Rapid and Successful Rehabilitation and Return to Play for a D1 Gymnast After Treatment for Lateral Epicondylosis with Ultrasound Guided Percutaneous Tenotomy (Tenex)

Abstract

Lateral elbow pain is a commonly seen in sports medicine. There are multiple interventions for this chronic condition which may lead to difficulty with successful treatment. There are also multiple rehabilitation strategies employed for treatment. Variations in treatments and rehabilitation protocols can lead to different and sometimes unsuccessful long term outcomes. We present a novel case of a Division 1 college gymnast with recalcitrant lateral elbow pain who underwent percutaneous tenotomy (Tenex) of the common wrist extensor tendon. The athlete was able to return to full Division 1 athletics two months after the procedure. This case is unique secondary to the patient being a high level athlete and his rapid return to the intensity and requirements of competing in Division 1 sports. We also developed a specific rehabilitation protocol that we postulated would be appropriate after this procedure. We illustrate the athlete's rehabilitation in detail. We feel that this specific protocol may have also influenced his rapid and complete return. We anticipate that this specific rehabilitation protocol may potentially guide future rehabilitation protocols after the Tenex procedure for recalcitrant lateral epicondylosis. In addition, this rehabilitation protocol may be considered after the Tenex procedure for additional conditions like medial epicondylosis, achilles tendinosis, patella tendinosis and gluteal tendinosis.

Percutaneous ultrasonic debridement of equine tendinopathy and desmopathy: A report of 10 cases

“…By operating in a closed fluid system, normal tissue is not affected by the procedure ( Morrey, 2014 ; Kamineni et al , 2015 ; Morrey, 2018 ). As demonstrated in humans, the procedure is safe and well-tolerated ( O’Daly et al , 2009 ; Morrey, 2018 ; Walrod et al , 2020 ). Horses in this study demonstrated improvement with no adverse events, and complete resolution of lameness in 8 of 10 treated limbs following a single treatment.…”

“…As of 2023, more than 160,000 human patients have been treated with the Tenex procedure, and fewer than 30 adverse events (mostly localized swelling) requiring medical attention were reported (Morrey B, personal communication, 2023; Tenex Health, Lake Forest, CA, File Data, 2023). The risk/benefit has been exceptional, with efficacy between 80% and 95% following a single procedure performed under local anesthesia ( Avella and Smith, 2012 ; Barnes, 2013 ; Koh et al , 2013 ; Nanos and Malanga, 2015 ; Patel, 2015 ; Morrey, 2017 , 2018 ; Freed et al , 2019 ; Walrod et al , 2020 ). PUD of tendinopathic tissue in human patients has demonstrated the advantage of excising nonstructural debris, thereby allowing regenerative cells to populate the newly cleared space ( Koh et al , 2013 ; Elattrache and Morrey, 2013 ; Barnes et al , 2015 ; Kamineni et al , 2015 ; Patel, 2015 ; Patel et al, 2015 ; Seng et al , 2016 ; Ostrom and Joseph, 2018 ; Freed et al , 2019 ).…”

Effects of Warm-Up Exercises With Interval Training on Fitness of Gymnasts

“…Gymnasts have different physical training plans during the preparation period and before the competition. 12 The training method can also use interval training. Preparing for a weekly training plan to increase the intensity of the training.…”

Percutaneous Interventions for Injuries in Athletes: Implications on Return to Play

“…35 A case report on Tenex in a Division 1 gymnast treated for lateral epicondylitis showed the athlete was able to return to competitive practice in 2 months and did not have recurrence of symptoms for up to 1 year of follow-up. 36 Allowing for appropriate recovery and rehabilitation following percutaneous tenotomy, the complication rate is reported to be low at 0.7%, which includes risks such as infection, postprocedural pain, and partial tendon rupture. 32,37 Overall, the literature suggests long-term success of percutaneous tenotomy but with a delay in RTP to allow for tendon healing and recovery.…”

“…35 A case report on Tenex in a Division 1 gymnast treated for lateral epicondylitis showed the athlete was able to return to competitive practice in 2 months and did not have recurrence of symptoms for up to 1 year of follow-up. 36…”