About Percutaneous Tenotomy (Tenex)
In chronic tendinopathy, part of a tendon becomes disorganized and weak and stops healing on its own. Percutaneous tenotomy uses a small probe, placed through a nick in the skin, that vibrates at an ultrasonic frequency to break up and remove that damaged tissue while leaving healthy tendon alone.
Removing the damaged tissue gives the tendon a fresh start so healthy tissue can regenerate. It can also break up and clear calcium deposits in calcific tendinitis. Everything happens in our office with local numbing medicine, without general anesthesia and usually without stitches.
Dr. Gruner uses ultrasound throughout to see exactly which part of the tendon is damaged and to guide the probe to it. Afterward, a structured rehab program gradually strengthens the tendon.
Where we use Tenex
Watch: Tenex explained
What happens during treatment
- 1.
Dr. Gruner confirms the diagnosis with an exam and ultrasound and maps the damaged area of the tendon.
- 2.
The skin and tissue around the tendon are numbed with local anesthetic.
- 3.
A tiny incision is made, and the probe is guided under live ultrasound to remove damaged tendon tissue or calcium.
- 4.
The incision is closed with a small adhesive strip, and a light dressing is applied.
- 5.
You go home the same day with a plan for protection, gradual loading, and follow-up.
Who may be a good candidate
- Adults with tendon pain lasting several months that has not improved with a solid course of rehab.
- People with tennis elbow, golfer's elbow, gluteal or hamstring tendon pain, patellar or Achilles tendinopathy, or plantar fasciitis.
- People with calcific tendinitis of the shoulder or other tendons.
- Patients who want an office-based alternative before considering open tendon surgery.
Recovery
The area is usually sore for several days. Depending on the tendon, you may use a brace or boot for a short period. Gentle movement begins early, and a progressive strengthening program follows over the next several weeks. Most people return to light activity within days, while return to sport or heavy work is gradual and guided by how the tendon responds.
Risks and limits
Risks include post-procedure soreness, bruising, bleeding, infection, and irritation of a nearby nerve, all uncommon. Some people have a slow recovery or ongoing symptoms. Percutaneous tenotomy is not designed for a complete tendon rupture, which often needs a surgical opinion, and it is not done over infected skin. Blood thinners and anti-inflammatory medicines should be reviewed ahead of time.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Rehab protocols
Dr. Gruner's week-by-week recovery guidelines. Your plan is individualized; follow these with your physician and physical therapist.
- After Your Tenex Procedure — InstructionsView PDF
- Elbow — Ultrasound-Guided Tenotomy / PRP ProtocolView PDF
- Knee (Quad / Patellar Tendon) — Ultrasound-Guided PRP / Tenotomy ProtocolView PDF
- Achilles Tendon — Ultrasound-Guided Tenotomy / PRP ProtocolView PDF
- Foot (Plantar Fascia) — Ultrasound-Guided Tenotomy / PRP ProtocolView PDF
Clinical evidence
Published studies our physicians draw on. Results in studies do not predict any one person's outcome.
- Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 YearsPubMed
- Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic ReviewPubMed
- Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitisPubMed
Questions about Tenex
- Is Tenex surgery?
- It is a minimally invasive procedure done in the office through a tiny incision, under local anesthetic and without general anesthesia. There is usually no need for stitches. It is far less invasive than open tendon surgery.
- When can I go back to running or sports?
- Return to sport is gradual and depends on the tendon treated and how it responds. Many people start light activity within days and build up over several weeks with a structured strengthening program. We guide each step at follow-up.
- Can Tenex be combined with PRP?
- In some cases, yes. Dr. Gruner may suggest adding PRP after removing damaged tissue to support healing. Whether that helps depends on the tendon and your situation.