What is a tendon synovectomy surgery? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you have a tendon injury that’s really been painful. It’s been bugging you a lot when you run. Maybe it’s posterior tibial tendinitis, or maybe it’s been perineal tendinitis, but you’ve had pain either on the inside or the outside of your foot that’s been bugging you for a long time. It continues to bother you every time you start running again.
Maybe you’ve been using a fracture walking boot for a month or something. Maybe you’ve even had a corticosteroid injection. Maybe you’ve even taken some oral corticosteroids but no matter what, you haven’t gotten better. So, you go in, you see the doctor and the doctor says, “Look, we tried everything. We should do surgery. Your tendon is not really torn, but we should do this thing called a synovectomy to actually get it to calm down so it will stop hurting.”
What is a tendon synovectomy?
So I talked to somebody who recently had one of these and to explain, it’s really simple. You’ve probably heard of a tonsillectomy. Well, that’s where you remove surgically, you remove the tonsils, or an appendectomy. That’s where you have appendicitis, and the surgeon goes in and actually removes your appendix.
“Ectomy” just means to cut out and when a tendon synovectomy, to understand it, you just have to understand a little bit about some very basic tendon anatomy. So, tendon is a huge cable made up of collagen strands basically. It’s what moves your foot when you actually fire the muscles. The tendon actually connects the bone in your foot to a muscle up in your leg and when you pull the muscle, it pulls the tendon and it slides.
Well, it goes through a lot of different tissue planes between a bunch of different tissues and for it to move without having friction, it has a sheath or a tube around that tendon to let it glide through the tube so it’s only rubbing against the tube. On the inside of that tube, you have synovium, which is a soft squishy tissue that actually makes synovial fluid that lubricates the tendons so that it can glide without resistance. It’s just like lubrication on the inside of a bike cable tube that actually makes that metal cable slide within the tube without resistance.
So, when you have irritation of the tendon sheath, we call that tenosynovitis. And the terms not important, but it just means that the synovial tissue is actually inflamed and swollen. So, when you move that tendon back and forth through the tube, and it actually sort of moves that squishy, inflamed tissue that’s swollen inside, that tube that doesn’t expand, well that causes pain. The idea with the surgery is to go in and take this really swollen, overgrown synovial tissue, open the tendon sheath, cut out that stuff, and then sew the tendon back up and close the skin with stitches. That’s tendon synovectomy surgery.
In theory that should fix it, but again, anytime you have surgery, you can get other problems. The big problem with this surgery in particular with the perineal tendons is that you have the peroneus longus and the peroneus brevis tendons in the same sheath. And many times when we do this synovectomy surgery, because the tendons are in that sheath and we’ve cut the sheath open and the tendons are sitting next to each other, you get scarring that happens that makes them stick together and then they don’t glide independently anymore.
That can be a real problem. So, you really got to talk to your doctor and figure out is there anything else that might be another option you could try to get this thing to calm down and heal without surgery before you go cut the sheath open and just cut some tissue out to see if that will help. By the way, the runner that I just talked to you who had that surgery, it actually didn’t help her at all. So, we always hope that it will help you but there are only two guarantees with surgery. You’re going to get a bill and you’re going to get a scar but that’s it.
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