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Mar 02, 2023

Non-surgical Treatments for Lateral Epicondylitis and Medial Epicondylitis: Tenex versus Platelet-Rich Plasma

Medial epicondylitis (golfer’s elbow) and lateral epicondylitis (tennis elbow) are among the most common elbow pathologies affecting people aged between 40 and 50 years. Although epicondylitis is often a self-limiting and improves with conservative treatment, the condition can be difficult to eradicate. In a recent publication, the effectiveness of platelet-rich plasma (PRP) injections and ultrasound-guided percutaneous tenotomy (Tenex) for the treatment of medial or lateral epicondylitis was reviewed.

In this retrospective study by Boden et al., the team at Emory contacted 75 patients who underwent either a PRP injection or the Tenex procedure for tennis elbow or golfer’s elbow. Of these patients 62 of them responded and completed surveys assessing their level of pain and function.

Thirty-two patients had received a PRP injection and 30 patients had undergone a Tenex procedure. In both groups, the patients both demonstrated clinical and statistical improvement in pain and function without a significant difference between the two groups.


This is one of the few studies comparing a partial tenotomy using the (Tenex device for the procedure) to another non-operative treatment for tennis and golfer’s elbow.

Tenex for medial epicondylitis showing interval healing from before the procedure and at teh 4-month follow up

Tenex has been studied for refractory lateral epicondylitis and demonstrated a significant improvement in pain and function. In a study following patient for up to 3 years after the procedure patients still had continued improvement for up to 3 years after the procedure, with no tendon ruptures, infections or other complications (Chalian et al, 2021). In two other studies, the minimally invasive tenotomy demonstrated evidence of tissue healing in response to the procedure on follow-up ultrasound imaging (Seng et al, 2016; Ang et al, 2021).


  1. Ang BFH, Mohan PC, Png MA, Allen JC Jr, Howe TS, Koh JSB, Lee BP, Morrey BF. Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months. Am J Sports Med. 2021 Jun;49(7):1854-1860. doi: 10.1177/03635465211010158.
  2. Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB. Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elbow Surg. 2019 Jan;28(1):112-119. doi: 10.1016/j.jse.2018.08.032.
  3. Chalian M, Nacey NC, Rawat U, Knight J, Lancaster T, Deal DN, Pierce J. Ultrasound-guided percutaneous needle tenotomy using Tenex system for refractory lateral epicondylitis; short and long-term effectiveness and contributing factors. Skeletal Radiol. 2021 Oct;50(10):2049-2057. doi: 10.1007/s00256-021-03778-9.
  4. Seng C, Mohan PC, Koh SB, Howe TS, Lim YG, Lee BP, Morrey BF. Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 Years. Am J Sports Med. 2016 Feb;44(2):504-10. doi: 10.1177/0363546515612758.

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