Tenex for Tennis Elbow – Patient Outcomes at 7-Year Follow-Up

Over the past 10 years, Tenex, otherwise referred to as ultrasound-guided percutaneous needle tenotomy with vacuum debridement, has been used to treat tennis elbow. 

In this minimally-invasive procedure, ultrasound imaging is used to identify the degenerative pain-producing portion of the tendon.  Local anesthesia is applied to numb the area.  A small 3-5mm incision is made through which the Tenex device is inserted.  Tenex then uses a combination of ultrasonic energy, irrigation, and vacuum function to break down and remove the degenerative tendon tissue, leaving surrounding healthy tendon tissue alone.  This process stimulates a natural healing response. 

Return to sports and other activities with similar demands is typically about 4-6 weeks after the procedure.  The procedure takes less than 20 minutes to perform. Typically no general anesthesia or stitches are needed. 

One of the most common indications for use of Tenex is tennis elbow, sometimes referred to as lateral epicondylitis or common extensor tendinosis.  In this condition there is pain at the outside part of the elbow, often associated with repetitive gripping or wrist movements. 

Tennis elbow effects 1-4% of the general population each year and up to 29.3% of laborers (Shiri et al. 2011).  Symptoms can linger for several months and at least one study has shown patients with greater than 6 months of symptoms often need surgical intervention (Sanders et al., 2016). 

Tenex is a minimally-invasive alternative to more invasive surgery.  But how well does Tenex actually work?  There are multiple studies showing improvement in pain and function with Tenex treatment as early as 6 weeks (Barnes et al., 2015) and sustained to 3 years (Chalian et al., 2021).  Of particular interest recently is a series of 3 studies encompassing a total of 7-year followup.

2 Initial Studies

A prospective case series was published as a part of two separate studies (Koh et al., 2013 and Seng et al., 2016).  20 patients diagnosed with tennis elbow with an average symptom duration of 12.5 months were treated with Tenex.  Outcomes measured included patient satisfaction, VAS (Visual Analog Scale) pain scores, DASH (Disabilities of the Arm, Shoulder, and Hand) scores, and ultrasound imaging.  The study results showed the following:

• 19/20 patients were essentially pain-free and satisfied at 6 months; 20/20 patients were essentially pain-free and satisfied at 36 months

• No complications

• No further treatment required

• Ultrasound imaging showed evidence of tissue healing by 6 months 

7-Year Follow-Up Study

In a subsequent 2021 study by Ang et al., the authors of the 2 abovementioned studies reached out to the same cohort of 20 patients for a 7-year follow-up.  The authors were able to successfully evaluate 19 of 20 patients and perform repeat ultrasound evaluations on 16 patients, with a median follow-up of 90 months.  Outcomes measured included VAS pain scores, DASH scores, need for additional intervention, and overall satisfaction.  The study results showed the following:

• 100% patient satisfaction (6 patients satisfied; 13 patients very satisfied)

• No additional interventions were needed

• Improvement in pain and function was sustained

• Ultrasound evaluation showed tissue healing was sustained

Conclusion

Treatment with Tenex for tennis elbow is a safe and effective treatment with long-term sustainable improvement in pain and function. Please note individual treatment results may vary. 

– Rajiv Verma, DO RMSK

References:

1. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb;25(1):43-57. 

2. Sanders TL, Maradit Kremers H, Bryan AJ, Ransom JE, Morrey BF. Health Care Utilization and Direct Medical Costs of Tennis Elbow: A Population-Based Study. Sports Health. 2016 Jul;8(4):355-8. 

3. Barnes DE, Beckley JM, Smith J. Journal of Shoulder and Elbow Surgery. 2015;24(1):67-73.

4. 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.

5. Koh JSB, Mohan PC, Howe TS, Lee BP, Yang Z, Morrey BF. American Journal of Sports Medicine. 2013;41(3):636-644.

6. Seng C, Mohan PC, Koh JSB, Howe TS, Lim YG, Morrey BF. American Journal of Sports Medicine. 2016;44(2):504-510.

7. 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.