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Treating Tendonitis TENEX
Posted on 09-01-2026 in Achilles Tendinitis & Minimally Invasive Surgery by Dr. Joshua Hackel
Treating Tendonitis with Percutaneous Tenotomy (TENEX)
Millions of people a year suffer from the pain, stiffness and inflammation caused by chronic tendonitis. Tendons are strong bands of connective tissue that serve as the attachment mechanism between muscles and bones. The fibrous collagen that makes up tendons can degenerate due to acute injury or overuse, ultimately leading to tendonitis, a painful, chronic condition. Over time, repetitive overuse of muscles and joints will cause microtears to develop in the tendons, ultimately leading to pain that can make performing the activities of daily living (ADLs), participating in casual or competitive athletics, and picking up heavy objects a challenge.
Traditional treatments for chronic tendon pain include rest, steroid shots, physical therapy, or, in extreme cases, surgery to repair the damaged tissue in the affected tendons. In recent years, percutaneous tenotomy (TENEX) has emerged as an innovative treatment option for patients experiencing this painful condition.
How does percutaneous tenotomy work?
Percutaneous tenotomy is a minimally invasive, ultrasound-guided procedure that is performed under local rather than general anesthesia. During the procedure, Dr. Hackel uses ultrasound imaging to locate the damaged tendon tissue causing pain. Once the damaged tissue is located, a small incision is made above the injury site so that a small, ultrasonic device can be placed near the tendon. This instrument emits ultrasonic frequency waves to break down and simultaneously remove the damaged tissue while leaving healthy tissue unharmed. Removing this necrotic tendon tissue allows the tendon to heal properly, bringing relief from the pain, swelling and inflammation of tendonitis. Furthermore, percutaneous tenotomy’s ability to leave the healthy tissue intact prevents unnecessary damage and reduces recovery time.
What can percutaneous tenotomy be used to treat?
Any condition that stems from damage to the tendons can be treated with percutaneous tenotomy. Some of the most common conditions Dr. Hackel treats with percutaneous tenotomy include:
- Tennis elbow (common extensor tendonitis): a chronic condition caused by microtears in the common extensor tendon, which is located on the outside of the elbow. Symptoms include pain on the outside of the elbow, inflammation, numbness, and tenderness.
- Jumper’s knee (patellar tendinitis): a chronic condition caused by degeneration in the patellar tendon, which connects the patella to the shin bone.
- Golfer’s elbow (medial epicondylitis): a chronic condition caused by microtears in the common flexor tendon, which is located on the inside of the elbow. Symptoms include pain on the inside of the elbow, inflammation, numbness, and tenderness.
- Plantar fasciitis: a chronic condition caused by inflammation in the plantar fascia, the flat band of connective tissue that connects the calcaneus (heel bone) to the metatarsal bones (toes). Symptoms include pain, swelling, and inflammation; “first step” pain when getting out of bed is a classic sign of plantar fasciitis.
- Achilles tendonitis: a chronic condition characterized by pain and swelling in the Achilles tendon, which connects the gastrocnemius (calf muscle) to the calcaneus (heel bone). Symptoms include pain, swelling, and inflammation in the back of the heel.
What are the benefits?
Percutaneous tenotomy offers several advantages over traditional treatment modalities for tendinopathy (disorders of the tendon). First, it is a minimally invasive procedure, so it can be done in the outpatient setting using minimal levels of sedation and with very little, if any, narcotics during recovery. Second, because the procedure uses an incision less than one inch long, there is a lower likelihood of infection and other life-threatening surgical complications following the procedure. It leaves behind far less scarring, which many patients appreciate. Finally, the recovery time following percutaneous tenotomy is significantly shorter than recovery from traditional tendon repair procedures, allowing patients to return to work and life sooner!
If you are still experiencing chronic pain caused by tendon disorders and other treatments you have undergone have offered little relief, percutaneous tenotomy may be for you. Dr. Josh Hackel specializes in providing patients with non-surgical procedures for pain relief. His experience, caring demeanor and dedication to his patients make him one of the top sports medicine physicians in and around Gulf Breeze, Florida.
To learn more, watch Dr. Hackel’s TENEX Presentation given during the 2021 American Medical Society for Sports Medicine to learn more about the procedure.
Sources
https://hackelmd.com/treatments/tenex/
[TENEX Health TX Info — The Hughston Clinic](https://www.hughston.com/tenex-health-tx-info/)
[Tenex Health – Tenex Health](https://tenexhealth.com/)
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