1026 - Ultrasound Guided Percutaneous Tenotomy for Treatment of Elbow Tendinopathies

Objectives: Ultrasound-guided percutaneous tenotomy (UGPT) is a minimally invasive procedure that has been used for treatment of elbow tendinopathies, such as medial and lateral epicondylitis. This procedure can be performed with needles with different medications and ultrasonic devices, such as the TX-1 device. Physiatrists may be able to utilize these treatments for patients who fail conservative therapies. The goal of this review is to gather current evidence pertaining to the efficacy and safety of the different variations of UGPT for the treatment of elbow tendinopathies.

Design: 17 articles pertaining to UGPT for elbow tendinopathies were reviewed. These articles were found by entering keywords, such as “ultrasound-guided percutaneous tenotomy,” “elbow tenotomy,” “epicondylitis,” “percutaneous ultrasonic tenotomy,” “tenex,” and “elbow tendinopathy” into the PubMed database both separately and in combination.

Results: Multiple articles demonstrated that use of UGPT resulted in significant improvement of clinical outcomes, including pain and disability. Percutaneous ultrasonic tenotomy (PUT), using the TX-1 device, has been shown to lead to symptomatic improvement in medial and lateral epicondylitis with minimal complications. PUT showed similar outcomes as surgical tenotomy and PRP injections. UGPT with needles has also shown to have clinical benefits for elbow tendinopathies. There was no added benefit when adding PRP, amniotic membrane allograft, and corticosteroid injections. There are no studies available that compare the use of ultrasonic devices and dry needles.

Conclusions: UGPT is a safe and effective treatment, both with ultrasonic devices and with standard needles, for medial and lateral elbow tendinopathies. Physiatrists may use these therapies to treat patients with inadequate improvement after conservative management. There is a lack of studies comparing the efficacy and safety of UGPT with ultrasonic devices to UGPT with standard needles. Surgical tenotomy and UGPT with corticosteroid, amniotic membrane allograft, or PRP injections were not shown to provide significantly better outcomes than UGPT with lidocaine alone.