A tendon typically goes through 3 phases of healing; inflammatory, proliferative, and remodeling. Chronic tendinitis is a process of disordered healing, wherein there is an imbalance of matrix degeneration and synthesis, leading to degeneration through the deposition of lipid, mucoid or calcific deposition.
Various conservative treatment options exist, including mechanical loading (eccentric strengthening) to stimulate cellular response leading to structural change, cross friction massage, and orthotics/splints. Cortisone injections can provide short term effective, but are often ineffective without load management and rehabilitation. Alternative treatment options include percutaneous tenotomy and platelet rich plasma, where focal area or tendon degeneration are targeted. Ultrasound can be used in the office to diagnose chronic and guide procedures for chronic tendinitis.
TENEX is machine that allows percutaneous tenotomy of this area of chronic tendinopathy. This is accomplished through the use of high frequency ultrasound energy targeted at diseased tendon in order to break it up. The area is simultaneously irrigated with cool saline to then remove the diseased area of tendon. This is done under ultrasound guidance to properly visualize the focal area of pathology.
This procedure is considered when conservative care has failed and symptoms are refractory.
It is successfully used for the following diagnosis; tennis elbow/lateral epicondylitis, golfers elbow/medial epicondylitis, rotator cuff tendinitis, proximal bicep tendinitis, patellar tendinitis, hamstring tendinitis, achilles tendinitis, plantar fasciitis.
The procedure is minimally invasive, not requiring any stitches but only steri-strips. It is a single treatment and last less than 5 minutes. It is done with only local anesthetic and patients tolerate it very well. The side effects are minimal, similar to that of a joint injection.
After the procedure, there is brief 1-2 week period of unloading as tendon begins to heal, followed by slow progression of activity with goal of returning to full activity by 4-6 weeks.
Studies show pain relief and functional improvement up to 3 years out. In addition, they have demonstrated an ultrasonographic tissue-healing response.
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