TENEX &
Needle Tenotomy
Minimally invasive, ultrasound-guided procedures for chronic tendon pain, tendinosis, and selected degenerative tendon injuries. Target damaged tissue and build a path toward functional recovery.
When Tendon Pain Becomes a Persistent Problem
Chronic tendon pain can persist despite rest, physical therapy, medication, bracing, activity modification, or injections.
In many long-standing cases, the underlying problem is not simply active inflammation. Instead, the tendon may contain disorganized collagen, thickened fibers, calcification, scar tissue, or areas of structural degeneration.
These chronic degenerative changes are often described as tendinosis and may interfere with the tendon's ability to tolerate normal mechanical loading.
TENEX and percutaneous needle tenotomy are procedures designed to address selected areas of abnormal tendon tissue.
Both can serve as intermediate treatment options between conservative rehabilitation and more invasive surgery.
Common Features of Tendinosis
Increased tendon dimensions and altered architecture.
Changes in normal tendon fiber alignment.
Areas of structural disruption within the tendon.
Abnormal tissue deposits or chronic fibrotic changes.
Altered blood-vessel patterns sometimes seen on Doppler imaging.
Pain or reduced function during exercise and activity.
Two Procedures. Different Treatment Mechanisms.
TENEX and needle tenotomy both target chronically abnormal tendon tissue under ultrasound guidance, but use different instruments and treatment techniques.
TENEX Ultrasonic Tenotomy
TENEX is a minimally invasive procedure that uses a specialized ultrasonic microtip to fragment and remove selected areas of damaged soft tissue.
The microtip delivers ultrasonic energy while irrigation and aspiration help break down and extract abnormal tissue.
The procedure is performed through a small skin opening under direct musculoskeletal ultrasound guidance.
TENEX may be considered when imaging demonstrates a focal region of chronic degeneration, thickening, scarring, or calcific tissue.
Ultrasound-Guided Needle Tenotomy
Percutaneous needle tenotomy, also called tendon fenestration, uses a standard medical needle to make multiple controlled passes through abnormal tendon tissue.
The procedure is intended to provide a mechanical stimulus that initiates a localized healing and remodeling response.
Unlike TENEX, conventional needle tenotomy does not use ultrasonic energy or aspiration to remove tissue.
It may be selected for certain chronic tendon abnormalities that do not require tissue debridement.
Tenotomy With PRP
Needle tenotomy may be combined with platelet-rich plasma in selected treatment plans.
The needle mechanically stimulates the degenerative tendon while PRP introduces concentrated platelets and associated signaling proteins.
The potential additional benefit of PRP varies by condition and has not been established for every tendon.
Shockwave & Rehabilitation
Not every chronic tendon requires an invasive procedure.
Shockwave therapy, progressive tendon loading, strength training, movement correction, and targeted rehabilitation may be appropriate alternatives or complementary treatments.
Treatment selection depends on the diagnosis, symptom duration, tendon structure, and previous response to care.
TENEX vs. Needle Tenotomy
Both are minimally invasive ultrasound-guided techniques. The primary difference is whether damaged tissue is mechanically stimulated or physically debrided and removed.
| Feature | TENEX | Needle Tenotomy |
|---|---|---|
| Instrument | Ultrasonic microtip | Standard medical needle |
| Mechanism | Fragmentation and aspiration | Controlled tendon fenestration |
| Tissue Removal | Yes, selected abnormal tissue | No routine tissue aspiration |
| Ultrasound | Real-time guidance | Real-time guidance |
| Skin Access | Small opening | Needle puncture |
| Anesthesia | Usually local anesthesia | Usually local anesthesia |
| Typical Application | Selected focal degenerative tissue | Selected chronic tendon abnormalities |
| PRP Combination | May be considered separately | May be combined with PRP |
| Rehabilitation | Required for functional recovery | Required for functional recovery |
| Recovery | Varies by tendon and procedure | Varies by tendon and procedure |
Neither procedure is automatically superior. The appropriate choice depends on the tendon involved, imaging findings, extent of degeneration, previous treatment, activity demands, and rehabilitation goals.
Targeted Care for Chronic Tendon Conditions
These procedures may be considered for selected tendon and fascial disorders that have not improved sufficiently with appropriate conservative care.
Tennis Elbow
Chronic lateral epicondylitis and common extensor tendon degeneration.
Golfer's Elbow
Chronic medial epicondylitis and common flexor tendon disorders.
Achilles Tendinopathy
Selected midportion and insertional Achilles tendon abnormalities.
Plantar Fasciopathy
Chronic plantar heel pain associated with degenerative plantar fascia changes.
Patellar Tendinopathy
Jumper's knee and selected chronic patellar tendon degeneration.
Rotator Cuff Tendinopathy
Selected chronic shoulder tendon disorders and calcific tendinopathy.
Gluteal Tendinopathy
Gluteus medius and minimus tendon abnormalities associated with lateral hip pain.
Hamstring Tendinopathy
Selected chronic proximal hamstring and tendon attachment disorders.
Other Tendon Disorders
Quadriceps, peroneal, posterior tibial, and other selected chronic tendon abnormalities.
Listing a condition does not mean every patient with that diagnosis is suitable for tenotomy. Complete tears, substantial tendon retraction, severe instability, and major structural abnormalities may require surgical assessment.
Ultrasound Allows Us to See What We're Treating.
Musculoskeletal ultrasound plays a central role in TENEX and needle tenotomy.
It allows the provider to identify abnormal tendon architecture and visualize the treatment instrument in real time.
Ultrasound can reveal focal thickening, hypoechoic degeneration, partial tears, calcific deposits, and other structural changes.
Image guidance helps select the treatment target while identifying nearby nerves, vessels, and healthy anatomy.
Explore MSK UltrasoundWhy Ultrasound Guidance Matters
How TENEX Ultrasonic Tenotomy Works
TENEX uses ultrasound imaging for guidance and a separate ultrasonic instrument for soft-tissue fragmentation and aspiration.
01. Identify the Tissue
Diagnostic ultrasound locates the abnormal tendon region and helps plan the treatment approach.
02. Local Anesthesia
The skin and surrounding treatment area are numbed to improve procedural comfort.
03. Microtip Placement
A small skin opening allows the ultrasonic microtip to be directed into the target tissue.
04. Ultrasonic Energy
Mechanical vibration fragments and emulsifies selected abnormal soft tissue.
05. Tissue Aspiration
Irrigation and suction help remove fragmented tissue through the specialized instrument.
06. Recovery Planning
A dressing is applied and individualized protection and rehabilitation begin.
How Needle Tenotomy Stimulates Tendon Tissue
Needle tenotomy uses controlled needle passes through a region of abnormal tendon tissue.
This mechanical stimulation is intended to initiate localized bleeding and cellular signaling associated with tissue remodeling.
The technique is sometimes called tendon fenestration because it creates multiple small channels in the targeted tendon region.
Needle tenotomy may be performed alone or incorporated into selected PRP or plasma-based injection protocols.
The intended biological response does not guarantee tissue regeneration or symptom relief.
Explore Regenerative MedicineTypical Needle Tenotomy Steps
Identify the abnormal tendon with musculoskeletal ultrasound.
Clean and sterilize the skin and administer local anesthesia.
Advance the needle into the targeted tissue.
Make multiple controlled passes through the abnormal tendon.
Apply a dressing and provide post-procedure instructions.
When Is Tenotomy Worth Considering?
TENEX and needle tenotomy are usually considered after an appropriate course of conservative care has failed to provide adequate improvement.
Potential Candidates
When Other Care May Be Necessary
Many tendon injuries improve with structured physical therapy, progressive loading, activity modification, and appropriate conservative treatment. Tenotomy is generally considered when symptoms remain persistent and imaging supports the procedure.
From Evaluation to Procedure Completion
Both procedures are generally performed in an outpatient setting, using local anesthesia and ultrasound guidance.
Pre-Procedure Review
Review the diagnosis, medical history, relevant imaging, risks, and treatment plan.
Preparation
Position the patient, prepare the skin, identify the target, and administer local anesthesia.
Targeted Procedure
Use ultrasound guidance to perform either needle fenestration or ultrasonic debridement.
Aftercare
Apply the appropriate dressing or support and establish recovery instructions and follow-up.
Patients may experience pressure, vibration, or mild discomfort during treatment. The active procedure is often relatively brief, but appointment time varies by the anatomical location, procedure complexity, anesthesia, and preparation required.
Treating the Tendon Is Only the Beginning.
Recovery after TENEX or needle tenotomy requires a balance of early tissue protection, mobility, strengthening, and progressive loading.
Initial Protection
Manage soreness, bruising, or swelling. Temporary bracing, walking boots, or activity limits may be required.
Early Mobility
Introduce gentle movement when appropriate to limit stiffness and maintain function.
Progressive Loading
Gradually introduce isometric, concentric, eccentric, and other resistance exercises.
Return to Activity
Progress to work, exercise, running, lifting, and sport based on function and tendon tolerance.
What We Monitor Clinically
Additional Recovery Factors
There is no universal return-to-sport timeline after TENEX or needle tenotomy. Early soreness may increase temporarily, and tendon remodeling can require weeks to months. Loading progression should follow the treating provider's instructions and functional assessments, not pain alone.
A Less Invasive Option for Selected Tendon Injuries
Traditional open tendon surgery may require a larger incision, direct surgical exposure, and more extensive tissue dissection.
TENEX uses a small access point and ultrasound guidance to remove selected diseased tissue without broadly exposing the tendon.
Needle tenotomy is even less instrument-intensive and aims to stimulate abnormal tissue without removing it.
These procedures cannot replace surgical repair when major structural damage, tendon rupture, retraction, or instability requires reconstruction.
Schedule a ConsultationPotential Procedural Advantages
Understanding Potential Benefits and Limitations
TENEX and needle tenotomy are minimally invasive, but they remain medical procedures with potential complications and variable outcomes.
Potential Benefits
Risks and Limitations
Published studies report pain and functional improvement after percutaneous tenotomy in selected chronic tendon conditions. However, study quality, treatment techniques, patient populations, and rehabilitation protocols vary. Neither procedure guarantees tissue regeneration, symptom resolution, or avoidance of surgery.
A Coordinated Approach to Tendon Recovery
Successful tendon recovery involves more than treating the area of degeneration. We also evaluate strength, mobility, mechanical loading, and contributing health factors.
MSK Ultrasound Diagnostics
Real-time imaging to identify chronic tendon abnormalities, evaluate anatomy, and guide selected procedures.
Regenerative Medicine
PRP and other selected orthobiologic treatments may be considered as part of an individualized tendon treatment strategy.
Physical Therapy
Progressive loading, strength training, mobility, and movement correction support long-term functional recovery.
Health & Recovery Optimization
Nutrition, metabolic health, sleep, and lifestyle factors can influence musculoskeletal recovery and rehabilitation.
TENEX & Needle Tenotomy Frequently Asked Questions
Answers to common questions about procedural selection, ultrasound guidance, pain, recovery, risks, and expected outcomes.
What is TENEX?
What is percutaneous needle tenotomy?
What is the difference between TENEX and needle tenotomy?
What is tendinosis?
Which tendon injuries may be treated?
Is TENEX considered surgery?
Does the procedure require general anesthesia?
Does TENEX remove damaged tendon tissue?
Does needle tenotomy stimulate healing?
Can PRP be combined with needle tenotomy?
Why is ultrasound used?
Is TENEX the same as a cortisone injection?
Will I have pain after the procedure?
How long does recovery take?
Will I need a walking boot or brace?
Is physical therapy necessary afterward?
Is TENEX better than open surgery?
What are the risks of tenotomy?
Does insurance cover TENEX or needle tenotomy?
How do I know which treatment is right for me?
Persistent Tendon Pain Deserves a More Targeted Evaluation.
Whether you're dealing with chronic tennis elbow, Achilles tendinopathy, plantar fascia pain, or another persistent tendon condition, we can help determine which treatment options may be appropriate.
PRO Sports Medicine
2034 E Southern Ave, Suite O
Tempe, AZ 85282
480-400-6225
Medical Information Disclaimer: This page is provided for patient education and does not establish an individual diagnosis or medical treatment recommendation.
TENEX and percutaneous needle tenotomy are minimally invasive procedures with potential benefits, risks, limitations, and contraindications. Treatment eligibility requires clinical examination and appropriate diagnostic evaluation.
Published outcomes vary by anatomical site, severity of tendinopathy, procedural technique, patient factors, and rehabilitation adherence. No procedure guarantees tendon regeneration, symptom relief, return to sport, or avoidance of surgery.
Orthobiologic and recovery-related treatments discussed on linked pages have different levels of supporting clinical evidence and regulatory status. Treatment decisions should consider available evidence, risks, alternatives, and individualized goals.