Percutaneous Tenotomy

Tendon injuries are incredibly common. Around 33 million musculoskeletal injuries are reported in the U.S. annually, and approximately half of them are injuries to tendons or ligaments. Athletes and individuals who regularly engage in exercise are at greater risk of experiencing such injuries, as are those who are employed in occupations that involve repetitive movement, lifting or reaching. 

Tendon injuries, including tendinitis, are often treatable with conservative efforts such as rest and anti-inflammatories. When these types of options don’t have a positive outcome, doctors may consider other treatments, including a procedure known as a percutaneous tenotomy. Find out more about this procedure below, including how it works and what to expect in recovery.

Technically, a percutaneous tenotomy is a surgery. However, it’s minimally invasive, is typically conducted in an outpatient setting and doesn’t require general anesthesia. That means you remain awake and can go home the same day the procedure is performed.

During a percutaneous tenotomy, the doctor breaks up tissue that’s leading to irritation, pain or range-of-motion issues at the site of the tendon. That tissue is typically removed because it’s damaged. Once the damaged tissue is removed, the healthy parts of the tendon can begin work to repair and heal.

Are you a good candidate for Percutaneous Tenotomy?

  • Positive

    You have injuries in your tendons, such as tendinitis, or other ligaments and you’re not responding to other treatments.

  • Positive

    You have tennis elbow or other injuries in the shoulders, knees, hips, ankles and elbows.

  • Negative

    You have an infection or a rash on the overlying site.

  • Negative

    You have a tumor on the overlying site.

Frequently asked questions

How Do You Prepare for a Percutaneous Tenotomy?

Preparation for percutaneous tenotomies begin with an evaluation by a qualified doctor. Before prescribing this treatment, a doctor may recommend the patient try conservative methods to treat tendinitis. In many cases, tendon injuries heal on their own and patients can treat symptoms during the healing process with ibuprofen, ice, compression and rest.

Once a percutaneous tenotomy is recommended, the doctor provides instructions for preparation. This may include resting before the procedure and not taking certain medications that could interfere with the outcome of the procedure. 

Plan to arrive at the office early to ensure all paperwork is taken care of before the procedure.


How Effective Is Percutaneous Tenotomy in Treating Tendinitis?

Ultrasound guided percutaneous tenotomy is considered an effective treatment for tendinitis. It’s been used for several decades, and studies have indicated that the use of ultrasound to guide the procedure increases the chances of accurately identifying the damaged tendon and removing it without impacting healthy tissue or other functions. 


How Long Does Percutaneous Tenotomy Take?

The actual procedure can take as little as 15 minutes. However, an appointment for a percutaneous tenotomy may take a bit longer. Patients will need to be evaluated and prepared prior to the procedure. They may also be asked to remain in the office for a period of time just after the surgery to ensure immediate recovery seems to be going well.


What Are Potential Side Effects of Percutaneous Tenotomy?

As a minimally invasive procedure, a percutaneous tenotomy is considered fairly safe. However, there are always some risks when you’re undergoing medical treatment. The most common risks with this procedure include:

  • Temporary injury or damage to nerves in the area where the tendon is being broken down
  • Some soreness or swelling around the treatment site
  • Infection at the incision

Patients can substantially reduce the risks of some of these outcomes by following their doctor’s recommendations for aftercare. For example, keeping the incision site clean and free of moisture can drastically cut down on the chances of infection after a percutaneous tenotomy.


What Is Percutaneous Tenotomy Used for?

One of the most common reasons for percutaneous tenotomy is tennis elbow. This is an injury to the tendons at or near the elbow. However, this procedure can be used as a treatment option for a variety of injuries, including:

  • Rotator cuff injuries
  • Medial epicondylitis, which is often referred to as golfer’s elbow
  • Achilles tendon issues
  • Plantar fasciitis
  • Patellar tendinitis, which is sometimes called jumper’s knee

Percutaneous tenotomy can be used on the shoulders, knees, hips, ankles and elbows.


What is Recovery after Treatment with Percutaneous Tenotomy Like?

It can take up to six weeks to recover from a percutaneous tenotomy. In the few days or weeks following the procedure, patients may experience soreness or pain at the treatment site. This is partly because the tendon is working to rebuild itself. The doctor might prescribe medication to help with the pain or recommend over-the-counter options.

One reason percutaneous tenotomies are beneficial is that you can recover from them without prescription (narcotic) pain relievers. Individuals that struggle with addiction or those who simply don’t want to take prescription level pain relievers may find this attractive.

Patients may need to limit the motion and burden put on the area treated for a period of time after treatment to allow the tendon to heal. Then, they may undergo exercise rehab or physical therapy to help support strengthening of the new tendon tissue. In some cases, doctors may simply recommend home exercises.


What to Expect During a Percutaneous Tenotomy?

Patients preparing for a percutaneous tenotomy should follow any instructions they were provided. Typically, there aren’t a lot of special preparations to be made. During the appointment, the following things will likely occur:

  • A brief evaluation or interview with the nurse or doctor, which will likely include taking your vitals and checking that you’re feeling well enough for the procedure
  • The doctor or a member of the staff will numb the area for the procedure with a local anesthetic
  • An ultrasound device will be used by the doctor to locate the damaged area of the tendon
  • The doctor will make a small incision and insert a medical device near the tendon
  • The device sends ultrasonic frequencies to the tendon that break up the damaged tissue so it can be removed from the area
  • Once the procedure is complete, the doctor will close the incision with the appropriate method, which might include stitches

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