Specializing in Pain Management and Sports Medicine

Tenex Procedure

Treatment of Chronic Tendinitis

Chronic tendinitis is a common problem that increases in prevalence with increasing age. The areas most commonly affected include the outside of the elbow commonly referred to as tennis elbow, the inside of the elbow (golfer’s elbow), the outside of the hip, the front of the knee, the Achilles tendon and the heel. The most common cause of tendon pain is overuse followed by inadequate rest and recovery time. The best first treatment for a recent onset problem is to avoid those activities that aggravate the pain. By doing this the tendon can take the time it needs to heal. Unfortunately for some, the pain continues and other treatments are required. There is a long list of potential treatments and each person can respond differently to different treatment modalities.

Treatment options for tendon pain

If tendinitis pain continues for a few months it becomes somewhat more challenging to treat. Options for treatment for a subacute tendinitis such as tennis elbow include physical therapy, anti-inflammatory medication, ice, acupuncture and a tennis elbow strap. The purpose of the strap is to move the stress  from the bone on the outside of the elbow to area where the brace is located. These can be an effective form of treatment for some but not all.

A person putting on a tennis elbow brace

Tennis Elbow Brace

Injections for tendinitis

A standard treatment for tendinitis, especially lateral epicondylitis or tennis elbow has been the cortisone injection. These have been performed for probably close to 1/2 a century. While they clearly provide pain, albeit temporary for most, are they a good thing for long term treatment of tendinitis? At this point in time, steroid injections for tennis elbow are controversial in the medical literature. What we do know is that in the first month after injection patients do better but by 6 months they are not better and in fact in some studies worse. One study demonstrated that the group of patients that received cortisone injections were worse off at the 2 year point post injection than those that did not. Some recent research suggests that corticosteroid injection actually causes more problems for people in the long term. About a year ago I stopped doing them because the research was convincing enough that while short term benefit is gain, long term outcomes are worse. Steroid injected into tendons can actually cause further and greater degeneration and in the treatment of a chronic tendinopathy that is really the last thing you want.

Treatment of chronic tendinitis/tendinosis

As an aside, on a another page I covered the topic of tendinitis vs tendinosis and how medicine has essentially changed the terminology used to described the condition. This change occurred when samples of the tendons of those with chronic tendon pain  were operated on.

It has been shown through clinical study that most people that experience chronic tendon pain for greater than 5-6 months if left untreated, usually continue to deal with the problem for another year and a half at the least. The current treatments available for someone with a chronic tendinosis/tendinitis include an open surgical procedure, a Tenex procedure, and a myriad if different what is referred to as regenerative medicine injections. These injections include prolotherapy and PRP (platelet rich plasma) taken from the person’s own blood and injected it into the tendon structure. I have done several PRP injections and I have had some success for some people and little for others. Insurance companies do not cover the procedure because it has not been proven to be effective in medical studies so far to date.

Percutaneous Tenotomy- Tenex Procedure

When I was first introduced to the Tenex device a little over three years ago my initial impression was that here comes another product that proclaims great success with a very difficult to treat condition – chronic tendinitis. But something was a little different with the Tenex device and that was that it was covered by Medicare, Workers’ Compensation and all of the major insurance carriers. Also, the developers of the device were highly respected physicians in the field of orthopedics. It is also FDA cleared.

My experience using the Tenex device and performing many percutaneous tenotomy procedures over the past three years on a variety of tendon problems has been positive. I have found it an extremely valuable tool in the treatment of chronic tendon pain.

It can be used for the following:

  • Chronic lateral epicondylitis or Tennis Elbow
  • Chronic medial epicondylitis or Golfer’s Elbow
  • Runner’s or Jumper’s knee- Patellar Tendinitis
  • Achilles Tendinitis
  • Gluteal tendinopathy– Pain from the gluteal tendons that attach to the outside of the hip
  • Calcific tendinitis of the rotator cuff
  • Plantar fasciitis

With over 75,000 procedures already performed the complication rate is very low. I believe that there has only been two tendon ruptures, a few infections and one or two nerve injuries. Only 0.001% of Tenex Health TX patients have experienced complications. The Tenex procedure takes about 20-30 minutes to complete.Because the surrounding healthy tissue is not disturbed, and no stitches or usually no general anesthesia is required, typical recovery is 6-8 weeks– 1/4 the recovery time compared to open surgery. The procedure is done with ultrasound imaging so there is no radiation exposure and one treatment is usually enough.

How the Tenex Device Works

The Tx microtip treating a area of disease tendon

The Tenex device works by emitting a high frequency ultrasound beam that causes normal tendon to vibrate but degenerative tissue to break up. The debrided tissue is the removed through a flushing port that cycles sterile fluid into and out of the area.

Watch the procedure being performed for tennis elbow

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