Tenotomy: What It Is, Types, Risks, and Recovery
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is tenotomy?
Tenotomy is a procedure that treats a painful or damaged tendon by dividing or releasing it. A provider either uses a needle through the skin, often guided by ultrasound, or makes small incisions to cut or remove part of the tendon. Tenotomy is usually offered after rest, physical therapy, NSAIDs, and steroid injections haven't relieved symptoms. [1]
What the research says
Biceps tenotomy works as well as tenodesis for pain and function. A meta-analysis of 25 studies (2,191 patients) found no clinically relevant differences in shoulder scores, pain, or arm strength between the two surgeries. The main trade-off was a visible upper-arm bulge (Popeye deformity), seen in 23% after tenotomy vs. 9% after tenodesis. (Kooistra et al., Arthroscopy, Sports Medicine, and Rehabilitation, 2021) [2]
Needle tenotomy gives lasting relief for chronic tendon pain. A systematic review of 12 studies (481 people) found ultrasound-guided needle tenotomy matched surgical tenotomy in the two studies that compared them. Steroid injections relieved pain faster (about 2 weeks), but the effect faded, while needle tenotomy improved symptoms more slowly and more persistently. (Shomal Zadeh et al., Skeletal Radiology, 2023) [3]
Achilles tenotomy for clubfoot is safe even in a clinic setting. Across 19 studies, the procedure is needed in 80–90% of babies treated for clubfoot with casting. Complications occurred in 1.6% of clinic procedures under local anesthesia vs. 0.5% in the operating room, a difference that was not statistically significant; bleeding was the most common problem. (Rangasamy et al., Foot, 2022) [4]
Key takeaways
Tenotomy treats tendon pain by poking, trimming, or cutting the injured tendon. [1]
There are two main techniques: percutaneous needle tenotomy (not surgery) and open tenotomy (minimally invasive surgery). [1]
It's most often used on the biceps tendon, elbow tendons, and tendons of the feet and ankles. [1]
Most people wait a few months before returning to sports or intense exercise. [1]
Needle tenotomy works through the skin; open tenotomy uses a small incision to release the tendon.
What is tenotomy?
Tenotomy is a procedure that treats pain in a tendon, the tough cord that connects muscle to bone. You may also see it called "dividing a tendon" or "releasing a tendon." [1]
Depending on the problem, your provider may:
Poke the injured tendon with a needle through your skin, or
Remove a damaged piece of the tendon through small cuts (incisions). [1]
Tenotomy can be used on tendons anywhere in the body. Your specific technique depends on which tendon is injured and what caused the damage. [1]
What conditions does tenotomy treat?
Tenotomy treats a range of tendon problems, from overuse injuries in adults to foot conditions in babies. The most common include: [1]
Body area | Conditions treated with tenotomy |
Shoulder & arm | Biceps tendinitis, shoulder calcific tendinitis |
Elbow | |
Knee | Patellar tendinitis (jumper's knee), patellofemoral pain syndrome (runner's knee) |
Foot & ankle | Achilles tendon problems (heel cord tenotomy), plantar fasciitis, hammertoes |
Babies' feet | Clubfoot and other birth differences of the feet and ankles |
If you're dealing with general tendon pain, our guide to tendonitis symptoms, causes, and treatment explains the condition behind most of these diagnoses. You can also read a plain-language overview of tendinitis from the U.S. National Library of Medicine.
The tendons most often treated with tenotomy, grouped by body area.
What are the types of tenotomy?
The two types of tenotomy are percutaneous needle tenotomy and open tenotomy. [1]
Feature | Percutaneous needle tenotomy | Open tenotomy |
Is it surgery? | No | Yes, minimally invasive |
Anesthesia | Local anesthetic to numb the area | Local anesthesia or general anesthesia (asleep) |
What happens | A needle pokes holes in the tendon or removes damaged pieces | A skin cut exposes the tendon, which is then cut |
Imaging | Often guided by ultrasound | Not required |
How it helps | Triggers inflammation and extra blood flow that help the tendon repair itself | Releasing the tendon relieves pain; it may regrow longer and less tight |
Scar | None to speak of | Small scar, under a few inches |
Complication risk | Very low | Low |
How does percutaneous needle tenotomy work?
Percutaneous needle tenotomy works by deliberately creating a small amount of inflammation around the tendon. Your body responds by sending more blood to the area, and this boost stimulates the tendon's ability to regrow and repair itself. [1]
A review of 10 studies covering 11 tendon sites found that people reported better pain, function, and quality of life after needle-based tenotomy, with minimal side effects. [5]
How does open tenotomy work?
Open tenotomy works by surgically releasing the tendon to relieve tension and pain. After numbing you or putting you to sleep, the surgeon cuts through the skin to reach the tendon and then cuts it. In some cases, the tendon regrows longer and less tight than before. [1]
What is the difference between tenotomy and tenodesis?
The difference between tenotomy and tenodesis is what happens to the biceps tendon after it's cut. Both are used to treat biceps tendon injuries. [1]
Biceps tenotomy | Biceps tenodesis | |
What the surgeon does | Cuts the biceps tendon on purpose to relieve pain | Cuts the tendon from the shoulder and reattaches it to a new hole in the upper arm bone (humerus) |
Tendon afterward | Left free; the muscle moves further down the arm | Anchored in a new spot |
Arm appearance | May look different (bulge in the upper arm) | Less likely to change |
Choosing between them depends on how active you are, how quickly you want to recover, and whether you're comfortable with your arm looking different after surgery. [1] Research supports both: pain, function, and strength outcomes are similar, but the upper-arm bulge is more common after tenotomy. [2] Read more in our full guide to biceps tenodesis surgery and recovery.
What is the difference between tenotomy and tenolysis?
The difference between tenotomy and tenolysis is that tenolysis frees a stuck tendon rather than dividing it. Tenolysis, sometimes called a tendon release, is done when a tendon is stuck in place after trauma or another surgery. [1]
Tenolysis is a common treatment for trigger finger or trigger thumb. The surgeon makes a tiny cut in the sheath around the tendons, widening the space so the finger or thumb can move smoothly again. [1]
What treatments are tried before tenotomy?
Non-surgical treatments are usually tried before tenotomy. Your provider will often suggest: [1]
Rest: Avoiding the sport or activity that irritated the tendon.
Ice and NSAIDs: Ice and over-the-counter anti-inflammatory pain relievers can ease inflammation and pain.
Physical therapy: Stretching and strengthening the muscles around the tendon reduces tension on it.
Corticosteroid injections: Steroids lower inflammation.
If you've tried some or all of these and still have pain or discomfort, your provider may recommend tenotomy. [1]
What happens during a tenotomy?
What happens during a tenotomy depends on the technique your provider chooses. [1]
Numbing or anesthesia. You receive a local anesthetic (needle tenotomy) or local or general anesthesia (open tenotomy).
Reaching the tendon. A needle is passed through the skin, often with ultrasound guidance, or a small incision exposes the tendon.
Treating the tendon. The provider pokes holes in the tendon, removes damaged tissue, or cuts the tendon to release it.
Closing up. Needle tenotomy leaves no incision to close; open tenotomy leaves a small scar.
For babies with clubfoot, Achilles tenotomy is part of the standard casting treatment and can be done safely in a clinic under local anesthesia. [4]
What are the benefits and risks of tenotomy?
Tenotomy is a safe, effective treatment for many tendon conditions, and both techniques are quick procedures that can relieve symptoms. [1]
Benefits | Risks |
Quick procedure | Cramping near the treated area after biceps tenotomy; many people don't notice it, and it improves over time |
Relieves symptoms and treats the underlying condition | Scar tissue around the tendon, which can be painful |
Needle technique isn't surgery and has very low complication risk | Return of symptoms, sometimes years later, especially with repeated overuse at work or in sports |
Open technique leaves only a small scar |
How long is recovery after tenotomy?
Recovery after tenotomy usually takes a few months before sports or intense exercise. The exact timeline depends on the type of tenotomy and which tendon was treated. [1]
During recovery:
Rehabilitation advice after needle tenotomy still varies between clinics, so your provider's individual plan matters. [3]
The usual path from first-line care to tenotomy and recovery, with warning signs to watch for.
When should you call a doctor after tenotomy?
You should call your doctor after tenotomy if you notice any of these: [1]
Pain that gets worse or doesn't improve after a few days
Swelling
Discoloration
Difficulty or pain moving or using a part of your body
Go to the emergency room if you've had a trauma or can't move a part of your body that you normally can. [1]
Tenotomy at a glance
Question | Answer |
What it is | A procedure that divides, releases, or trims an injured tendon |
Main types | Percutaneous needle tenotomy; open tenotomy |
Common sites | Biceps, elbow, knee, Achilles tendon, foot |
Anesthesia | Local (needle); local or general (open) |
Tried first | Rest, ice, NSAIDs, physical therapy, steroid injections |
Return to sports | Usually after a few months |
Main risks | Cramping, scar tissue, symptoms returning |
Conclusion
Tenotomy is a well-established way to treat stubborn tendon pain when rest, therapy, and injections haven't been enough. The needle technique avoids surgery and relies on your body's own healing response, while the open technique releases the tendon directly through a small incision. Both are quick, and research supports their safety and effectiveness for the right patient.
The best next step is a conversation with your provider about your tendon, your activity level, and your recovery goals. Want to understand the condition behind your pain first? Start with our guides to tendonitis, plantar fasciitis surgery, and biceps tenodesis.
FAQ
What is tenotomy?
Tenotomy is a procedure that treats a painful or damaged tendon by dividing, releasing, or trimming it. A provider uses either a needle through the skin or small incisions, depending on the tendon and the cause of damage.
Is tenotomy surgery?
Tenotomy can be surgical or non-surgical. Percutaneous needle tenotomy is not surgery, while open tenotomy is a minimally invasive surgery that leaves a small scar.
What conditions does tenotomy treat?
Tenotomy treats tendon problems such as biceps tendinitis, tennis and golfer's elbow, patellar tendinitis, Achilles tendon problems, plantar fasciitis, hammertoes, and clubfoot in babies. It is used most often on the biceps, elbow, foot, and ankle tendons.
How long does it take to recover from a tenotomy?
Recovery from a tenotomy usually means waiting a few months before returning to sports or intense exercise. The exact timeline depends on the technique used and which tendon was treated, so your surgeon will give you a personal plan.
What are the risks of tenotomy?
The main risks of tenotomy are cramping near the treated area, painful scar tissue, and symptoms coming back later. Needle tenotomy carries a very low risk of complications.
Is tenotomy better than tenodesis for the biceps?
Biceps tenotomy and tenodesis give similar results for shoulder pain, function, and strength. An upper-arm bulge is more common after tenotomy, so the choice depends on your activity level, recovery goals, and how you feel about your arm's appearance.
When should I see a doctor after a tenotomy?
A doctor visit is needed after a tenotomy if pain worsens or doesn't improve after a few days, or if you notice swelling, discoloration, or trouble moving the area. Go to the emergency room after a trauma or if you can't move a body part you normally can.
Will I be awake during a tenotomy?
For a needle tenotomy, you are usually awake and the area is numbed with a local anesthetic. For open tenotomy, your care team will explain which type of anesthesia you will receive.
What is percutaneous needle tenotomy?
It is a procedure in which a provider passes a needle through the skin into the damaged tendon, often using ultrasound to guide it. This creates a small, controlled injury that helps the tendon start healing.
What is the difference between tenotomy and tenolysis?
Tenotomy cuts or removes part of a damaged tendon. Tenolysis frees a tendon that has become stuck to nearby tissue, without dividing it.
Related Reading
Biceps Tenodesis: Surgery, Recovery Timeline, Risks and Results explains how biceps tenodesis reattaches the tendon and what recovery involves.
Tendinopathy: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know covers why tendons become painful and the treatments tried first.
Tennis Elbow: Symptoms, Causes, and Treatment explains the causes and treatment of outer elbow tendon pain.
Achilles Tendinitis: Complete Guide to Symptoms, Causes, Self-Care, and Treatment Options covers symptoms, self-care and treatment for Achilles tendon pain.
References
Cleveland Clinic. Tenotomy: Procedure, What It Is & Why It’s Used. Cleveland Clinic. Last updated September 7, 2022. https://my.clevelandclinic.org/health/treatments/24123-tenotomy
Kooistra B, Gurnani N, Weening A, et al. Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis. Arthrosc Sports Med Rehabil. 2021;3(4):e1199-e1209. PMID 34430901. https://doi.org/10.1016/j.asmr.2021.02.010
Shomal Zadeh F, Shafiei M, Hosseini N, et al. The effectiveness of percutaneous ultrasound-guided needle tenotomy compared to alternative treatments for chronic tendinopathy: a systematic review. Skeletal Radiol. 2023;52(5):875-888. PMID 35896736. https://doi.org/10.1007/s00256-022-04140-3
Rangasamy K, Baburaj V, Gopinathan NR, et al. Techniques, anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method of idiopathic clubfoot correction: A systematic review. Foot (Edinb). 2022;52:101922. PMID 36030649. https://doi.org/10.1016/j.foot.2022.101922
Maag L, Linder S, Hackett L, et al. Effectiveness of Percutaneous Needle Tenotomy for Tendinopathies: A Systematic Review. Sports Health. 2025;17(4):834-842. PMID 39238190. https://doi.org/10.1177/19417381241275659
Medical disclaimer
This article is for general education and does not replace advice from a qualified healthcare provider. Talk to your doctor about your symptoms, diagnosis, and treatment options before making decisions about your care.
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