Tenex, Percutaneous Tenotomy

Ultrasound-guided removal of diseased tendon tissue through a needle-sized opening.

What It Is

Tenex is a short, ultrasound-guided procedure. It targets and removes the small pocket of worn-out tissue inside a painful tendon. After the skin is numbed, a needle-sized probe goes in under ultrasound guidance. The probe uses high-frequency sound energy to break down and wash out the diseased tendon tissue. The healthy fibers around it are left intact.

It is designed for people with chronic tendinopathy (a slowly worn-down tendon, not a sudden inflammation). It fits when physical therapy, bracing, and injections have not worked, but open surgery feels like too large a step. Because only a needle-sized opening is made, there are no stitches.

The procedure uses the TX1 device (made by Tenex Health, which gives the procedure its common name). A related tool, TenJet, works the same way. This is a small, brief procedure, and we group it with our non-operative options because the goal is to delay or avoid formal surgery.

Where It Fits in Care

Tenex is a step between injections and open surgery. A good candidate has:

  • Pain in one specific tendon that has lasted through a full course of non-surgical care.
  • Imaging (ultrasound or MRI) showing worn-down tendon tissue (thickened, disorganized fibers) rather than a clean tear needing repair.
  • A finished course of physical therapy and usually at least one targeted injection (cortisone, PRP, or similar) without lasting relief.
  • A wish to avoid, or not yet be ready for, formal surgery to clean out the tendon.

Conditions We Consider It For

Tennis elbow

Chronic outer-elbow tendon wear that has not responded to a counterforce strap, physical therapy, and prior injection.

Golfer’s elbow

Long-standing inner-elbow tendon pain, considered the same way.

Achilles tendinopathy

Mid-tendon cases, and some at the heel attachment, after a structured loading program.

Plantar fasciitis

Stubborn heel pain when stretching, orthotics, and prior injections have not fixed it.

Patellar tendinopathy (jumper’s knee)

Chronic kneecap-tendon pain that has not improved with a rehab program.

Quadriceps tendinopathy

Wear at the top of the kneecap tendon after heavy slow resistance training and biologic injection.

Gluteus medius tendinopathy

Outer-hip pain from long-term wear of the hip-abductor tendon.

What to Expect

  • The procedure itself is brief, done under local anesthesia, with light sedation available if needed.
  • Ultrasound guides the probe to the exact area of damaged tissue, so the healthy tendon is not disturbed.
  • The entry point is a small nick in the skin, smaller than a stitch and usually closed with a bandage rather than stitches.
  • Early recovery brings local soreness and a short stretch of protected activity, sometimes with a brace or boot, depending on the tendon treated.
  • Return to activity is gradual and follows a rehab program. Your surgeon will walk you through the phases for the tendon being treated.
  • The pain eases over time as the tendon remodels.

Insurance and Cost

Most insurance carriers still consider percutaneous tenotomy investigational for many uses. Coverage is spotty and often limited. Patients who are not covered can proceed on a self-pay basis.

Self-pay pricing is available, ask at scheduling. A written estimate is provided in advance so there are no surprises.

Risks

  • Local soreness and bruising at the entry site, expected and short-lived.
  • Temporary swelling or stiffness in the nearby joint.
  • Infection, rare with sterile technique.
  • Injury to nearby tissue, very uncommon with ultrasound guidance.
  • No benefit, the most common “complication.” As with any tendon treatment, not everyone responds, and some patients still go on to open surgery to clean out the tendon.

Frequently Asked

questions we hear in clinic
Will I be asleep?

The procedure is done under local anesthesia, with light sedation available if needed. It is brief.

Will I have stitches?

No. The entry point is a small nick in the skin, smaller than a stitch, and is usually closed with a bandage rather than stitches.

Is Tenex a surgery?

No. It is a small, brief procedure done through a needle-sized opening, not an open operation. We group it with our non-operative options because the goal is to delay or avoid formal surgery.

Am I a good candidate?

A good candidate has pain in one specific tendon that has lasted through a full course of non-surgical care, imaging showing worn-down tendon tissue rather than a clean tear needing repair, a finished course of physical therapy and usually at least one targeted injection, and a wish to avoid or delay formal surgery.

How long is recovery?

Early recovery brings local soreness and a short stretch of protected activity, sometimes with a brace or boot depending on the tendon treated. Return to activity is gradual and follows a rehab program, and the pain eases over time as the tendon remodels.

Does insurance cover Tenex?

Most insurance carriers still consider percutaneous tenotomy investigational for many uses, so coverage is spotty and often limited. Patients who are not covered can proceed on a self-pay basis, with a written estimate provided in advance.