Chronic tendonitis can significantly impact daily life and athletic performance. When simple treatments such as modified activity strengthening exercises and shockwave therapy fail, procedures like percutaneous tenotomy offer a minimally invasive alternative to surgery. So what is percutaneous needle tenotomy, and how can it improve tendon recovery?  

What is percutaneous tenotomy?

Percutaneous needle tenotomy is a minimally invasive technique for treating chronic tendon injuries. It involves using a fine needle to disrupt scar tissue and promote natural healing in the tendon. 

How does it work? 

Tendonitis is a degenerative process arising from repetitive tendon stress without enough time for the tendon to heal. Tenotomy stops this degenerative process. Repeated tendon needling promotes local bleeding and increased growth factors, boosting tendon healing. It also breaks down scar tissue formation that impedes healing.

The procedure is commonly performed for conditions such as:

Percutaneous needle tenotomy procedure

This procedure typically takes less than 45 minutes in an office setting. Below is an outline of the method:

Preparation:

  • The affected area is sterilised, and a tiny dose of local anaesthesia is administered for comfort. However, the dose is kept to a minimum to enhance healing. 
  • Ultrasound imaging is used to locate the damaged portion of the tendon.

Needle Insertion:

  • A fine needle is inserted carefully into the tendon using ultrasound.
  • Your doctor moves the needle in and out of the damaged tendon to disrupt scar tissue and stimulate healing. Generally, we perform about 10-20 needle passes. 

Completion:

  • The needle is removed, and a small bandage is applied to the puncture site.
  • No sutures are required, as the skin incision is minimal.
percutaneous needle tenotomy of tennis elbow on ultrasound

Benefits and results 

Generally, patients experience a positive effect within 4-6 weeks of the procedure. Overall, studies show that tenotomy achieves pain relief and functional improvement in 80-90% of cases. It is particularly effective for patients who have not responded to rehab or other non-injection treatments for tendonitis, such as GTN patches or shockwave therapy. 

A recent review assessing higher-level studies (randomised studies) of needle tenotomy found that needle tenotomy responded faster than open surgery with fewer complications. Moreover, in the long term, needle tenotomy was better than cortisone injections and equal to PRP injections. However, there remains controversy about whether tenotomy and PRP are better than tenotomy alone. More studies are needed to determine which is the best tendon injection option. 

Potential side effects and risks

While this procedure is generally safe, some side effects and risks may occur. These include:

  • Temporary Discomfort: Mild pain, soreness, and swelling at the treatment site is common and typically resolves within a few weeks. However, we must counsel patients that their pain may worsen in the short term (a few weeks). 
  • Infection: Though rare, any procedure involving a needle carries a small risk of infection. Infection rate is approximately 1/10000. 
  • Unsuccessful response: While needle tenotomy results are generally good, some patients may require additional treatments if symptoms persist.

Patients must follow this procedure with good physiotherapy and rehab to improve outcomes and minimise risks. 

Post-procedure recovery

Recovery after tenotomy is typically faster than traditional surgery, but a structured rehabilitation plan is essential for optimal healing.

Immediate Post-Procedure Care:

You should rest the treated area for 2-3 days. For pain relief, you can take regular oral paracetamol or low-dose co-codamol, but you should avoid NSAIDs as they interfere with tendon healing. Apply an ice pack for 10 minutes every 3-4 hours to reduce swelling and pain. 

Gradual Return to Activity:

After 2 days, you can start stretching and range-of-motion exercises. Sometimes, a boot for ankle tendons (such as the Achilles or peroneal tendons) may be needed for a week. Physiotherapy can be restarted after 7-10 days, but your doctor should guide you. You should follow a progressive rehab programme guided by your physiotherapist. For four weeks, you should avoid sports and heavy loading. 

Most patients can return to normal activities within 6-8 weeks. 

Other commonly asked questions about percutaneous needle tenotomy 

Is percutaneous needle tenotomy as good as a platelet-rich plasma (PRP) injection? 

According to recent studies, we don’t know which injection is better. Some studies suggest adding PRP to a needle tenotomy might be better. 

As a general rule, we suggest PRP injections for tendons showing a partial tear on a background of tendonitis. However, the cost of PRP injections is also an issue.

Is the Tenex procedure for tendonitis similar to needle tenotomy? 

Yes, but Tenex is more aggressive and potentially more effective. The Tenex procedure is a new, innovative procedure for tendonitis. It uses ultrasonic energy to remove damaged tendon tissue while preserving the healthy part. Unlike surgery, it is minimally invasive and performed with local anaesthetic. Thus, it replaces the need for more invasive and riskier surgery. It is a good option for upper and lower limb tendonitis that has failed other treatments. 

Final word from Sportdotorlondon regarding percutaneous tenotomy

Percutaneous needle tenotomy offers a minimally invasive solution for tendonitis when conservative treatments fail. By stimulating the body’s natural healing process,  this procedure provides lasting pain relief with minimal downtime and a low risk of complications.  

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