that posterior tenotomy and tenectomy of superior oblique muscle is one of the useful methods for correction of superior oblique overaction in "A" pattern strabismus.
Exotropia ; Humans ; Strabismus* ; Tenotomy*

Following both tenotomy and tenectomy of the homolateral superior oblique muscle as surgical tnatment for isolated paresis of inferior oblique muscle, iatrogenic progressing paralysis of the superior oblique muscle can occur. But tenotomy of the superior oblique muscle resulted in a far lower rate of superior oblique palsy than that of the tenectomy. The authors experienced a case of left superior oblique muscle(LSO) palsy and moderate limitation of left eye in left down gaze after superior oblique tenotomy in left inferior oblique(LIO) paresis and we performed adhesiolysis at tenotomy site and modified Harada-Ito procedure on reconnected superior oblique muscle which had been tenotomized. After surgery, right head tilting disappeared and diplopia remained in left down gaze with minimal limitation of left eye in that direction.
Diplopia ; Head ; Paralysis* ; Paresis* ; Tenotomy*

Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown's syndrome. Authors performed a technique for weakening the superior oblique muscle by lengthening the superior oblique tendon with silicone. Lengthening was accomplished by a nasal superior oblique tenotomy and inserting a segment of silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 6 patients (8 eyes), 2 (4 eyes) with superior oblique overaction (SOOA), and 4 (4 eyes) with Brown's syndrome. Preoperatively patients with SOOA demonstrated A-patterns of 26 and 29 prism dioptersrespectively, and versions of +2 or +3 SOOA. Patients with Brown's syndrome demonstrated version of -3 or -4 elevation on adduction. Postoperatively, the A -patterns disappeared and SOOA was improved to 0 or +1, and underaction on adduction improved to 0 or -0.5 in Brown's syndrome. Based on these results, the superior oblique tenotomy with silicone expander is useful in patients with SOOA and Brown's syndrome.
Humans ; Retinaldehyde ; Silicones* ; Tendons ; Tenotomy*

PURPOSE: To report a case of superior oblique muscle tenotomy in a patient with suspected bilateral inferior oblique muscle overaction. The patient showed secondary superior oblique muscle overaction and inferior oblique muscle underaction after inferior oblique muscle myectomy. CASE SUMMARY: The patient showed V-pattern exotropia with suspected bilateral inferior oblique muscle overaction. After bilateral lateral rectus muscle recession with bilateral inferior oblique muscle myectomy, the patient showed secondary esotropia and inferior oblique underaction. After the surgery, progressive secondary superior oblique muscle overaction continued and finally, a superior oblique muscle tenotomy was performed. After the superior oblique muscle tenotomy, the superior oblique muscle overaction was corrected but the inferior oblique muscle underaction continued. CONCLUSIONS: After an inferior oblique muscle myectomy, secondary superior oblique muscle overaction can develop. Thus, caution should be taken in diagnosing inferior oblique muscle overaction in patients who show minimally inferior oblique muscle overaction as well as the surgical methods chosen.
Esotropia ; Exotropia ; Humans ; Muscles ; Tenotomy

The procedures available to weaken inferior oblique muscle overaction(IOOA) are disinsertion, tenotomy, myectomy, and recession. But those procedures are ineffective in the cases of 4+ overacting inferior oblique and postoperative return of overaction following those surgeries. The author performed denervation and extirpation in 8 cases with 4+ or marked IOOA and 1 case of return of IOOA following 14mm recession of inferior oblique. None of those has shown a return of IOOA, undercorrection, overcorrection and any other complications such as adherence syndrome at follow-up of at least 10 months.
Denervation* ; Follow-Up Studies ; Tenotomy

PURPOSE: Snapping triceps syndrome is dynamic condition in which medial head of triceps snaps (dislocates) over the medial epicondyle as the elbow is flexed. MATERIALS AND METHODS: The symptoms are pain or snapping at the medial aspect of the elbow and/or symptoms from coexisting ulnar nerve irritation. The diagnosis can be made by dynamic ultrasonography. RESULTS AND CONCLUSION: And successful outcome can be archived by operative treatment, which are ulnar nerve anterior transposition and tenotomy of medial head of triceps.
Dislocations ; Elbow ; Head ; Tenotomy ; Ulnar Nerve

We performed modified Z-plasty (N-plasty) in the patients with snapping hip syndrome arising from the iliotibial band whose pain and clicking sensation persisted despite conservative treatments. We analyzed clinical results to evaluate the effectiveness of this new technique. Among 51 patients (65 cases) who still felt pain and reported clicking sensation during daily life despite hospitalization for at least 2 months from January 1999 to November 2011, we evaluated a total of 32 patients (37 cases) who underwent N-plasty and followed up for more than 6 months. All patients were male whose average age was 24 years. Initial symptoms developed an average of 10 months before hospital visit. Surgery was defined success by postoperative 6 months at which time the patient could be able to carry on with daily life and to exercise without clicking sensation and pain, and defined failure when either clicking sensation or pain was present. We observed that the posterior portion of the iliotibial band was thickened by an average of 8.4 mm. Tenotomy of the iliotibial band lengthened the band by an average of 23mm and narrowed the width of the iliotibial band anterior to posterior. Success was in 33 cases (89%) after surgery. Failure was observed in 4 cases. Three were improved after resurgery and 1 was treated conservatively. We found that N-plasty performed in external type snapping hip patients was an effective method yielding a high success rate.
Hip ; Hospitalization ; Humans ; Male ; Sensation ; Tenotomy

No abstract available.
Animals ; Calcaneus* ; Muscle, Skeletal* ; Rats* ; Tenotomy*

PURPOSE: Modified Z-plasty(N-plasty) was performed on patients with snapping hip syndrome arising from the iliotibial band, whose pain and clicking sensation persisted despite conservative treatment. The effectiveness of this new technique was evaluated from an analysis of the clinical results. MATERIALS AND METHODS: Among the 44 patients (58 cases), who still felt pain and reported a clicking sensation during daily life despite hospitalization for at least 2 months from January 1999 to August 2007, this study evaluated a total of 25 patients (30 cases) who underwent N-plasty and were followed up for more than 6 months. All patients were male with a mean age of 21 years. The initial symptoms developed an average of 11.5 months prior to the hospital visit (range, 1 month to 4 years). The affected side was the right side in 6 cases and the left in 10. Among 9 patients affected bilaterally, 5 patients (10 cases) underwent surgery on both sides, 1(1 case) on the right side, and 3 (3 cases) on the left side. Surgery was defined as being successful when at 6 months after surgery the patient could carry out their daily activities and exercise without a clicking sensation or pain. Failure was defined when either a clicking sensation or pain was present. RESULTS: The posterior portion of the iliotibial band was thickened by an average of 8.9 mm (range, 6~14 mm). A tenotomy of the iliotibial band lengthened the band by an average of 25 mm (range, 20~35 mm) and narrowed the width of the iliotibial band anterior to posterior. Twenty-nine cases (97%) had a successful outcome after surgery. Recurrence occurred in 1 case. After additional surgery, the recurrence was found to be due to the insufficient length of the tenotomy. CONCLUSION: N-plasty performed in external type snapping hip patients is an effective method with a high success rate.
Hip ; Hospitalization ; Humans ; Male ; Recurrence ; Sensation ; Tenotomy