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Tennis elbow, also known as lateral epicondylitis, is a common cause of elbow pain (Sanders et al.). The majority of cases resolve on their own with conservative treatments, such as nonsteroidal anti-inflammatory drugs, bracing or physical therapy (Sims et al.). However, recent studies demonstrate that only 67% of patients treated with physical therapy and 75% of patient treated with splinting avoided surgery (Knutsen et al.). In cases that do not respond to non-surgical treatments there is no preferred treatments (Ma & Wang).
There is growing number of studies looking at the use of platelet-rich plasma (PRP) injections and tenotomy under ultrasound guidance using the Tenex device from Tenex Health (Ma & Wang; Lenoir et al.). With PRP and Tenex it may be possible to avoid more invasive surgical intervention with a longer recovery.
Tenex is a device that emits high-frequency sound waves to cut, debride and remove tendinopathic tissue, without damaging healthy tissue (Peck et al.). The procedure is performed with local anesthesia, a small incision and using ultrasound to advance the device to the region of the pathologic tissue. Current studies demonstrate the effectiveness of Tenex in treating tennis elbow (Boden et al.; Seng et al.; Chalian et al.; Barnes et al.).
A recent study by Rupe et al. (2023) looked at patient characteristics that may contribute to treatment failure of either PRP or Tenex for tennis elbow. Eighty-eight Patients with tennis elbow were included in the study and 37 were treated with PRP and 52 were treated with Tenex. Patients had chronic symptoms that averaged 742 days in the PRP group and 594 days in the Tenex group. No complications were reported with either the PRP or Tenex procedure.
The procedure was successful and patients did not require surgery or any further intervention in 87.7% of the patients treated with Tenex and 84.6% of the PRP group. Variables that led to failure of the Tenex treatments included tendon tearing and worker’s compensation cases, while failure in the PRP group included ligament involvement.
References
Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015;24(1):67e73.
Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB. Plateletrich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elbow Surg. 2019;28(1):112e119.
Chalian M, Nacey NC, Rawat U, et al. Ultrasound-guided percutaneous needletenotomy using Tenex system for refractory lateral epicondylitis; short and long-term effectiveness and contributing factors. Skeletal Radiol. 2021;50(10):2049e2057.
Knutsen EJ, Calfee RP, Chen RE, Goldfarb CA, Park KW, Osei DA. Factors associated with failure of nonoperative treatment in lateral epicondylitis. Am J Sports Med. 2015;43(9):2133e2137.
Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res. 2019;105(8S):S241eS246.
Ma KL, Wang HQ. Management of lateral epicondylitis: a narrative literature review. Pain Res Manag. 2020;2020:6965381.
Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am. 2016;27(3):733e748.
Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015 May;43(5):1066-71.
Seng C, Mohan PC, Koh SB, et al. Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: sustainability and sonographic progression at 3 years. Am J Sports Med. 2016;44(2):504e510
Sims SE, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y). 2014;9(4):419e446.
Rupe MW, Fleury IG, Glass N, Kruse R, Buckwalter V JA. Efficacy of Ultrasonic Tenotomy and Debridement and Platelet-Rich Plasma Injections for Lateral Elbow Tendinopathy. J Hand Surg Glob Online. 2023 May 18;5(5):667-672.
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