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Tenex Health TX™ Procedure for Elbow, Shoulder and Knee Tendonitis

If you suffer from tendonitis of the elbow, shoulder or knee that has not improved with conservative therapy, this amazing new treatment can help.

What is the Tenex Health TX Procedure?

TenexThe Tenex Health TX™ system is a brand new, groundbreaking tool for the treatment of a variety of soft tissue injuries. The procedure is a percutaneous tenotomy and percutaneous fasciotomy – a gentle method using ultrasonic energy to simultaneously cut and remove diseased soft tissue, restoring natural tendon and soft tissue function.

This unbelievable procedure sits firmly at the crossroad of latest technologic advances and prevalent medical problems lacking a definitive treatment option. The TX1 technology, which was developed as part a collaboration between Tenex Health and the world famous Mayo Clinic, uses an ultrasonic cutting tool to treat a variety of tendon and soft tissue injuries.

The Tenex Health TX™ procedure has been proven to improve tendonitis in the elbow, shoulder, and knee. It dramatically decreases pain and improves overall functionality– all without the need for traditional open or arthroscopic surgery.

Indications

The Tenex Health TX™ procedure has been shown to effectively treat tendonitis in the elbow, shoulder, and knee – all without the need for invasive surgery. Because the procedure is performed under ultrasound, there is little to no scarring. The recovery time is a fraction of that of traditional surgery.  Studies have found the procedure to be a definitive treatment for:

Medial Epicondylitis (Tennis Elbow)
Lateral Epicondylitis (Golf Elbow)
Plantar Fasciitis
Achilles Tendonitis
Patellar Tendonitis (Jumper’s Knee)
Rotator Cuff Tendonitis
What is Tendonitis?

FAST-Procedure-Elbow-with-ultrasoundTendonitis literally means “inflammation of a tendon.” It is a type of soft tissue injury that is very common in athletes and active individuals. Symptoms can include painful movement and localized joint stiffness. In moderate to severe cases, patients might describe a burning that surrounds the whole joint around the inflamed tendon. Other common symptoms are swelling, warmth and redness, or even a visible knot. Pain is typically worse during and immediately after activity. Periods of stiffness can last a day or two. If the symptoms of tendonitis persist beyond the acute phase (4-6 weeks), it is called tendonosis.

Tendonosis is chronic tendonitis that fails to heal after the acute phase, resulting in damage to the tendon at the cellular level. Tendonosis leads to decreased tensile strength and a higher chance of tendon rupture.  

What are the Benefits?

FAST_ApplicationsThe Tenex Health TX™ system is a new, non-surgical intervention for treating chronic tendon and soft tissue pain using cutting edge technology and a minimally invasive approach. The procedure can be used to address the most common areas of tendon and soft tissue injuries, including medial and lateral epicondylitis, patellar tendonitis, rotator cuff tendonitis in the shoulder, achillies tendonitis, and plantar fasciitis.

Tenex Health TX™ is a good option for patients who want to return to normal activities quickly. The procedure uses the highly advanced TX Microtip™ to simultaneously cut and debride diseased tissue.

Tenex is an outpatient procedure performed under local anesthetic and is as safe as a cortisone shot. It is as effective as surgery without the need for post-procedure physical therapy, and typically returns the patient to their full level of activity in a relatively short time. When compared to conventional, open surgery, Tenex boasts a number of advantages:

TenexTraditional Tendon Surgery
Inexpensive and covered by most insuranceCan be extremely expensive even with good insurance
Outpatient procedure - performed in your doctor’s office or ambulatory surgery centerPerformed in hospital
Can be done with only local anestheticRequired general anesthesia and regional anesthesia
Minimal risk of infectionRisk of post-surgical or hospital-acquired infection infection
No extensive post-procedural physical therapy regimenLong postoperative recovery period
In many cases, can go back to work the same dayCan be weeks to months before returning to normal activities
Little to no postoperative pain, typically controlled with NSAIDsSignificant postoperative pain and may require a brace, crutches or cast
Rapid recovery; can return to normal activities in as little as 6 weeks in many casesSlow recovery time

More Details

The procedure is performed under ultrasound guidance and uses the latest in ultrasonic technology (TX Microtip™) to painlessly remove pain-generating tissue within a pathologic tendon. Using the Tenex Health TX device on a painful elbow or leg can dramatically decrease pain and increase functionality – all without the need for traditional open or arthroscopic surgery.

Most cases of tendonitis and plantar fasciitis will resolve spontaneously with conservative treatment[1][2], while others will improve up to a year later with no treatment at all.[3] If pain persists after the acute phase, the tissue will heal insufficiently, leaving painful scar tissue behind that can cause chronic discomfort with movement. This state is extremely difficult to treat and will often linger for months to years. While surgery has typically been considered the accepted treatment for tendonitis and plantar fasciitis that fails conservative therapy, most orthopedic surgeons will choose not to operate until the disease is extremely advanced, leaving individuals waiting and in pain.

Tenex offers a number of advantages, not only over surgery, but within the existing treatment paradigm for these injuries. The most obvious advantage is the ability to avoid invasive surgery and the postoperative recovery period. Also, after surgery, the tendon will never be as stable or as strong. The biggest benefit of Tenex is that it can be performed (with results as definitive as surgery) much earlier in the treatment phase due to its minimally invasive nature, all the while avoiding the need to wait in pain until the disease progresses to state where surgery becomes the only option.

How Many Treatments Will I Need?

One treatment is typically enough.

When Will I Feel Better?

There is a minor recovery period from the procedure itself.  Patients typically report improvement in pain in as little 2-3 weeks after the procedure.

Is Tenex Right for Me?

If traditional treatments and therapies have not provided you relief, the Tenex Health TX™ procedure may be an option. It’s less invasive, less aggressive, and less expensive than surgery. The procedure involves minimal to no scarring, and alleviates further degeneration of tissues that could otherwise require a surgical intervention.

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for Tenex.

Procedure - Patient Details

This procedure is performed in an outpatient setting and is extremely well tolerated with just local anesthetic. Firstly, the affected body part will be comfortably placed on a procedure table and then skin will be thoroughly cleaned with sterile soap to minimize infection. A sterile ultrasound probe will then be applied to your skin to visualize the injured tendon and adjacent structures surrounding it. After the target tissue is found, the skin and underlying area will be anesthetized. Once the region is completely numb, a small incision approximately 2-3 mm in length will be made in the skin for the Tenex TX device to be inserted. The active tip of the device is no bigger than a needle and can be advanced painlessly into the treatment area without affecting the surrounding structures.

patellar-tendonThe Tenex TX device is maneuvered with the aid of ultrasound – this will allow the physician to completely visualize the tip during the entire procedure in real time. Once the tip is in the proper position, the device will be activated and high frequency ultrasonic energy will be deployed. The energy will breakup the damaged tissue within the tendon and, through a microscopic catheter built into the tip,  simultaneously extract the damaged tissue as well, leaving only the healthy tissue behind. The ultrasonic energy is totally painless and will only affect damaged tissue. This portion of the procedure will take 1-2 minutes to complete. The device is gently withdrawn from the area and small Band-Aid is placed on the skin.

 

Risk Factors

Complications with Tenex are very rare. The procedure is performed percutaneously so the risk of damage to collateral structures is minimal. There is small risk of bleeding and infection associated with the procedure. Mild postoperative pain and soreness is to be expected, however over-the-counter NSAID’s are typically sufficient. Tendon rupture is a theoretical complication though unreported at the time of this article.

Evidence of Performance

For patients suffering from tendon and soft tissue injuries, options as suggested by evidence-based medicine have been very limited. Conventionally, if the symptoms fail to resolve after a short period of time there are two options 1) cortisone injections, and if those were unsuccessful 2) surgery. For many surgery is not an option, or at least not a desirable one given the long and arduous postoperative recovery period and intense commitment to physical therapy afterward. The Tenex Health TX™ System is an exciting alternative to surgery and is no more invasive than a cortisone injection.

The seminal study establishing the efficacy of Tenex was done in 2012 at the Mayo clinic in conjunction with Singapore General Hospital.[4]  In this study, 20 patients with chronic tennis elbow (recalcitrant lateral epicondylitis) were treated with the Tenex TX1 system under local anesthesia only. The study reported a statistically significant improvement in pain at 1 week and 1 month follow-ups. The authors further reported continued improvements at 3, 6, and 12-month follow-ups, thus establishing the TX1 as a safe and effective treatment for chronic tendonopathy.

In a study by Finnoff and colleagues in 2011, the authors researched the effects of ultrasound-guided needle tenotomy and platelet-rich plasma (PRP) injections for the treatment of chronic tendonopathy.[5]  The subjects in the study had tendonopathy for a minimum of 3 months that failed to improve non-operatively. Patients were then treated with a percutaneous ultrasound-guided tenotomy followed by a PRP injection. The study reported statistically significant improvements in both function and pain scores leading the authors to conclude this treatment was a safe and effective treatment for chronic tendonopathy with obvious structural improvements in the tendon anatomy resulting.

The Ainsworth Institute is Here to Help

If you are suffering from tendonitis, tendonoathy, soft tissue injury or chronic pain in the elbow, knee, shoulder or foot, Tenex TX1 may be right for you. It is a safe, nonsurgical treatment option shown to be effective for a variety of injuries. If you would like to learn more about this state-of-the-art treatment, or if you would like to find out if you are a candidate the procedure, contact the Ainsworth Institute of Pain Management and schedule an appointment to speak with once of our board certified pain specialists.

References

[1] Zhiyun L, Tao J, Zengwu S (July 2013). “Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis”. Swiss Med Wkly 143: w13825.

[2] Wilson, JJ; Best TM (Sep 2005). “Common overuse tendon problems: A review and recommendations for treatment” (PDF). American Family Physician 72 (5): 811–8.

[3] Goff JD, Crawford R (September 2011). “Diagnosis and treatment of plantar fasciitis”. Am Fam Physician 84 (6): 676–82.

[4] Koh J, Mohan P, Howe T, Lee B, et al. Fasciotomy and Surgical Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Early Clinical Experience With a Novel Device for Minimally Invasive Percutaneous Microresection. Am J Sports Med 2012; 41: 636-44.

[5] Finnoff J, Fowler S, Lai J, Santrach P, et al. Treatment of Chronic Tendinopathy with Ultrasound-Guided Needle Tenotomy and Platelet-Rich Plasma Injection. PM&R 2011.

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