Table of ContentsView AllTable of ContentsWhat It IsPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What It Is
Purpose
How to Prepare
What to Expect
Recovery
Also known as percutaneous ultrasonic tenotomy and percutaneous ultrasonic fasciotomy, the Tenex procedure is commonly used to treat tendinitis of the elbow, hip, knee, shoulder, and ankle, as well asplantar fasciitisfoot pain. The Tenex procedure may, in some cases, be a reasonable alternative to conventional tendon surgery when conservative therapies fail to provide relief.
How Tendinitis Differs From Tendinosis
Tenex Health
What Is the Tenex Procedure?
The Tenex procedure is typically performed as a single treatment. It involves making multiple tiny incisions through which a needle-like ultrasound transducer is inserted into or near a joint space to break up and remove damaged tissues. Most procedures can be performed within 20 minutes without the need for stitches.
How Foot and Ankle Tendonitis Is Treated
Contraindications
Although there are no absolute contraindications for the Tenex procedure, it may be deferred if there is a local skin infection due to the risk ofcellulitis. The procedure should also be avoided if there are significant changes in a joint resulting injoint instabilityor recurrentdislocation, both of which indicate the need for more invasive treatment.
The Tenex procedure is neither used to replace first-line conservative treatments nor use as a stopgap measure when conventional surgery is clearly indicated (such as for aruptured tendon).
How to Treat a Torn Achilles Tendon
Possible Risks
There are few notable side effects associated with the Tenex procedure. Other than mild bleeding and short-term pain, redness, and swelling at the treatment area, the Tenex procedure is considered safe with a low risk of infection.
On rare occasions, nerve damage has been reported, but the risk is low (less than 1%) due to the absence of nerve fibers within tendon tissues.
Purpose of the Tenex Procedure
Tendonitis Facts and Statistics: What You Need to Know
Preoperative Evaluation
The Tenex procedure may be considered when conservative therapies fail to provide relief.These may includenonsteroidal pain relievers,splints/braces,foot orthotics,physical therapy, eccentric joint exercises,therapeutic ultrasound,cortisone injections,extracorporeal shock wave therapy, andplatelet-rich plasma (PRP) injections.
This evaluation would involve a physical exam, a review of your medical history, and, most importantly, the imaging of the joint—using anX-ray,computed tomography (CT) scan, ormagnetic resonance imaging (MRI)—to determine the location and extent of the degenerated tissue.
The examination is meant to confirm that the Tenex procedure is the appropriate treatment option. The imaging studies also help map the general treatment area.
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Although the Tenex procedure is fast and minimally invasive, there are still things you need to do before undergoing the procedure. The healthcare provider trained in the technology will walk you through the steps, including what to expect during recovery.
Location
The Tenex procedure can be performed in a hospital, clinic, specialized surgical center, or a healthcare provider’s office. The procedure room is comprised of an operating chair or table and the patented Tenex Health TX system.
The Tenex Health TX System is comprised of a pen-like device fitted with a 1.8-gauge needle that oscillates at high frequency. The device is connected to a series of tubes that continuously irrigate the treatment area with saline solution.
What to Wear
Wear something comfortable that you can change into and out of easily if needed. Leave jewelry and any valuables at home. You will be provided a gown and possibly head cap to change into.
Food and Drink
There are no food and drink restrictions for the Tenex procedure.
Medications
As a general rule,nonsteroidal anti-inflammatory drugs (NSAIDs)are stopped at least one weekbefore and afterany percutaneous joint procedure to reduce the risk of bleeding. The restriction applies whether the procedure is ultrasonic or employs some other form of energy, such as heat or electricity.
This includes such common over-the-counter and prescriptions NSAIDs as:
In the interim, chronic pain can be controlled with Tylenol (acetaminophen) (which is not an NSAID) or regularice application.
Natural Remedies for Tendinitis
What to Bring
You will need to bring your driver’s license or another form of government photo ID for registration. Also, bring your insurance card and an approved form of payment ifcopayment or coinsurancecosts are required upfront.
Even though the Tenex procedure involves only local anesthesia, it is still a good idea to bring someone with you to drive you home. Depending on the joint treated, you may experience pain and a significant restriction of movement that may impair your ability to drive safely.
When in doubt, it is best to play it safe and organize for a friend, family member, or car service to drive you home.
What to Expect on the Day of the Procedure
Upon arrival, you will check-in and be asked to complete the necessary forms, including a medical history sheet and a consent form stating that you understand the aims and risks of the procedure.
Before the Procedure
Unlike tendon surgery, the Tenex procedure doesn’t involveintravenous anesthesia or sedativesof any sort. This negates the need for ananesthesiologist, as well as an IV line,pulse oximeter, and other equipment typically used in surgery.
During the Procedure
Once prepped, you are placed on a table or chair in a position that provides direct access to the treatment site. A handheld MSK ultrasound helps map the needle insertion point on the skin, which is marked with a pen.
Next, a local anesthetic like 1% lidocaine is delivered under the skin to numb the general area. You may feel a little prick but generally little pain. When sufficient numbing has occurred, more of the local anesthetic is delivered into deeper tissues. As much as 10 to 30 cubic centimeters (cc) may be used.
After swabbing the skin with an antimicrobial wash, the healthcare provider makes a 3-millimeter (1/10th-inch) incision on the premarked location on the skin. Using the MSK ultrasound for guidance, the healthcare provider then inserts the oscillating needle at a shallow angle into the damaged tendon (which appears black on the video monitor).
The high-frequency oscillating action scrapes away tissues with extreme precision. The debris is cleared with a continuous stream of saline solution that is propelled from and suctioned back into the base of the needle.
Once completed, the needle is extracted, and the incision is closed with an adhesive strip.
How Long Does It Take Incisions to Heal?
After the Procedure
Depending on the area of treatment, the healthcare provider may decide to temporarily immobilize the joint with a brace, splint, or a walking boot. Crutches may be needed for people who have undergone treatment of the foot, ankle, knee, or hip.
You can usually go home immediately after the Tenex procedure is complete. Many people report immediate pain relief.
How to Properly Use a Knee Brace
Upon your return home, you will need to relax for several days, placing minimal weight on the affected joint. Pain, if any, can usually be treated with Tylenol or acold compress.
Although excessive movements are avoided, you will need to perform gentlerange of motion exercisesfor the first 48 hours to prevent adhesions (the sticking together of tissues).Wound care instructionswill also be provided.
After a week, a routine program of eccentric exercises (in which a muscle is lengthened at the same time it is being contracted) should be included in the treatment plan to build strength and restore joint mobility. Aphysical therapistcan help design the appropriate home-based program.
Most people are able to return to work and normal activity within a week to 10 days of the procedure. Even though the pain relief is often striking and immediate, it can take anywhere from four to 12 weeks before you regain full function of a joint and a return to unencumbered physical activity.
Physical Therapy as a Treatment for Chronic Pain
You will need to schedule regular follow-up appointments with your healthcare provider to gauge your response to treatment and monitor for complications. Additional imaging studies may be ordered.
Although the Tenex procedure provides significant relief for many people, retreatment is sometimes necessary. A 2016 study published in theJournal of the American Podiatric Associationfound that two of 26 procedures for Achilles tendinitis required repeated treatment.
The Tenex procedure is still relatively new, but early studies suggest that it has a success rate of around 84.6% when used appropriately. If the procedure is not successful, it is often because more invasive treatment was needed in the first place.
8 Ways to Treat and Prevent Achilles Tendinitis
Lifestyle Adjustments
It is important to remember that the Tenex procedure relieves the pain associated with chronic tendinitis but doesn’t necessarily correct the underlying cause.
Though many people who undergo the procedure may remain symptom-free for years (and possibly permanently), those who developed tendinitis due torepetitive stressor extreme sports may experience a relapse unless certain behaviors are modified.
Modifications may include the use of braces or splints in occupations that involve repetitive motions (such as acarpal tunnel brace). Athletes may require joint-specific strengthening exercises or the modification of sports techniques (such as moving from a one-handed to two-handed tennis backhand) to avoid recurrence.
By adjusting behaviors that contribute to tendinitis, you stand a far better chance of remaining pain-free over the long run.
A Word From Verywell
The Tenex procedure is a new and promising technique whose use is expanding in tandem with its growing acceptance in the treating community. Still, it can be hard to find a healthcare provider qualified in the Tenex procedure or to know who is competent in delivering effective treatment.
If exploring the Tenex procedure for the treatment of refractory pain, do not hesitate to interview the treating healthcare provider and ask about their qualifications. This includes asking how long the healthcare provider has performed the procedure, how frequently they use it in their practice, and what response rates they have achieved.
The Tenex procedure is not a one-size-fits-all solution. If used appropriately, it can deliver impressive results. But, if used solely to avoid surgery, it less likely to do anything but provide short-term relief and may end up causing you harm.
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12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barnes, DE.Ultrasonic energy in tendon treatment.Operative Tech Orthopaed.2013;23(2):78-83. doi:10.1053/j.oto.2013.05.006Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB.Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis.J Shoulder Elbow Surg. 2019;28(1):112-9. doi:10.1016/j.jse.2018.08.032Sanchez PJ, Grady JF, Saxena A.Percutaneous ultrasonic tenotomy for Achilles tendinopathy Is a surgical procedure with similar complications.J Foot Ankle Surg. 2017;56(5):982-4. doi:10.1053/j.jfas.2017.06.015Chesnel C, Genêt F, Almangour W, Denormandie P, Parratte B, Schnitzler A.Effectiveness and complications of percutaneous needle tenotomy with a large needle for muscle contractures: A cadaver study.PLoS One. 2015;10(12):e0143495. doi:10.1371/journal.pone.0143495Morrey BF.A new safe and effective treatment for chronic refractory tendinopathy.Ortho Rheum Open Access J.2018;11(5):555825. doi:10.19080/OROAJ.2018.11.555825Formaini NT, Levy JC.Minimally invasive treatment of medial epicondylitis. In: Minimally Invasive Surgery in Orthopedics. 2016.Childress MA, Beutler A.Management of chronic tendon injuries.Am Fam Physician.2013 Apr 1;87(7):486-90.Baker CL, Mahoney JR.Ultrasound-guided percutaneous tenotomy for gluteal tendinopathy.Orthop J Sports Med. 2020;8(3):2325967120907868. doi:10.1177/2325967120907868U.S. National Library of Medicine.Percutaneous US guided elbow tenotomy with the TenJet hydrosurgery system. April 3, 2018.Chimenti RL, Stover DW, Fick BS, Hall MM.Percutaneous ultrasonic tenotomy reduces insertional Achilles tendinopathy pain with high patient satisfaction and a low complication rate.J Ultrasound Med. 2019;38(6):1629-35. doi:10.1002/jum.14835Sconfienza LM, Albano D, Messina C, et al.Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: In vivo non-controlled prospective study.J Clin Med. 2020;9(7):2114. doi:10.3390/jcm9072114Freed L, Ellis MB, Johnson K, Haddon TB.Fasciotomy and surgical tenotomy for chronic Achilles insertional tendinopathy: A retrospective study using ultrasound-guided percutaneous tenotomy approach.J Am Podiatr Med Assoc.2019;109(1):1-8. doi:10.7547/15-168
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barnes, DE.Ultrasonic energy in tendon treatment.Operative Tech Orthopaed.2013;23(2):78-83. doi:10.1053/j.oto.2013.05.006Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB.Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis.J Shoulder Elbow Surg. 2019;28(1):112-9. doi:10.1016/j.jse.2018.08.032Sanchez PJ, Grady JF, Saxena A.Percutaneous ultrasonic tenotomy for Achilles tendinopathy Is a surgical procedure with similar complications.J Foot Ankle Surg. 2017;56(5):982-4. doi:10.1053/j.jfas.2017.06.015Chesnel C, Genêt F, Almangour W, Denormandie P, Parratte B, Schnitzler A.Effectiveness and complications of percutaneous needle tenotomy with a large needle for muscle contractures: A cadaver study.PLoS One. 2015;10(12):e0143495. doi:10.1371/journal.pone.0143495Morrey BF.A new safe and effective treatment for chronic refractory tendinopathy.Ortho Rheum Open Access J.2018;11(5):555825. doi:10.19080/OROAJ.2018.11.555825Formaini NT, Levy JC.Minimally invasive treatment of medial epicondylitis. In: Minimally Invasive Surgery in Orthopedics. 2016.Childress MA, Beutler A.Management of chronic tendon injuries.Am Fam Physician.2013 Apr 1;87(7):486-90.Baker CL, Mahoney JR.Ultrasound-guided percutaneous tenotomy for gluteal tendinopathy.Orthop J Sports Med. 2020;8(3):2325967120907868. doi:10.1177/2325967120907868U.S. National Library of Medicine.Percutaneous US guided elbow tenotomy with the TenJet hydrosurgery system. April 3, 2018.Chimenti RL, Stover DW, Fick BS, Hall MM.Percutaneous ultrasonic tenotomy reduces insertional Achilles tendinopathy pain with high patient satisfaction and a low complication rate.J Ultrasound Med. 2019;38(6):1629-35. doi:10.1002/jum.14835Sconfienza LM, Albano D, Messina C, et al.Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: In vivo non-controlled prospective study.J Clin Med. 2020;9(7):2114. doi:10.3390/jcm9072114Freed L, Ellis MB, Johnson K, Haddon TB.Fasciotomy and surgical tenotomy for chronic Achilles insertional tendinopathy: A retrospective study using ultrasound-guided percutaneous tenotomy approach.J Am Podiatr Med Assoc.2019;109(1):1-8. doi:10.7547/15-168
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Barnes, DE.Ultrasonic energy in tendon treatment.Operative Tech Orthopaed.2013;23(2):78-83. doi:10.1053/j.oto.2013.05.006Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB.Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis.J Shoulder Elbow Surg. 2019;28(1):112-9. doi:10.1016/j.jse.2018.08.032Sanchez PJ, Grady JF, Saxena A.Percutaneous ultrasonic tenotomy for Achilles tendinopathy Is a surgical procedure with similar complications.J Foot Ankle Surg. 2017;56(5):982-4. doi:10.1053/j.jfas.2017.06.015Chesnel C, Genêt F, Almangour W, Denormandie P, Parratte B, Schnitzler A.Effectiveness and complications of percutaneous needle tenotomy with a large needle for muscle contractures: A cadaver study.PLoS One. 2015;10(12):e0143495. doi:10.1371/journal.pone.0143495Morrey BF.A new safe and effective treatment for chronic refractory tendinopathy.Ortho Rheum Open Access J.2018;11(5):555825. doi:10.19080/OROAJ.2018.11.555825Formaini NT, Levy JC.Minimally invasive treatment of medial epicondylitis. In: Minimally Invasive Surgery in Orthopedics. 2016.Childress MA, Beutler A.Management of chronic tendon injuries.Am Fam Physician.2013 Apr 1;87(7):486-90.Baker CL, Mahoney JR.Ultrasound-guided percutaneous tenotomy for gluteal tendinopathy.Orthop J Sports Med. 2020;8(3):2325967120907868. doi:10.1177/2325967120907868U.S. National Library of Medicine.Percutaneous US guided elbow tenotomy with the TenJet hydrosurgery system. April 3, 2018.Chimenti RL, Stover DW, Fick BS, Hall MM.Percutaneous ultrasonic tenotomy reduces insertional Achilles tendinopathy pain with high patient satisfaction and a low complication rate.J Ultrasound Med. 2019;38(6):1629-35. doi:10.1002/jum.14835Sconfienza LM, Albano D, Messina C, et al.Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: In vivo non-controlled prospective study.J Clin Med. 2020;9(7):2114. doi:10.3390/jcm9072114Freed L, Ellis MB, Johnson K, Haddon TB.Fasciotomy and surgical tenotomy for chronic Achilles insertional tendinopathy: A retrospective study using ultrasound-guided percutaneous tenotomy approach.J Am Podiatr Med Assoc.2019;109(1):1-8. doi:10.7547/15-168
Barnes, DE.Ultrasonic energy in tendon treatment.Operative Tech Orthopaed.2013;23(2):78-83. doi:10.1053/j.oto.2013.05.006
Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB.Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis.J Shoulder Elbow Surg. 2019;28(1):112-9. doi:10.1016/j.jse.2018.08.032
Sanchez PJ, Grady JF, Saxena A.Percutaneous ultrasonic tenotomy for Achilles tendinopathy Is a surgical procedure with similar complications.J Foot Ankle Surg. 2017;56(5):982-4. doi:10.1053/j.jfas.2017.06.015
Chesnel C, Genêt F, Almangour W, Denormandie P, Parratte B, Schnitzler A.Effectiveness and complications of percutaneous needle tenotomy with a large needle for muscle contractures: A cadaver study.PLoS One. 2015;10(12):e0143495. doi:10.1371/journal.pone.0143495
Morrey BF.A new safe and effective treatment for chronic refractory tendinopathy.Ortho Rheum Open Access J.2018;11(5):555825. doi:10.19080/OROAJ.2018.11.555825
Formaini NT, Levy JC.Minimally invasive treatment of medial epicondylitis. In: Minimally Invasive Surgery in Orthopedics. 2016.
Childress MA, Beutler A.Management of chronic tendon injuries.Am Fam Physician.2013 Apr 1;87(7):486-90.
Baker CL, Mahoney JR.Ultrasound-guided percutaneous tenotomy for gluteal tendinopathy.Orthop J Sports Med. 2020;8(3):2325967120907868. doi:10.1177/2325967120907868
U.S. National Library of Medicine.Percutaneous US guided elbow tenotomy with the TenJet hydrosurgery system. April 3, 2018.
Chimenti RL, Stover DW, Fick BS, Hall MM.Percutaneous ultrasonic tenotomy reduces insertional Achilles tendinopathy pain with high patient satisfaction and a low complication rate.J Ultrasound Med. 2019;38(6):1629-35. doi:10.1002/jum.14835
Sconfienza LM, Albano D, Messina C, et al.Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: In vivo non-controlled prospective study.J Clin Med. 2020;9(7):2114. doi:10.3390/jcm9072114
Freed L, Ellis MB, Johnson K, Haddon TB.Fasciotomy and surgical tenotomy for chronic Achilles insertional tendinopathy: A retrospective study using ultrasound-guided percutaneous tenotomy approach.J Am Podiatr Med Assoc.2019;109(1):1-8. doi:10.7547/15-168
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