Revolutionizing Tendon Pain Treatment: New Approaches

Revolutionizing Tendon Pain Treatment: A Look at Percutaneous Tenotomy

Abstract

Tendon-related pain, or tendinopathy, is a common and often debilitating condition affecting millions. Traditionally, treatments have ranged from conservative therapies like rest and physical therapy to more invasive surgical options. However, a minimally invasive, FDA-approved procedure known as percutaneous tenotomy is changing the landscape of tendon care. This educational post explores the science behind this advanced, ultrasound-guided technique, which precisely removes damaged tendon tissue and promotes natural healing.

As Dr. Alex Jimenez, I will guide you through the latest findings from leading researchers, detailing procedures like Tenex and TenJet. We will explore how these methods work, their approved applications for conditions like tennis elbow and plantar fasciitis, and how they represent a significant step forward in evidence-based medicine. This post will also show how we integrate these advanced treatments into our clinic’s multidisciplinary framework, where I, as a Doctor of Chiropractic and certified Family Nurse Practitioner, work alongside our Medical Director, Dr. Maria Guadalupe Cardenas, MD, to provide comprehensive, patient-centered care.

A Collaborative Approach to Advanced Musculoskeletal Care

Hello, I’m Dr. Alex Jimenez. With a background in chiropractic care, advanced practice nursing, and functional medicine, my mission has always been to find and provide the most effective, evidence-based treatments for my patients. At Injury Medical Clinic, PA, we pride ourselves on a unique, integrative model of care that brings together diverse medical disciplines to achieve the best possible outcomes.

A cornerstone of our practice is the collaborative relationship between me and our esteemed Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a Board-Certified Internist with over four decades of experience (NPI #1164426749, Texas MD License #J2933). Her deep medical knowledge and clinical oversight are invaluable, allowing us to offer a spectrum of care that bridges conventional medicine and advanced therapeutic modalities.

This multidisciplinary setup is fundamental to our philosophy. This means a team oversees a patient’s journey, which includes:

• Chiropractic Care (Dr. Alex Jimenez, DC): Focusing on spinal health, biomechanics, and nervous system function to restore the body’s structural integrity.
• Medical Oversight (Dr. Maria Cardenas, MD): Providing essential medical diagnostics, management of underlying health conditions, and ensuring all treatments meet the highest standards of medical safety and efficacy.
• Functional Medicine: Investigating the root causes of dysfunction and creating personalized health plans that address diet, lifestyle, and biochemical imbalances.
• Rehabilitation and Personal Injury Care: Developing customized programs to restore function, reduce pain, and facilitate recovery after an injury.

By integrating these services, we can manage complex conditions like chronic tendinopathy not just as a localized problem but as part of a whole-body system. This brings us to an exciting advancement in musculoskeletal medicine that fits perfectly within our integrative model: percutaneous tenotomy.

Understanding Chronic Tendon Pain: From Tendinitis to Tendinopathy

For years, we used the term tendinitis to describe painful tendon conditions, assuming inflammation was the primary culprit. However, modern research has revealed a more complex picture. We now understand that most chronic tendon pain stems from tendinopathy, a degenerative condition characterized by a breakdown of the tendon’s collagen fibers, not acute inflammation. This distinction is crucial because treatments aimed at reducing inflammation often fail in the long run.

In tendinopathy, the tendon tissue becomes weak, disorganized, and filled with abnormal blood vessels. This damaged tissue drives persistent pain and functional limitation. The body’s natural healing response stalls, unable to effectively clear out the degenerated tissue and replace it with healthy, new collagen. This is where percutaneous tenotomy offers a groundbreaking solution.

What is Percutaneous Tenotomy? A Minimally Invasive Breakthrough

Percutaneous tenotomy is a revolutionary, FDA-approved procedure designed to precisely target and remove degenerated tendon tissue using ultrasound guidance. The term “percutaneous” means “through the skin,” highlighting its minimally invasive nature. Unlike traditional open surgery, which requires large incisions and can lead to significant scarring and lengthy recovery times, percutaneous tenotomy is performed through a tiny entry point, often in an office-based setting.

This procedure has become a powerful tool for primary care providers, sports medicine specialists, and integrative practitioners like myself. It effectively “restarts” the healing process by debriding, or cleaning out, the specific area of tendinopathy.

Current FDA-approved indications for percutaneous tenotomy include:

• Extensor and Flexor Tendinopathy at the elbow (e.g., Tennis Elbow and Golfer’s Elbow)
• Patellar Tendinopathy (Jumper’s Knee)
• Achilles Tendinopathy
• Plantar Fasciopathy (often called Plantar Fasciitis)

The Technology Behind the Technique: Tenex and TenJet

Two primary technologies dominate percutaneous tenotomy, each using a unique mechanism to achieve the same goal: precise debridement of pathologic tissue.

1. Tenex Health TX: Ultrasonic Emulsification and Aspiration

At our clinic, we use the Tenex system, a sophisticated device based on technology originally developed for cataract surgery. The process is based on a principle called phacoemulsification.

• How it Works: The Tenex device uses a handheld instrument connected to a console. This instrument houses a special 18-gauge double-lumen needle.
  • One lumen contains a needle tip that vibrates at an ultrasonic frequency (approximately 20,000 times per second). This rapid vibration emulsifies, or liquefies, only the targeted degenerative tendon tissue, leaving healthy tissue unharmed.
  • The second lumen provides both continuous irrigation and aspiration (suction) at the same time. This removes the emulsified debris from the body.
• The Procedure in Practice: I perform the entire procedure under real-time ultrasound guidance. I use an ultrasound probe (covered in a sterile sheath) to visualize the tendon in detail. This allows me to identify the exact location of the tendinopathy and guide the Tenex needle directly to the site. A foot pedal controls the device, allowing for precise activation of the ultrasonic energy. The actual “cutting time” is remarkably short, typically ranging from 30 seconds to two minutes. The procedure is performed under local anesthesia to ensure patient comfort.

The video below demonstrates the debridement of an extensor carpi radialis brevis tendinopathy (tennis elbow). You can see the needle moving back and forth within the area of degenerated tissue, carefully removing it. The sound of the device activating indicates when it applies ultrasonic energy.

2. TenJet: High-Pressure Saline Jet

The TenJet system offers an alternative mechanism. Instead of ultrasonic energy, it uses a highly controlled, high-velocity jet of pressurized saline to cut and remove damaged tissue.

• How it Works: The TenJet device also uses a dual-lumen wand.
  • One lumen shoots a fine, targeted stream of saline that acts like a water-based scalpel, precisely cutting away the diseased tendon tissue.
  • The other lumen simultaneously suctions away the saline and the debrided tissue fragments.
• The Advantage: This method offers another effective way to debride without the thermal effects sometimes associated with ultrasonic energy.

Both Tenex and TenJet represent a paradigm shift, allowing for surgical-level precision in a minimally invasive, office-based procedure.

Integrating Percutaneous Tenotomy with Chiropractic and Functional Medicine

Performing a percutaneous tenotomy is only one part of the healing journey. Simply removing the damaged tissue is not enough. To support a full, lasting recovery, we must address the underlying biomechanical and physiological factors that led to the tendinopathy in the first place. This is where our integrative model is most effective.

The Role of Chiropractic Care

Following a procedure like Tenex, the body has a clean slate to begin healing. Chiropractic care is essential during this phase for several reasons:

• Restoring Proper Biomechanics: Tendinopathy often develops due to repetitive strain caused by faulty movement patterns or structural misalignments. For example, tennis elbow may be linked to poor mechanics in the shoulder or even the thoracic spine. As a chiropractor, I assess and correct these biomechanical faults through spinal adjustments, extremity manipulation, and soft tissue therapies. This ensures that as the tendon heals, it is not subjected to the same abnormal stresses that caused the injury.
• Enhancing Nervous System Function: Chiropractic adjustments help optimize nerve function. The nerves that control the muscles and supply the healing tendon must function without interference. By supporting proper spinal alignment, we help the body coordinate the healing and rehabilitation process.
• Post-Procedure Rehabilitation: We guide patients through a structured rehabilitation program that begins with gentle range-of-motion exercises and progresses to strengthening. This protocol is carefully designed to stimulate the production of strong, organized collagen fibers in the healing tendon.

The Role of Functional Medicine

Functional medicine complements this process by addressing the body’s internal environment. Chronic tissue degeneration is often a sign of systemic imbalances. We may investigate:

• Nutritional Deficiencies: Nutrients like Vitamin C, zinc, manganese, and certain amino acids (proline, glycine) are critical for collagen synthesis. We can identify and correct any deficiencies through targeted supplementation and dietary changes.
• Systemic Inflammation: While tendinopathy is degenerative, a state of chronic, low-grade systemic inflammation can impair healing. A functional medicine approach can identify and address the drivers of this inflammation, such as gut dysbiosis, food sensitivities, or metabolic dysfunction.
• Metabolic Health: Conditions like insulin resistance and diabetes can negatively impact tissue repair. By optimizing blood sugar control and metabolic function, we create an internal environment that is conducive to robust healing.

Under Dr. Cardenas’s medical direction, we can order appropriate lab work and manage any underlying medical conditions, ensuring a safe, holistic approach. This combination of advanced procedural intervention, biomechanical correction, and metabolic support gives our patients the most comprehensive and effective path to recovery.

Conclusion: A New Era in Tendon Health

Percutaneous tenotomy is more than just a new procedure; it is a testament to the power of evidence-based innovation. It provides a highly effective, minimally invasive solution for a problem that has long frustrated both patients and clinicians. By precisely removing the source of pain—the degenerated tissue—we can trigger a true healing response.

At Injury Medical Clinic, PA, we are proud to offer this advanced treatment as part of a broader, integrative framework. My collaboration with Dr. Cardenas and our entire team ensures every patient receives personalized, sophisticated care that addresses their condition from every angle. By combining the precision of percutaneous tenotomy with the foundational principles of chiropractic and functional medicine, we are not just treating symptoms; we are restoring function, promoting long-term health, and empowering our patients to return to the activities they love.

In health,

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST

References

1. Chimenti, R. L., et al. (2017). A mechanistic review of the effects of needle-based interventions for tendinopathy. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 394–405. https://www.jospt.org/doi/10.2519/jospt.2017.7088
2. Kheterpal, A. B., & Sampson, S. (2019). Percutaneous ultrasonic tenotomy for tendinopathies. Bio-orthopaedics: A new approach, 223–231. Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-23093-0_19
3. Koh, E. S., & Robinson, P. (2013). The use of ultrasound in the diagnosis and management of tendinopathy. Ultrasound, 21(1), 16–22. https://journals.sagepub.com/doi/10.1177/1742271X12470720
4. Seng, C., & Mohan, P. C. (2018). Ultrasound guided percutaneous needle tenotomy for chronic tendinopathy. The Indian Journal of Radiology & Imaging, 28(02), 232–237. https://www.thieme-connect.com/products/ejournals/html/10.4103/ijri.IJRI_408_17