Understanding Treatment Challenges for Chronic Rotator Cuff Tendinopathy

Rotator cuff tendinopathy refers to chronic degeneration or partial tearing of the shoulder’s rotator cuff tendons. The primary challenge in management is the chronic, degenerative nature of the condition, which often results in persistent pain and functional limitation, especially in patients with partial tears or advanced age [Jain & Khazzam, 2024].

Conventional treatment approaches include:

• Non-operative methods: physical therapy, corticosteroid or platelet-rich plasma (PRP) injections, and oral pain medications.

  • Physical therapy is the first-line treatment and is supported by high-quality evidence for improving pain and function in most patients, with over 80% reporting benefit at 6–12 months. Manual therapy and exercise are as effective as glucocorticoid injections and arthroscopic decompression, but adverse events, though more frequent than placebo, are mild and transient. Predictors of better outcomes include partial thickness tears and high patient expectations [Jain & Khazzam, 2024].
    
  • Corticosteroid injections provide short-term pain relief but are not superior to physical therapy in the mid- or long-term and carry risks, including potential tendon degeneration and increased infection risk if surgery is performed soon after injection. Repeated injections may further compromise tendon quality [Brand & Hardy, 2023; Hurley et al, 2023; Lazzarini et al, 2025].
  • Platelet-rich plasma (PRP) injections have shown mixed results. Some studies report superior long-term pain and function compared to corticosteroids, but the clinical benefit is modest and technique-dependent. PRP is more expensive and its optimal use remains under investigation [Vaquerizo et al, 2023; A Hamid et al, 2021; Jo et al, 2020].
  • Oral pain medications (NSAIDs, acetaminophen) are commonly used adjunctively but do not address the underlying pathology and are not curative [Jain & Khazzam, 2024].
    

• Surgical interventions: (arthroscopic debridement or repair) are reserved for refractory cases or full-thickness tears. Surgery requires anesthesia, carries perioperative risks, and entails lengthy rehabilitation, making it less suitable for older adults or those with comorbidities [Jain & Khazzam, 2024].

A significant treatment gap exists for patients who are not surgical candidates or who desire less invasive, faster recovery options. For these patients, nonoperative management remains the mainstay, but there is ongoing research into minimally invasive procedures and biologic therapies to address this gap [Jain & Khazzam, 2024].

The Tenex Procedure: What Is It?

The Tenex procedure is a device used to perform a tenotomy under ultrasound guidance, and uses high-frequency ultrasonic energy to break down and remove damaged tendon tissue. Originally used for conditions like Achilles tendinitis and tennis elbow, this study marks one of the first investigations into its use for rotator cuff tendinopathy.

This technique is performed under ultrasound guidance, allowing for precise targeting of diseased tissue. It requires only local anesthesia and a small skin incision, making it significantly less invasive than traditional surgery.

Study Overview: Structural and Clinical Outcomes of Tenex for RCT

In this recent retrospective study, 15 patients (16 shoulders) with chronic rotator cuff tendinopathy underwent the Tenex procedure [Trivedi et al, 2024]. The majority had previously failed conservative treatments such as physical therapy and steroid injections.

Methods:

• Pre- and post-treatment evaluations included Shoulder Pain and Disability Index (SPADI) scores and MRI imaging.

• MRI assessments were graded using the Sein classification system.

• The procedure was performed using local anesthesia and real-time ultrasound imaging

Results: Significant Pain Relief and Structural Stability

• There were no major complications—no infections, bleeding, or wound issues were reported.
  
• One patient reinjured her shoulder post-procedure, highlighting the importance of post-op activity restrictions.
• Functional Improvement Scores: Patients experienced an average improvement of 38.9 points in total SPADI scores—well beyond the minimal clinically important difference (8–13 points).
  
  • Pain scores decreased by an average of 45.6 points.
    
  • Disability scores improved by an average of 34.8 points
• MRI Imaging:
  
  • 50% of patients showed no progression in tendon degeneration.
    
  • 16.7% showed improvement in tendon quality.
  • Only two patients showed imaging progression, and one underwent later surgical intervention.
    

Why Tenex May Be a Game-Changer?

What makes Tenex so compelling is its balance of efficacy, safety, and convenience. Patients received substantial pain relief and functional improvement in this study, without undergoing invasive surgery or enduring extended recovery periods. Many patients in this study began to see improvement in their symptoms within weeks, and the imaging suggests that in some cases, the tendons are not just symptomatically better—but structurally improved.

Compared to corticosteroid injections, which may harm tendon tissue over time, Tenex offers a targeted, tissue-preserving solution. And unlike traditional surgical repair, there's no need for general anesthesia or prolonged immobilization. This makes the Tenex procedure especially appealing for:

• Older adults or those with comorbidities precluding surgery
  
• Active individuals seeking rapid return to function
  
• Patients who have failed conservative therapies but want to avoid surgery
  

Limitations and Future Directions

While the results are promising, this study had a small sample size and was retrospective in nature. Larger, randomized trials with long-term follow-up are needed to:

• Determine the durability of symptom relief
  
• Compare Tenex outcomes directly with surgical repair and PRP
  
• Better understand which patient populations benefit most
  
  

Should You Consider Tenex for Rotator Cuff Tendinopathy?

If you or your patients are experiencing chronic shoulder pain from rotator cuff tendinopathy and haven’t found relief through physical therapy or injections, Tenex may be an option. Learn more at:

(781) 591-7855

info@BSBortho.com

20 Walnut St

Suite 14

Wellesley MA 02481

Reference:

A Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One. 2021 May 10;16(5):e0251111.

Brand JC, Hardy R. Editorial Commentary: Platelet-Rich Plasma May Be Superior to Corticosteroid Injection for Rotator Cuff Disease Because of Improved Chance of Healing, Longer-Lasting Pain Relief, and No Detriment if Surgery Is Needed. Arthroscopy. 2023 Feb;39(2):422-424.

Hurley ET, Danilkowicz RM, Klifto CS. Editorial Commentary: Platelet-Rich Plasma Injections Produced a Significant Improvement in Most Patients With Rotator Cuff Tendinopathy.Arthroscopy. 2023 Sep;39(9):2009-2011.

Jain NB, Khazzam MS. Degenerative Rotator-Cuff Disorders. N Engl J Med. 2024 Nov 28;391(21):2027-2034.

Jo CH, Lee SY, Yoon KS, Oh S, Shin S. Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease: A Randomized Controlled Trial. J BoneJoint Surg Am. 2020 Dec 16;102(24):2129-2137.

Lazzarini SG, Buraschi R, Pollet J, Bettariga F, Pancera S, Pedersini P. Effectiveness of Additional or Standalone Corticosteroid Injections Compared to Physical Therapist Interventions in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2025 Mar 3;105(3):pzaf006.

Plancher KD, Shanmugam J, Briggs K, Petterson SC. Diagnosis and Management of Partial Thickness Rotator Cuff Tears: A Comprehensive Review. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1031-1043.

Trivedi A, Yian E, Cho Y, Hwang J. Structural and Clinical Outcomes after Tenex Debridement for Rotator Cuff Tendinopathy. Journal of Orthopaedic Experience & Innovation. 2024. 5(1).

Vaquerizo V, García-López M, Mena-Rosón A, Prado R, Padilla S, Anitua E. Plasma rich in growth factors versus corticosteroid injections for management of chronic rotator cuff tendinopathy: a prospective double-blind randomized controlled trial with 1 year of follow-up. J Shoulder Elbow Surg. 2023 Mar;32(3):555-564.