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Percutaneous Ultrasonic Tenotomy Treatment for Tendinopathy

Percutaneous ultrasonic tenotomy (PUT) offered through the Mass General Brigham Sports Medicine program is a treatment option for tendon-related pain.

What is percutaneous ultrasonic tenotomy?

Percutaneous ultrasonic tenotomy (PUT) is a treatment option for tendon-related pain. Unlike open surgery, PUT is minimally invasive—meaning the procedure can be done with a small incision that does not require stitches, so your recovery can be speedier.

During PUT, your doctor inserts a needle into your damaged tendon under direct ultrasound visualization. Ultrasonic energy is emitted from the end of the needle device which removes damaged tissue and promotes healing. The procedure is performed in an outpatient setting using local anesthesia. This means you can go home the same day.

The Food and Drug Administration cleared PUT in 2012 and more than 150,000 procedures nationwide have been completed since its approval. And it’s effective: A 7-year follow-up study on tennis elbow shows significant improvement in tendon pain and function after PUT.

Who can benefit from percutaneous ultrasonic tenotomy?

If you have been experiencing continued pain from a chronic tendon disorder, even after physical or occupational therapy, bracing, modifying activity, and over-the-counter medicine, you may benefit from PUT. Most PUT candidates qualify after experiencing pain for over 3 months. PUT can be used to treat most areas of tendon disorders, including (but not limited to):

  • Elbow: tennis elbow and golfer’s elbow 
  • Shoulder: calcific tendinopathy, bicep tendinopathy, and other rotator cuff disorders 
  • Hip: hip bursitis and tendonitis 
  • Knee: jumper’s knee 
  • Foot and ankle: Plantar fasciitis, Achilles’ tendinopathy

What are the risks of percutaneous ultrasonic tenotomy?

In any procedure that involves piercing the skin, there are risks such as infection, bleeding, bruising, pain, tissue damage in the targeted areas, and nerve injury. Risks specific to PUT also include tendon rupture and needle malfunction or breakage.

What to expect

A sports medicine specialist can determine if you’re a candidate for PUT. During this appointment, your doctor performs a diagnostic ultrasound on the painful area to learn more about the injury within your tendon. They may recommend alternative treatment methods first, particularly if your diagnosis is different than expected or if you haven’t tried more conservative treatment options (for example, therapy). Please be aware:

  • You should stop taking any anti-inflammatory medicine for 1 week prior to the procedure. This includes medicine such as ibuprofen (Advil) and naproxen (Aleve) among others. 
  • If you are on any strong blood thinners, such as coumadin, it’s important to notify your physician as soon as possible. 
  • Depending on your unique situation, you may need a driver to take you home once your procedure is complete.

During the procedure, your doctor applies a numbing medicine to your skin where he inserts the needle. This is called a local anesthetic. Then, they make a very small incision your skin so that your doctor can ensure they guide the needle straight to the affected tissue. They use musculoskeletal ultrasound imaging (a form of ultrasound where they can see your muscles and joints) so they can see where the needle needs to go.

After they’re finished, you won’t need stitches. Instead, your team applies a small steri-strip and clear bandage over the incision site to help you heal.

The affected area may feel quite sore after this procedure, particularly in the first 3 days. You can take acetaminophen (Tylenol) as needed to reduce pain and apply ice to the treated area for up to 20 minutes at a time.

Avoid anti-inflammatory medicine (like ibuprofen and naproxen) for 2 weeks after the procedure.

Rehabilitation timeline after percutaneous ultrasonic tenotomy

  • 0–2 weeks: You may do limited activity and weight bearing exercises with boot or crutches. Your goal is to start working on regaining range of motion in the treated body part. Limit lifting to less than 2 pounds. 
  • 2–6 weeks: Slowly progress rehab lifting less than 5 pounds. Depending on your condition, you start formalized physical therapy around 2 weeks after the procedure. 
  • 6–12 weeks: Continue resistance exercise and daily activities as you’re able. 
  • 12 weeks: After 12 weeks, you can resume normal activities, unless your care team tells you otherwise. 

Please note that your recovery time can vary. Depending on the severity of your condition and the area treated, you may start to notice reduced pain as soon as 2 weeks. Other times it can take up to 3 months to start to experience the beginnings of improvement.

Follow-up appointments

You will return to the clinic 2 weeks after your procedure so your team can check your incision and ensure you are healing well. Depending on your condition and how you’re healing, you may also be seen again 6–8 weeks after the procedure. You’ll be seen in clinic one last time about 3 months after your procedure is complete.

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