What is a tenotomy?
Tendon degeneration and pain occur when excessive repetitive strain of the tendon causes breakdown to a degree that the tendon can no longer heal itself.  This leads to weakening, scarring and swelling of the tendon.  A percutaneous tenotomy is a new procedure to try to repair the tendon through the skin without the need of a large incision and open surgery.

How is the procedure done?
An ultrasound machine is used to identify the painful tendon.  The skin is then sterilized with an alcohol-based solution, and local anesthetic is used to numb the skin.  A needle is directed into the tendon under direct visualization using the ultrasound machine.  The tendon is then pierced multiple times to break up the scarring and degeneration that have been causing the pain.

Does the procedure hurt?
The injections are relatively comfortable and pain free, but you will feel pushing and scraping as the tendon is pierced repeatedly.

How long does it take the treatment to work?
The tenotomy stimulates healing of the diseases tendon.  The procedure does not provide the instant relief that a cortisone injection does, but the big difference is that the tenotomy can actually heal the tendon over a period of time.  Cortisone stops inflammation, but does not cause the tendon to heal.  A tenotomy typically takes several weeks to work while the tendon is healing.

How long will it last?
The duration of improvement varies, but most patients treated in medical studies have reported long term relief.  A study published in the Journal of Ultrasound Medicine in 2008 in patients with tennis elbow showed that over 90% of patients had excellent or good results.1

What should I expect after the injection?
When the local anesthetic wears off, it is common to feel an increase in discomfort in the tendon.  You may treat this discomfort by applying an ice pack and by using acetaminophen.  You should not use ibuprofen or other anti-inflammatory medicines that may interrupt the healing process started by the tenotomy.  For a number of days after the procedure, active non-weight bearing motion of the tendon is encouraged, but heavy repetitive motions should be avoided for 4-6 weeks to allow the tendon to heal.  Some patients benefit from 4-6 weeks of physical therapy.

What are the possible side effects?
Most tendon injections result in no side effects.  The side effect of greatest concern is an infection of the deep tissues around the tendon.

1 John M. McShane, Vinil N. Shah, and Levon N. Nazaian Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow: Is a Corticosteroid Really Necessary? J Ultrasound Med 2008 27: 1137 1144.