TENEX Procedure

What is The TENEX Procedure?

The Tenex procedure is a minimally invasive treatment for chronic tendon pain, such as tendinitis and tendinosis, using ultrasound guidance and local anesthesia. It involves making a small incision to insert a specialized ultrasonic tool that breaks down and removes damaged tendon tissue while sparing healthy tissue. This method, known as percutaneous tenotomy, typically results in quicker recovery and significant pain relief compared to traditional surgery, allowing patients to return to normal activities within a few weeks.

Tenex procedure for tendon pain

The Tenex procedure, also known as percutaneous tenotomy, is a minimally invasive treatment designed to alleviate chronic tendon pain. Here’s a step-by-step description of the procedure:

Preparation: The patient is positioned comfortably, and the area around the affected tendon is cleaned and sterilized. Local anesthesia is administered to numb the area, ensuring the patient remains awake but pain-free during the procedure.

Ultrasound Guidance: An ultrasound device is used to visualize the damaged tendon tissue in real-time. This ensures precise targeting of the area that needs treatment.

Small Incision: A tiny incision, typically less than a quarter of an inch, is made over the targeted area. This small incision minimizes scarring and facilitates a quicker recovery.

Insertion of Tenex Device: A specialized ultrasonic tool, part of the Tenex Health TX system, is inserted through the incision. This tool uses high-frequency ultrasound energy to break down and emulsify the damaged tendon tissue.

Removal of Damaged Tissue: The ultrasonic tool both cuts and removes the damaged tissue while sparing the healthy surrounding tissue. The emulsified tissue is then suctioned out through the same small incision.

Completion and Closure: Once the damaged tissue is removed, the tool is withdrawn, and the incision is closed with a small bandage. Stitches are generally not required due to the minimal size of the incision.

Post-Procedure Care: Patients receive instructions on post-procedure care, which typically includes rest and gradual return to normal activities. Follow-up appointments may be scheduled to monitor the healing process.

The entire procedure usually takes about 20 to 30 minutes, and patients often experience significant pain relief and improved function, with most able to resume normal activities within a few weeks.

The Tenex procedure, while generally safe and minimally invasive, does carry some risks and potential complications. These include:

  1. Infection: As with any procedure involving an incision, there is a risk of infection at the site. Proper sterilization and post-procedure care minimize this risk.

  2. Bleeding: Minor bleeding can occur during or after the procedure. This is usually minimal due to the small size of the incision.

  3. Nerve or Blood Vessel Damage: There is a small risk of inadvertently damaging nearby nerves or blood vessels during the procedure, which could lead to numbness, tingling, or other complications.

  4. Incomplete Pain Relief: In some cases, patients may not experience the desired level of pain relief or improvement in function. Additional treatments or alternative therapies might be necessary.

  5. Tendon Rupture: Although rare, there is a possibility of weakening or rupturing the tendon during the procedure, especially if the tendon is already severely damaged.

  6. Scar Tissue Formation: As the tendon heals, there may be some formation of scar tissue, which could affect tendon flexibility and function.

  7. Allergic Reactions: Although uncommon, patients could have an allergic reaction to the local anesthetic or other materials used during the procedure.

It’s important for patients to discuss these risks with their healthcare provider to ensure they are fully informed and to determine if the Tenex procedure is the best option for their specific condition.


If the Tenex procedure does not provide the desired pain relief or functional improvement, several steps can be taken to address the persistent issues:

Follow-Up Evaluation: The patient should return to their healthcare provider for a thorough evaluation. This may include physical examinations, imaging studies (such as ultrasound or MRI), and a review of the patient’s symptoms and response to the procedure.

Physical Therapy: Sometimes, additional physical therapy may be recommended to strengthen the affected area, improve flexibility, and reduce pain. Physical therapy can help address any residual issues and enhance the recovery process.

Pain Management: The healthcare provider may explore other pain management options, such as medications, corticosteroid injections, or platelet-rich plasma (PRP) injections, to alleviate pain and promote healing.

Alternative Minimally Invasive Procedures: Other minimally invasive procedures, such as dry needling or extracorporeal shock wave therapy (ESWT), may be considered to treat the damaged tendon tissue.

Traditional Surgery: If non-surgical treatments are unsuccessful, traditional open or arthroscopic surgery might be necessary. This involves more extensive surgical intervention to repair or remove damaged tendon tissue.

Lifestyle and Activity Modifications: Patients may need to adjust their activities or modify their lifestyle to reduce stress on the affected tendon. This can help prevent further injury and manage symptoms.

Second Opinion: Seeking a second opinion from another specialist, such as an orthopedic surgeon or a sports medicine doctor, can provide additional insights and alternative treatment options.

The appropriate next steps depend on the individual’s condition, severity of symptoms, and overall health. Collaborating closely with a healthcare provider ensures a tailored approach to achieve the best possible outcome.

After the Tenex procedure, there are certain activities and actions that patients should avoid to ensure proper healing and recovery. Here are some general guidelines on what not to do following the procedure:

  1. Avoid Strenuous Activities: Refrain from engaging in strenuous activities, heavy lifting, or any movements that put excessive strain on the treated tendon for several weeks. This includes sports, exercise, and vigorous physical work.

  2. Limit Use of the Affected Area: Minimize the use of the affected area to prevent overloading the healing tendon. For example, if the procedure was done on your elbow, avoid repetitive arm movements or heavy gripping tasks.

  3. Do Not Ignore Pain: Avoid pushing through pain. Pain can be a sign that the tendon is not healing properly or that you are overexerting the affected area.

  4. Avoid Immersing the Area in Water: Keep the incision site dry and avoid immersing it in water, such as in baths, hot tubs, or swimming pools, until it is fully healed to reduce the risk of infection.

  5. Skip High-Impact Activities: Avoid high-impact activities like running, jumping, or any exercise that could jar or stress the tendon until you get clearance from your healthcare provider.

  6. Avoid Wearing Tight Clothing: Refrain from wearing tight or restrictive clothing over the treated area to avoid irritation and allow for proper circulation and healing.

  7. Do Not Skip Follow-Up Appointments: Ensure you attend all scheduled follow-up appointments with your healthcare provider to monitor your progress and adjust your recovery plan as needed.

  8. Avoid Smoking and Excessive Alcohol Consumption: Smoking and excessive alcohol can impair the healing process. It’s best to avoid these to promote optimal recovery.

Your healthcare provider will give you specific instructions based on your individual case, so it’s important to follow their advice closely. Adhering to these guidelines can help ensure a smooth and successful recovery after the Tenex procedure.