Percutaneous Needle Tenotomy

What is Tendinopathy?

Tendinopathy (disease of the tendon) or tendinosis is a non-inflammatory degeneration of the tendon, usually due to excessive repetitive strain and injury. There are a couple of theories that try to explain the development of tendinopathies (or tendinosis): (1) The Mechanical/Trauma Theory: mechanical trauma or microtrauma caused by overuse and (2) The Vascular Theory: since tendons have less blood supply and consumes less oxygen than muscle, repetitive increased stress/demand on the tendon will lead to decreased blood/O2 delivery, which over time, leads to degeneration/breakdown of the normal tendon tissue.

Whether Mechanical, Vascular, or some combination thereof, the final result is that tendon is damaged, dysfunctional, and can no longer heal itself completely after repetitive trauma.

How is the procedure done?

An informed consent is obtained. Then the area is properly cleaned and prepared. A needle of suitable gauge and length depending on the location is inserted through the skin. Local anesthetic is used to make the procedure relatively painless. Then the needle is advanced through the tendon until it contacts bone (the tendon attaches to the bone, this is called the enthesis). The enthesis is poked with the needle multiple times.

What is the standard treatment for Tendonopathy and tendon related pain?

Conservative management (therapies, medications, splinting) are tried first and if they fail to resolve the problem, PNT are a good option.

What is the importance of the Ultrasound?

The musculoskeletal ultrasound identifies the affected tendon. The Ultrasound makes the procedure more accurate as we are able to see the deep tissue and place the needle in the correct location.

Where are Tendinopathies more common?

Tendons often affected are located at the shoulders, elbows, knee, ankle and foot.

What should I expect after the procedure?

Pain medication is given to help ease the pain which can occur after this procedure.