Percutaneous Tenotomy

Good candidates have chronic tendon pain that has lasted several months despite physical therapy, activity changes and medicines, with ultrasound or MRI showing tendinosis or a small partial tear. Common examples are tennis or golfer’s elbow, rotator cuff tendinosis, gluteal tendinopathy at the outer hip, patellar tendinopathy and insertional Achilles tendinopathy. It is not for complete tendon tears, which usually need surgical repair.

It is a minimally invasive procedure rather than open surgery. It is done through a puncture about the size of a needle stick, under local anesthetic and ultrasound guidance, usually without stitches, and you go home the same day. Open tenotomy, by contrast, uses an incision to reach the tendon. Because it is still a procedure on the tendon, it is followed by a period of protection and rehab.

Tenex is a brand name for one type of percutaneous ultrasonic tenotomy, which uses a probe that vibrates at ultrasonic frequency to cut and remove damaged tendon tissue. Needle tenotomy achieves a similar goal with repeated passes of a fine needle. Systematic reviews have reported improvements with both approaches^[2]. Your physician will recommend a technique based on the tendon and the extent of damage.

The visit usually takes 30 to 60 minutes, and the tendon work itself often takes only a few minutes. The area is numbed with local anesthetic, so most people feel pressure or vibration rather than sharp pain. The numbing injection stings briefly. Soreness is common for several days afterward and is usually managed with ice and acetaminophen.

Bring a list of your medicines and supplements, and stop anti-inflammatory medicines beforehand if your physician advises. Do not stop a prescribed blood thinner on your own — we will coordinate with the doctor who prescribed it^[5]. Wear loose clothing, and arrange a ride home if you will leave in a sling, brace or walking boot.

Recovery is gradual. Most people go back to light daily activities within days, with the treated area protected at first, then follow a graded rehab program over the following weeks. In one study across several tendons, pain scores dropped substantially by four weeks and stayed lower at 12 weeks^[6]. Returning to heavy work or sport usually takes longer and depends on the tendon treated.

Avoid heavy lifting, forceful gripping, running or jumping with the treated tendon until your physician or therapist clears you, and wear any brace or boot as instructed. Ask before taking anti-inflammatory medicines. Many protocols also avoid cortisone injections into the treated tendon for a period afterward^[3]. Gentle movement and prescribed exercises are encouraged.

Many patients improve, especially with chronic tennis elbow, but the evidence comes mostly from case series. Systematic reviews report better pain and function scores with minimal adverse effects^[2], and one elbow study found relief sustained at three years^[7]. Results for the Achilles, shoulder and knee are less well studied^[1], and some people do not improve.

Risks are generally low. The most common are soreness, swelling and bruising for several days. Infection, injury to a nearby nerve or blood vessel, and tendon weakening or rupture are uncommon. In a chart review of 40 Achilles procedures, there was one minor complication^[10]. The main limitation is that the procedure does not help everyone.

Coverage varies by plan and by the tendon treated. Medicare and commercial plans look at the diagnosis and at documentation that conservative care has failed, some plans consider ultrasonic techniques investigational, and prior authorization is often required. For New York workers’ compensation, the elbow guidelines do not currently recommend sonographically guided percutaneous tenotomy for epicondylitis^[4]. No-fault claims follow their own rules. We verify your benefits before scheduling.

Alternatives include a structured exercise program, shockwave therapy, dry needling and PRP injections, which gave similar results to tenotomy in comparison studies of the elbow and outer hip^[8][9]. Cortisone injections can relieve pain in the short term. Open tendon surgery is an option when other treatments have not helped.