Tendonitis is a common condition that affects the upper and lower body. While most cases of tendonitis will improve with conservative measures, such as modified activity and strengthening exercises, some cases are resistant to these treatments and may require surgery. The Tenex procedure UK is a minimally invasive approach that can potentially replace surgery. This blog will explore the Tenex tenotomy procedure, including preparation, results, potential complications, and post-intervention rehabilitation.
What is tendonitis?
Common tendinopathies include tennis elbow, plantar fasciitis, Achilles tendonitis, and patellar tendonitis. Generally, people with tendonitis report pain with activity, including sports. Previously, we thought that tendonitis was an inflammatory process. More recent studies suggest that it’s a little more complicated. We believe that excessive activity leads to impaired healing, resulting in tendon swelling and the ingrowth of abnormal blood vessels and nerves within the tendon.
Generally, we treat tendonitis first with simple measures, such as strengthening exercises. Sometimes, we use other treatments, such as GTN patches, shockwave therapy, supplements, and tendon injections. However, some cases do not respond to these treatments and need more targeted interventions.
The Tenex Tenotomy Procedure
The Tenex procedure, also known as percutaneous tenotomy, utilises ultrasonic energy to remove damaged tendon tissue while preserving the healthy portion. Unlike surgery, it is minimally invasive and performed with local anaesthetic. Thus, it replaces the need for more invasive and riskier surgery.
What is the purpose of the Tenex procedure?
The Tenex procedure is used to treat tendonitis, which is resistant to other treatments. In tendonitis, the tendon swells, leading to collagen breakdown, microtears, and the ingrowth of abnormal nerves. We suspect that these abnormal nerves are the cause of the pain. The Tenex procedure aims to remove damaged tissue, including abnormal nerve ingrowth, while sparing normal tendon tissue.
Is the Tenex procedure right for you?
Generally, we use Tenex for upper and lower limb tendonitis that fails to respond to other treatments. It is also effective at removing tendon calcification. The tendinopathies suitable for Tenex include:
It is essential to consult a sports doctor experienced in the Tenex procedure to determine if it is the right option for you. Your doctor will need to assess your tendonitis to determine your suitability for treatment. Imaging, such as ultrasound and/or MRI, is crucial to deciding the location and extent of damaged tissue. Also, Tenex should only be considered in cases that have failed simple treatments such as rehab and adjuncts like GTN patches, shockwave therapy, supplements, and injections (needle tenotomy, barbotage, PRP).
Tenex Procedure Success Rate
Clinical studies and patient experiences report high success rates with the Tenex procedure.
Studies have shown success rates of 85-90% in pain relief and functional improvement following Tenex treatment.
A recent systematic review found that Tenex was effective for various tendinopathies, including tennis elbow, golfer’s elbow, Achilles tendonitis, Patellar tendonitis, plantar fasciitis, and gluteal tendinitis. Significantly few patients in these studies progressed to surgery. Moreover, there was a low rate of complications limited to post-procedure pain and skin infections. Notwithstanding these promising results, the studies were of lower-level evidence. We need more randomised studies on Tenex to establish it as a viable alternative to tendon surgery.
Possible risks
Like any medical procedure, TENEX carries some risks. However, complications are rare due to its minimally invasive nature. Possible side effects and risks include:
- Temporary Soreness: Mild pain or swelling around the treated area is common but typically resolves within a few days.
- Bruising: Minor bruising may occur at the incision site.
- Infection: Although rare, the risk exists, as with any procedure involving an incision.
- Incomplete Response: Sometimes, patients may not experience complete relief and require additional interventions such as surgery.
- Tendon rupture: Any tendon procedure can cause a tendon rupture. However, the risk of rupture is very low if performed on the right patient.
Preparation on the day
Although the Tenex procedure is fast and minimally invasive, you still need to take steps to prepare for it.
The procedure can be performed in a hospital or procedure room equipped with an operating table, the Tenex machine, and an ultrasound scanner to direct the Tenex accurately. Wear something comfortable that you can easily take off and put back on. There are no food or drink restrictions with this procedure.
Generally, to reduce bleeding, you should discontinue taking NSAIDS (such as ibuprofen and diclofenac), aspirin, or blood thinners before the procedure. However, you should consult your doctor to determine when and how long to discontinue these medications.
After the procedure, you should use regular ice and paracetamol/codeine for pain relief.
During the Tenex tenotomy procedure
Step-by-Step Description:
First, an ultrasound is performed to define tendon pathology and guide the precise location of the damaged tissue. Next, after cleaning the skin with an antiseptic, a local anaesthetic (such as lidocaine 1%) is placed in the skin and tendon to numb the area. Then, a small incision (usually less than 1 cm) is made in the skin adjacent to the tendon.
Using the ultrasound scan as guidance, your doctor inserts the oscillating needle into the damaged part of the tendon. The machine is turned on, delivering ultrasonic energy to break up the injured tendon, remove abnormal calcification, and destroy nerves. We clear the debris with continuous sterile water propelled from and suctioned back into the needle. Finally, the needle is removed, and the skin is closed with a small bandage, often without the need for sutures.
The procedure takes about 30-40 minutes, depending on the case’s complexity. You can go home on the same day as the procedure.
Recovery and post-procedure rehab
Depending on the area treated, your doctor may recommend resting the tendon in a sling or a walker boot. Sometimes, crutches may be needed for lower limb tendons.
Proper rehabilitation is essential for optimal outcomes. The recovery plan typically includes:
Initial Rest: Patients should avoid strenuous activity for 48 to 72 hours after the procedure. Apply regular ice packs for 10 minutes every 2-3 hours to reduce swelling and bruising. Paracetamol +/—codeine may be needed for pain relief.
Gradual Reintroduction of Movement: Light stretching and range-of-motion exercises can begin a few days after the procedure.
Rehabilitation: After two weeks, a tailored program focusing on strengthening begins to restore full tendon function. Your doctor, in conjunction with your physiotherapist, will guide this process.
Activity Restrictions: High-impact activities should be avoided for 6 weeks, depending on the treated area. Return to impact activity will depend on pain and function. However, as a general rule, returning to sports will take 2-4 months.
Follow-Up Care: Regular check-ins with your doctor ensure the healing process is on track. Generally, we see patients two and six weeks after the procedure.
Other commonly asked questions about the Tenex procedure UK
What are the Tenex tenotomy procedure complications?
Like any procedure, Texex carries risks, including infection, tendon tears, worsening of pain, and incomplete pain relief. However, the risks are significantly lower than those associated with open surgery.
Can you walk after a Tenex procedure?
Your doctor will advise you on whether you can walk, depending on the tendon being treated. Generally, we protect the area for a few weeks. For example, patients wear a walking boot for two weeks after an Achilles procedure. For patellar tendonitis, we recommend using crutches for a few days before you can resume full weight-bearing.
Can I drive home after a Tenex procedure?
We advise you not to drive after the procedure and for the first 24 hours of recovery. You should consult your doctor about when to resume regular driving.
Tenex procedure UK success rates
A recent review published excellent results for various tendons. However, the current data is limited to lower-level evidence. We need better studies, including randomised controlled trials, before we can be sure that Tenex can replace surgery.
Can Platelet-rich plasma be used with Tenex?
Yes. However, we only consider PRP injections for persistent pain after 6-8 weeks.
Final word from Sportdoctorlondon about the Tenex Procedure UK
The TENEX procedure offers an innovative solution for patients with chronic tendonitis who are unresponsive to other treatments. Its precision targeting, minimal invasiveness, and faster recovery time make it an attractive alternative to traditional surgery. However, a thorough evaluation by a sports doctor is essential to determine if this procedure is correct for you.
Dr Masci performs the Tenex procedure in the UK for select cases of upper and lower limb tendonitis that have failed conservative management and other interventions, including shockwave therapy and injections.
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