Abstract
Chronic tendon pain, or tendinopathy, can be debilitating and significantly affect quality of life. Traditional treatments often provide only temporary relief, leaving many searching for more definitive solutions. This educational post explores a groundbreaking, minimally invasive procedure called percutaneous tenotomy, a technique transforming how we manage chronic tendinopathies like tennis elbow, plantar fasciitis, and Achilles tendinopathy. As Dr. Alex Jimenez, with extensive credentials in chiropractic and functional medicine, I will guide you through the science behind this procedure, drawing from the latest findings of leading researchers like Dr. Brian O'Connor.
We will delve into the mechanics of devices such as Tenex and TenJet, which use advanced technology to precisely remove damaged tendon tissue under ultrasound guidance. I will also explain how our multidisciplinary clinic integrates this advanced procedure with comprehensive chiropractic care, functional medicine, and rehabilitation, all under the expert medical direction of Dr. Maria Guadalupe Cardenas, MD. This integrated approach ensures we not only address the site of injury but also the underlying biomechanical and systemic factors contributing to the condition, creating a holistic path to lasting recovery.
My Perspective on Integrated and Advanced Musculoskeletal Care
As a clinician with a diverse background spanning chiropractic (DC), advanced practice nursing (APRN, FNP-BC), and functional medicine (CFMP, IFMCP), I have dedicated my career to finding the most effective, evidence-based solutions for my patients. My practice is built on the principle of integrative care, where different disciplines converge to provide a comprehensive treatment plan tailored to the individual.
This philosophy is embodied in our clinic, Injury Medical Clinic PA, here in El Paso, Texas. We operate as a multidisciplinary team, combining my expertise in chiropractic, functional medicine, and rehabilitation with the medical oversight of our esteemed Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a Board-Certified Internist with NPI #1164426749 and Texas MD License #J2933. With over 40 years of invaluable experience, she provides the essential medical direction that allows us to offer advanced procedures and ensure the highest standard of patient safety and care. This collaborative model is the cornerstone of modern injury and integrative health clinics, allowing us to bridge the gap between conservative care and more invasive interventions. Our team works together on personal injury cases, complex rehabilitation, and chronic pain management, ensuring every patient benefits from a full spectrum of expertise.
Within this framework, we embrace innovative treatments that promise better outcomes. Today, I want to share insights into one such advancement: percutaneous tenotomy. Highlighted by leading researchers in the field, this procedure represents a significant leap forward in treating chronic tendon pain and shows how advanced medical technology can integrate into a holistic care model.
Understanding Chronic Tendinopathy: When Rest and Ice Aren't Enough
Many of us are familiar with the pain of "tennis elbow" or the sharp, stabbing sensation of plantar fasciitis. These conditions are forms of tendinopathy, a term that describes collagen breakdown in a tendon in response to repetitive overuse or chronic strain. For years, these conditions were labeled as "tendinitis," implying that inflammation was the primary culprit. However, modern research shows that chronic tendon pain is less about inflammation and more about degeneration.
The Degenerative Process: When a tendon is repeatedly stressed without adequate time to heal, the organized, strong collagen fibers begin to break down. The body's attempt to repair this damage is often disorganized, resulting in abnormal, weaker tissue. This degenerative tissue is characterized by a tangled mess of immature collagen, an overgrowth of small, dysfunctional blood vessels (a process called neovascularization), and an increase in nerve endings, which contributes to the persistent pain.
Why It Becomes Chronic: This dysfunctional, degenerative tissue is the source of chronic pain and weakness. It doesn't function like a healthy tendon and is a poor scaffold for healing. Traditional conservative treatments like rest, ice, and anti-inflammatory medications may provide temporary symptom relief but often fail to address the root cause—the presence of this diseased tissue. That is why pain often returns once you resume normal activities.
Percutaneous Tenotomy: A Minimally Invasive Solution
This is where percutaneous tenotomy comes in. The term "percutaneous" means "through the skin," and "tenotomy" means "cutting or removing tendon tissue." It is a minimally invasive, ultrasound-guided procedure designed to precisely debride, or remove, the degenerative, diseased tissue from the affected tendon. By removing the source of the pain, we stimulate a new, robust healing response, allowing the body to lay down healthy, organized collagen fibers in its place.
As explained by leading specialists like Dr. Brian O’Connor, this procedure was recently FDA-approved for conditions such as:
Calcific Tendinopathy: The formation of calcium deposits within a tendon.
Lateral and Medial Epicondylopathy (Tennis and Golfer’s Elbow): Affecting the extensor and flexor tendons of the elbow.
Patellar Tendinopathy (Jumper’s Knee): Involving the tendon connecting the kneecap to the shinbone.
Achilles Tendinopathy: Affecting the large tendon at the back of the ankle.
Plantar Fasciopathy (Plantar Fasciitis): Involving the thick band of tissue on the bottom of the foot.
The beauty of this technique is that it is now accessible in an office setting, not just in a surgical suite, making it a powerful tool for primary care and specialty providers focused on musculoskeletal health.
The Technology Behind the Procedure: Tenex and TenJet
Two main technologies are currently on the market for percutaneous tenotomy. While they achieve the same goal—removing diseased tissue—they use different mechanisms.
Tenex Health TX (Vacuum Emulsification): This is the system we often utilize in our integrated practice. The Tenex device employs ultrasonic energy to debride the damaged tissue. Its design is inspired by the phacoemulsification technique used in modern cataract surgery.
How It Works: The procedure uses a handheld instrument with a specialized 18-gauge double-lumen needle. One lumen houses a tiny, vibrating tip that emits ultrasonic energy. This high-frequency vibration essentially emulsifies (liquefies) the targeted degenerative tissue. At the same time, the second lumen provides continuous suction, which vacuums the emulsified debris out of the body. This is performed in real time under ultrasound guidance, ensuring that only diseased tissue is removed while the surrounding healthy tendon is preserved. The entire cutting time is remarkably brief, typically ranging from just 30 seconds to two minutes.
TenJet (Pressurized Saline Jet): The TenJet system offers an alternative to ultrasonic energy.
How It Works: This device uses a fine, high-velocity, pressurized stream of saline to act as a cutting tool. The powerful water jet effectively cuts and removes soft, degenerative tissue. Like the Tenex system, it also incorporates a suction mechanism to aspirate debris from the treatment site.
Both techniques are highly precise and effective, offering a significant advantage over traditional open surgery, which requires larger incisions, carries a higher risk of complications, and involves a much longer recovery period.
The Role of Ultrasound Guidance: Precision and Safety
A critical component of percutaneous tenotomy is real-time ultrasound guidance. Ultrasound imaging lets the clinician see anatomical structures—muscles, bones, and tendons—beneath the skin with exceptional clarity.
Diagnostic Precision: Before the procedure, ultrasound pinpoints the exact location and extent of the tendinopathy. We can visualize thickened, hypoechoic (darker) areas representing degenerative tissue and identify any calcifications or tears.
Procedural Accuracy: During the tenotomy, the ultrasound probe, covered in a sterile sheath, allows me to guide the needle directly to the target area. I can watch the needle tip on the monitor as it moves back and forth, ensuring that I am debriding only the diseased portion of the tendon while meticulously avoiding healthy tissue, nerves, and blood vessels. This level of precision is simply not possible with "blind" procedures and is paramount to the treatment's safety and success.
The demonstrations provided by experts like Dr. O'Connor clearly show the needle entering the tissue in a linear fashion, directly under the probe, and meticulously debriding the damaged area. You can even hear the device activating as it performs its function. This visual feedback ensures controlled, thorough removal of pathological tissue.
Integrating Advanced Tenotomy with Chiropractic and Rehabilitative Care
While percutaneous tenotomy is a powerful tool for removing the source of pain, it is only one piece of the recovery puzzle. True, lasting healing requires a holistic approach that addresses the reasons why the tendon became overloaded in the first place. This is where our integrative model shines.
Following a procedure like a tenotomy, my role as a chiropractor and rehabilitation specialist becomes crucial. The procedure creates an opportunity for the body to heal correctly, and our job is to guide that process.
Correcting Biomechanical Imbalances: Very often, tendinopathy arises from faulty movement patterns, postural imbalances, or joint restrictions. For instance, tennis elbow might be linked to poor mechanics in the shoulder or thoracic spine. Plantar fasciitis is often associated with foot arch instability or tight calf muscles. Through chiropractic adjustments, we can restore proper joint mobility in the spine and extremities, which helps normalize movement patterns and reduce abnormal stress on the healing tendon.
Personalized Rehabilitation Protocols: After the initial post-procedure healing phase, we implement a structured rehabilitation program. This is not a one-size-fits-all plan. It is carefully designed to:
Promote Healthy Collagen Formation: We introduce specific, controlled loading exercises (like eccentric exercises) that stimulate the fibroblasts (tendon cells) to produce strong, organized Type I collagen fibers.
Strengthen Supporting Musculature: We focus on strengthening the muscles around the affected joint to provide better support and distribute forces more evenly.
Improve Flexibility and Mobility: We incorporate gentle stretching and mobility work to keep the healing tendon and surrounding tissues pliable and functional.
Functional Medicine for Systemic Support: My functional medicine training lets me look even deeper. Chronic inflammation, nutritional deficiencies (e.g., vitamin C, zinc, and manganese), or poor blood sugar control can all impair tissue healing. We may assess these factors and recommend targeted nutritional support or lifestyle changes to optimize the body's internal healing environment, ensuring you have the building blocks for a robust recovery.
This comprehensive, multifaceted approach, guided by Dr. Cardenas's medical expertise, ensures we not only eliminate degenerative tissue but also correct underlying dysfunctions, significantly reducing the risk of re-injury and paving the way for a full return to an active, pain-free life.
References
[1] O'Connor, B. (n.d.). Percutaneous Tenotomy. [Video].
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist follows their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
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Blessings
Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
Email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-State Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
New York APRN License #: N25929, Verified: APRN-N25929*
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
My Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
