About Ultrasound-Guided Tendon Scraping
In long-standing tendon pain, small blood vessels and nerves often grow into the thin layer of tissue on the surface of the tendon. These new nerves can be a major source of pain. Tendon scraping separates this layer from the tendon, which may quiet those pain signals.
The procedure uses ultrasound to see the tendon and the abnormal vessels around it, then a needle and a small amount of fluid to gently separate the tissue. It does not remove the tendon itself.
Dr. Gruner and Dr. Chen use tendon scraping for people whose tendon pain has not settled with a solid rehab program. It is followed by a progressive loading plan, since strengthening remains central to long-term tendon health.
Watch: Tendon Scraping explained
What happens during treatment
- 1.
Your physician examines the tendon with ultrasound, including a color setting that shows abnormal blood flow.
- 2.
The skin and the area around the tendon are numbed with local anesthetic.
- 3.
Under live ultrasound, a needle and fluid are used to separate the irritated tissue from the tendon surface.
- 4.
A small bandage is applied, and you go home the same day with a rehab plan.
Who may be a good candidate
- People with chronic Achilles or patellar tendon pain that has not improved with several months of rehab.
- People whose ultrasound shows abnormal blood vessels along the tendon surface.
- Active people who want to stay in their sport and prefer an office-based option before surgery.
Recovery
Most people walk out of the office and return to daily activity within a day or two. Mild soreness is common for a few days. Loading exercises restart early and build over the following weeks, with a gradual return to running or jumping.
Risks and limits
Risks include soreness, bruising, bleeding, infection, and irritation of a nearby nerve, all uncommon. Symptoms may not improve fully in everyone, and some people benefit from other treatments afterward. Tendon scraping is not a treatment for a complete tendon rupture, which needs a surgical opinion. Blood thinners 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.
Clinical evidence
Published studies our physicians draw on. Results in studies do not predict any one person's outcome.
- Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniquesPubMed
- Achilles Scraping and Plantaris Tendon Removal Improves Pain and Tendon Structure in Patients with Mid-Portion Achilles Tendinopathy: A 24 Month Follow-Up Case SeriesPubMed
Questions about Tendon Scraping
- How is tendon scraping different from percutaneous tenotomy (Tenex)?
- Tendon scraping works on the irritated tissue and nerves on the outside of the tendon. Tenex removes damaged tissue from inside the tendon. Your physician will recommend one based on what ultrasound shows.
- Will I need a boot or crutches?
- Most people do not. You can usually walk right away, and we give you guidance on how quickly to increase activity.
- Can tendon scraping be done on other tendons?
- It is used most for Achilles and patellar tendons. In some cases it may be considered for other tendons with a similar pattern on ultrasound. Your physician will discuss whether it fits your situation.