Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow

Abstract

Objective. Chronic refractory common extensor tendinosis of the lateral elbow has been shown to respond to sonographically guided percutaneous needle tenotomy (PNT) followed by corticosteroid injection. In this analysis, we attempted to determine whether the corticosteroid is a necessary component of the procedure. Methods. We performed PNT on 57 consecutive patients (age range, 34–61 years) with persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the tendon, and the tip of the needle was used to fenestrate the tendinotic tissue, break up any calcifications, and abrade the adjacent bone. After the procedure, patients underwent a specified physical therapy protocol. During a subsequent telephone interview, patients answered questions about their symptoms, the level of functioning, and perceptions of the procedure outcome. Results. Of the 52 patients who agreed to participate in the study, 30 (57.7%) reported excellent outcomes, 18 (34.6%) good, 1 (1.9%) fair, and 3 (5.8%) poor. The average follow‐up time from the date of the procedure to the telephone interview was 22 months (range, 7–38 months). No adverse events were reported, and 90% stated that they would refer a friend or close relative for the procedure. Conclusions. Sonographically guided PNT for refractory lateral elbow tendinosis is an effective procedure, and subsequent corticosteroid injection is not necessary.

Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease

“…34,35 Although a needling effect and subtendinous/intratendinous fluid infusion may contribute to the clinical benefit in this study, trauma was minimized via use of a 27-gauge needle, with 3 to 6 gentle entries through a tendon, and only light bone contact. Given identical needling technique in both dextrose and lidocaine groups in this study design, a unique quality of dextrose must account for its superior efficacy.…”

Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

“…The anatomic region of interest is first injected with local anesthetic. There is currently no evidence to support the routine use of general anesthesia for this procedure [56][57][58][59][60][61] . Subsequent to achieving adequate analgesia, the ultrasound probe is positioned parallel to the tendon of interest in order to help guide the procedure, preferably in the longitudinal view.…”

“…Specifically, we will discuss partial tenotomy using a needle (needling) and complete tenotomy using a scalpel [56][57][58][59][60][61] . The anatomic region of interest is first injected with local anesthetic.…”

“…A brief listing of clinical indications and contraindications for percutaneous tenotomy are listed in Table 5. A comprehensive discussion of this topic is beyond the scope of this review [53][54][55][56][57][58][59][60][61][62][63] . Percutaneous tenotomy is ideally performed at the bedside or in an outpatient setting.…”

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

“…The emergence of these new treatments, combined with the needle tenotomy techniques, have been made possible by the ability to visualize the degenerative tendon, perform percutaneous needling of the tendon and accurately place the injectate into the desired area. While [79] Acromioclavicular joint [80] Glenohumeral joint [81] Biceps tendon sheath [13] Aspiration/lavage of calcific tendinitis [68] Elbow Medial and lateral epicondyle [82] Elbow joint [83] Hand/wrist Carpal tunnel [84] De Quervain's tenosynovitis [85] Carpometacarpal and trapeziometacarpal joint [86] Trigger finger [87] Scaphotrapeziotrapezoid joint [88] Distal radioulnar joint [89] Lower extremity…”