Tenex procedure for tendonitis?

[PrairieGem]

Calling all my fellow injured VFers!

I've been fighting bad tendonitis in my elbow all spring, and my doctor (visit #3) has recommended seeing a radiologist for Tenex. I have never even heard of this procedure before this morning! But it's not improving with anti-inflammatories and a course of oral steroids... and even "resting" my elbow, I still have to do daily things like... my job, brushing my teeth, opening doors, etc. She said it was less invasive than surgery and safer than cortisone injections.

Hoping someone here has experience or familiarity with this. I've checked out a couple links (and contacted a friend whose DH is a radiologist), but nothing beats the human experience.

Thanks!!

[Jane P.]

I have had several cortisone injections, and, while they hurt at the time, I did find them helpful. I did not know they were unsafe unless you have an allergy or get them too frequently.

If the procedure involves radiation, I'd be concerned about that. If you can afford it, I'd consider getting a second opinion. In any case, do your homework.

[Vintage VFer]

I had elbow tendonitis. It even hurt to brush my teeth. My physical therapist did ASTYM treatments. They were painful at the time, but I guess they helped. I didn't do cortisone as I had had a bad experience with that years ago.

http://astym.com/Main

The thing that helped the most was time. It takes a LONG time to heal.

Surgery, even minimally invasive, should be the very last option. I've never even heard of Tenex. I watched the video demo. It may be new or experimental. Often times insurance doesn't cover newer, less tested procedures.

I would definitely seek a second opinion about your elbow.

[videofit]

Other than prolotherapy or PRP, I'd try what a fitness trainer suggested to me years ago that worked. I continued doing my regular arm workouts with slightly lighter weights but with a strap around the elbow below the joint. He said exercise brings blood to the area to help heal it. Anti-inflammatories inhibit healing. Then afterward ice it. Forgot how many minutes on/off. That worked and I didn't miss any workouts. Occasionally I'd start to feel those familiar twinges again and go back to that protocol. Never had a problem since.

[DawnP]

Gem,
I'm sorry to hear your elbow has been so painful. Unfortunately I don't have experience with the Tenex procedure.

In viewing their video I am concerned that the practice of break-in up & emulsifying "dead tissue" in the elbow joint and sucking out the debris out will likely cause more inflammation and could damage healthy tissue. It seems fairly invasive.

I would think this procedure would be recommended if steripoid injections failed. I have two friends who had good success with steroid injections.

If you know any sports medicine surgeons I would ask for references from folks who have had the procedure for the exact same injury you have.

Also if you know any recovery room nurses that work in nearby hospitals or surgery centers that perform this procedure, you could ask them how it compares with other procedures.

Your physical therapist may have great advice, since he/she sees folks recovering from a variety of treatments.

I'm a bit surprised the Tenex technique has been out a few years and I don't see any celebrity athletes bragging about having it done yet, LOL.

[raeven]

My hubby has recently begun getting something done called dry needling for his elbow issues. He has tricep tendinitis which took forever for docs to pinpoint what his problem was. He's had 2 cortisone shots in the past year or so.. The last one being less than 6 months ago. It recently started hurting again so he's trying this therapy now and so far so good.

[katmom]

I have de Quervain’s syndrome (and maybe some basal thumb arthritis) in my left hand which is basically a form of tendonitis that causes pain at the base of the thumb and the thumb side of the wrist. This is caused by using the PC mouse excessively (goes with the job), holding my cell phone or my iPad for extended periods of time. I am somewhat ambidextrous and can swap up using the mouse with my right hand to give the left hand a break. However, I am left eye dominent so I tend to hold reading material (phone or iPad) in my left hand.

I need to make an appointment with the doctor (orthopedist), however, after the last time I was there he indicated he would probably be sending me to a surgeon.

[Vintage VFer]

Another thing that bothered me about the Tenex video was describing the tissue to be debrided as "necrotic." Necrotic tissue is dead tissue. My understanding is that tendon issues are more due to scar tissue build up. Not dead tissue.

[katmom]

Originally Posted by Vintage VFer

Another thing that bothered me about the Tenex video was describing the tissue to be debrided as "necrotic." Necrotic tissue is dead tissue. My understanding is that tendon issues are more due to scar tissue build up. Not dead tissue.

Like you, I thought necrotic tissue would be dead tissue. I guess if the tendonitis cuts blood flow, then necrosis could occur. One site that I went to regarding Tenex described it as the removal of damaged tendon tissue.

[PrairieGem]

I want to thank everyone who replied! And I ESPECIALLY appreciate all the suggestions for additional treatments. I had never heard of many of them--and you can't investigate what you're not aware of. So thanks!!

I had my consultation today, and for anyone who wishes to skip to the end, we are NOT doing the procedure, and I left with a referral for physical therapy (finally!!). So it was all good.

***

The consultation was very informative, and we discussed more than just the Tenex. Please excuse my layperson's interpretation of the science; I am relating this second-hand. That said, I am a very experienced patient/medical client, and the guy was not a quack. He gave a thoughtful and balanced presentation of the procedure ("According to the company that developed it, ____, but our experience has been _____."), and explained that the ideal candidate is someone with a persistent tendon injury that has not healed on its own, with rest and other therapies, after 12 weeks. Most tendon injuries get better over time. Evidently in some chronic cases of tendonitis, instead of remodeling healthy tendon tissue, the body responds by producing scar tissue, which continues to release proteins that cause pain. The Tenex procedure uses targeted ultrasound to destroy that scar tissue. It is the same goal as open surgery, but performed with different tools and a minimum of invasion. It takes about 20 minutes; five minutes of actual time to "zap" (my word) the scar tissue; the rest is prep, topical anaesthesia, etc.

The procedure is performed by interventional radiologists, so while it is frightfully new technology, it's an extension of proven, analogous procedures, like ultrasound embolization of fibroids and kidney stones. The radiologist was frank with us and said that he's only performed about 55 of them (although he's been doing them for a year, so if he's doing one a week....), and that his patients have seen around 80% improvement (interpreted both as, about 80% of patients see improvement; those who see improvement see about 80% relief). The procedure is most effective for the elbow, although it's also performed on knees, achillies tendons, and for plantar fasciitis. (The shoulder, he said, is too complex to be read well by ultrasound, and the device is not long enough to reach deeply into the joint.)

According to this doctor, the device uses ultrasound set at a particular frequency that is only intended to destroy scar tissue, although it's his feeling that it's impossible to avoid minor damage to healthy tissue--"but the healthy tissue will heal." Thus, there is a six-week recovery time before you can resume full activity.

The other downside, of course, is that the procedure is very expensive. Most insurance plans will cover most of it, but he did suggest that if we were planning to do it this year, "you might want to get in before Dec. 31 and your deductible resets." Fair enough.

It was his description of the immediate aftermath of and recovery from the procedure that was the most persuasive part of helping us make a decision. Three days of complete rest, with your arm bandaged (and pretty significant pain), followed by six weeks of only light activity (ie, use your other arm to pick up anything heavier than a novel). There is basically no way I can lose functionality of my dominant arm for six weeks anytime in the next couple of years (I am the primary caregiver for elderly family members)! So for right now, anything else is a better idea. We also like the idea of waiting a couple more years and seeing longer-term data and more cases.

We also discussed other potential treatments, including topical ultrasound (which I've had done on my neck by a chiropractor), lasertherapy (which our vets have done for our dogs), and physical therapy.

Anyway, the radiologist was more than happy to suggest alternatives and to refer me to physical therapy in the same hospital, and I hope to hear from them next week. So that was the big win, because as much as I love my primary care physician, this is the FIRST TIME I have *ever* been referred to a physical therapist.

...It's weird to be excited about physical therapy, right? Um.

Thanks for reading and weighing in!