Tenex Procedure for Chronic Tendon Pain in Northern Virginia
A minimally invasive, ultrasound-guided procedure for selected chronic tendon and plantar fascia conditions that have not improved enough with appropriate nonsurgical treatment.
Tenex Procedure at a Glance
Procedure: Ultrasound-guided percutaneous ultrasonic tenotomy or fasciotomy
Designed For: Selected chronic tendon or plantar fascia conditions that have not improved adequately with conservative treatment
Common Treatment Areas: Elbow, shoulder, hip/gluteal tendons, knee tendons, Achilles tendon, and plantar fascia
How It Works: Uses ultrasound guidance and a small treatment instrument to remove selected abnormal soft tissue through a small incision
Anesthesia: Commonly performed using local anesthetic
Setting: Minimally invasive outpatient procedure
Recovery: Varies by tendon and condition; return to normal activity commonly progresses over several weeks
Rehabilitation: Activity progression and therapeutic exercise may be important after the procedure
What Is the Tenex Procedure?
Tenex is a minimally invasive procedure used to treat selected chronic tendon and plantar fascia conditions.
The procedure is medically described as percutaneous ultrasonic tenotomy when performed on a tendon and percutaneous ultrasonic fasciotomy when performed on the plantar fascia.
Using ultrasound imaging, the clinician identifies the area of abnormal tissue associated with the patient's chronic symptoms.
A small treatment instrument is then introduced through the skin and uses ultrasonic energy to break down and remove selected abnormal soft tissue.
Unlike traditional open tendon surgery, Tenex can generally be performed through a very small incision without a large surgical exposure.
The procedure does not guarantee that tendon pain will disappear, and it is not appropriate for every tendon problem.
Its role is primarily for carefully selected chronic conditions that have not improved enough with appropriate conservative treatment.
What Is Chronic Tendinopathy?
Tendons are strong tissues that connect muscles to bones.
When a tendon is repeatedly overloaded or injured, changes can develop within its structure.
Chronic tendinopathy may cause:
pain with activity;
localized tenderness;
stiffness;
reduced strength;
difficulty performing repetitive movements;
or pain that continues despite rest and rehabilitation.
Although the word “tendonitis” is commonly used, persistent tendon symptoms do not always represent ongoing inflammation alone.
Chronic tendinopathy can involve changes in tendon structure and tissue quality, which is why treatment often focuses on progressive rehabilitation rather than simply reducing inflammation.
When Is Tenex Considered?
Tenex is generally not the first treatment used for tendon pain.
Many patients improve with an appropriate nonsurgical treatment plan.
Depending on the diagnosis, this may include:
temporarily modifying aggravating activities;
progressive strengthening;
physical therapy;
appropriate stretching and mobility work;
medication when appropriate;
bracing or other supportive treatment;
and selected injections in certain circumstances.
Tenex may be considered when symptoms remain persistent despite an appropriate period of nonsurgical care and imaging identifies a tendon or plantar fascia abnormality that may be suitable for treatment.
The decision should be based on your diagnosis rather than simply how long you have been in pain.
Explore our non-surgical orthopedic treatments.
What Conditions May Be Treated With Tenex?
Tenex has been used for chronic tendinopathy and fasciopathy in several areas of the body.
Whether it is appropriate depends on the exact diagnosis and tissue involved.
Tennis Elbow & Golfer's Elbow
Lateral epicondylitis, commonly called tennis elbow, affects the tendons along the outside of the elbow.
Medial epicondylitis, or golfer's elbow, affects the tendon attachment along the inner side.
Most patients begin with nonsurgical care.
For persistent symptoms associated with chronic tendon changes, percutaneous ultrasonic tenotomy may be considered in selected cases.
Learn more about hand, wrist and elbow care.
Chronic Shoulder Tendon Problems
Certain chronic tendon problems around the shoulder may be candidates for Tenex when the abnormal tissue can be appropriately identified and targeted.
However, shoulder pain has many potential causes.
A complete rotator cuff tear, instability, arthritis, frozen shoulder, and chronic tendinopathy require very different treatment plans.
The diagnosis should therefore be established before considering Tenex.
Learn more about shoulder pain and orthopedic shoulder care.
Hip & Gluteal Tendinopathy
Chronic gluteal tendon problems can contribute to pain along the outside of the hip.
Patients may notice pain during walking, climbing stairs, exercise, or while lying on the affected side.
Some persistent tendon conditions may be candidates for minimally invasive treatment after appropriate nonsurgical care has not provided enough relief.
Learn more about hip pain and orthopedic hip care.
Patellar & Other Knee Tendon Problems
Chronic tendinopathy can affect the patellar tendon and other soft tissues around the knee, particularly in active patients.
Treatment usually begins with rehabilitation and progressive loading.
Tenex may be considered for selected chronic tendon abnormalities that continue to limit activity despite an appropriate treatment program.
Learn more about knee pain and orthopedic knee care.
Achilles Tendinopathy
The Achilles tendon can develop chronic changes either within the tendon or near its attachment to the heel bone.
Symptoms may include pain, stiffness, thickening, or difficulty running, walking, or pushing off.
Treatment typically begins with activity modification and a progressive rehabilitation program.
For selected persistent cases, ultrasound-guided percutaneous treatment may be considered.
Learn more about foot and ankle care.
Plantar Fasciitis
Chronic plantar fascia pain commonly causes discomfort beneath the heel, particularly with the first steps after rest or prolonged weight bearing.
Most patients improve without a procedure.
Treatment may include footwear modification, stretching, strengthening, orthotics, and other conservative care.
When symptoms remain persistent and imaging confirms chronic plantar fascia abnormality, percutaneous ultrasonic fasciotomy may be considered in selected patients.
Learn more about custom foot orthotics.
What Tenex Does—and Does Not—Treat
Tenex is designed to remove selected abnormal tendon or plantar fascia tissue identified during ultrasound-guided treatment.
It should not be presented as a general treatment for every type of pain.
Tenex does not:
reverse arthritis
regrow cartilage
repair every tendon tear
treat nerve compression
correct joint instability
heal fractures
or replace surgery when an injury requires structural repair
For example, pain near a tendon could actually originate from arthritis, a complete tendon rupture, a joint problem, nerve irritation, or another condition.
An accurate diagnosis is therefore essential before deciding whether Tenex is appropriate.
How Is Tenex Different From Physical Therapy?
Physical therapy and Tenex have different roles.
Physical therapy can improve strength, mobility, movement patterns, tendon-loading tolerance, and function.
For chronic tendinopathy, progressive exercise is often an important part of treatment.
Tenex is a procedure that may be considered when appropriate conservative care has not provided enough improvement and the abnormal tissue can be specifically identified.
Even after Tenex, patients may still need a gradual exercise and activity progression.
The procedure should not be viewed as a substitute for rehabilitation.
Learn more about physical therapy at Arthritis & Sports.
How Is Tenex Different From PRP?
Tenex and platelet-rich plasma work in very different ways.
Tenex
Tenex mechanically breaks down and removes selected abnormal soft tissue using ultrasonic energy.
PRP
Platelet-rich plasma is an injectable orthobiologic treatment prepared from a sample of the patient's own blood.
No tendon tissue is removed during PRP treatment.
The evidence, indications, costs, recovery, and potential benefits differ by condition.
Neither treatment is automatically better for every patient.
Your orthopedic provider can help determine whether continued rehabilitation, Tenex, PRP, surgery, or another treatment makes the most sense for your diagnosis.
Learn more about platelet-rich plasma injections.
How Is Tenex Different From Cortisone?
A corticosteroid injection delivers anti-inflammatory medication to a selected treatment area.
Tenex does not inject corticosteroid or another medication into the tendon.
Instead, it removes selected abnormal tissue through a minimally invasive procedure.
A patient does not necessarily need to receive or “fail” a cortisone injection before being considered for Tenex.
The appropriate treatment sequence depends on the condition and individual patient.
What Happens During a Tenex Procedure?
Tenex is generally performed as an outpatient procedure.
Ultrasound Evaluation
Ultrasound imaging is used to identify the abnormal portion of the tendon or plantar fascia and guide treatment.
Local Anesthetic
The treatment area is prepared and local anesthetic is commonly used to reduce procedural discomfort.
Small Incision
A very small opening is made in the skin so the treatment instrument can reach the targeted tissue.
Ultrasonic Tissue Removal
The Tenex instrument uses ultrasonic energy to break down selected abnormal tissue while simultaneously removing that tissue from the treatment area.
Ultrasound guidance allows the clinician to monitor the instrument and targeted tissue during the procedure.
Dressing
Because the opening is small, traditional sutures may not be necessary in many cases.
A small dressing or adhesive closure may be used depending on the treatment site and procedure.
How Long Does the Tenex Procedure Take?
The treatment portion of a Tenex procedure can often be completed relatively quickly.
However, the overall appointment also includes preparation, ultrasound localization, local anesthesia, the procedure itself, dressing, and postoperative instructions.
Procedure time varies depending on the area being treated and complexity of the condition.
Does Tenex Hurt?
Local anesthetic is commonly used during the procedure.
Patients may still experience pressure, vibration, soreness, or other temporary sensations.
After treatment, discomfort, swelling, bruising, or tenderness can occur around the procedure site.
The amount of discomfort varies depending on the tissue treated and individual patient.
What Is Recovery Like After Tenex?
Recovery depends heavily on the tendon or fascia being treated.
A plantar fascia procedure has different loading requirements from treatment of the elbow, shoulder, patellar tendon, or Achilles tendon.
The First Few Days
Temporary soreness, bruising, swelling, or tenderness may occur.
Your provider will give you specific instructions regarding:
wound care
weight bearing
activity
use of a brace, boot, or crutches when necessary
medication
and when exercise should resume
The First Several Weeks
Activity is gradually progressed as the tissue responds.
The fact that the incision is small does not mean the tendon is immediately ready for unrestricted exercise.
The treated tissue still needs time to recover and adapt to progressive loading.
Returning to Normal Activity
Tenex Health currently describes return to normal activities in approximately 6–12 weeks for many patients, but that should be treated as a general range rather than a guaranteed recovery timeline.
Your actual recovery depends on the tendon treated, severity and duration of the condition, activity demands, age, health, and rehabilitation.
Athletes may require additional time and functional progression before returning to high-impact or sport-specific activity.
Will I Need Physical Therapy After Tenex?
That depends on the condition.
There is currently no single standardized rehabilitation protocol that applies to every tendon treated with percutaneous ultrasonic tenotomy.
For many patients, however, progressive strengthening and tendon loading remain important for restoring function.
Your physician and physical therapist can determine:
when mobility exercises should begin
when strengthening should resume
how rapidly loading should progress
and when higher-level activity is appropriate
Learn more about physical therapy.
What Are the Potential Benefits of Tenex?
Potential advantages for appropriately selected patients include:
minimally invasive treatment
ultrasound-guided targeting
a small incision
local anesthesia in many cases
removal of selected abnormal tendon or fascia tissue
and potentially shorter recovery than traditional open surgery for certain chronic tendon conditions
Clinical studies have reported improvements in pain and function in many patients following percutaneous ultrasonic tenotomy.
However, individual results vary, and current evidence does not support promising that a specific percentage of patients will become pain-free.
What Are the Risks of Tenex?
Tenex is minimally invasive, but it is still a medical procedure.
Potential risks can include:
temporary pain or soreness
swelling
bruising
bleeding
infection
nerve or blood-vessel injury
damage to surrounding tissues
incomplete symptom relief
persistent weakness or dysfunction
or the need for additional treatment or surgery
Risks can vary depending on the tendon and treatment area.
Your provider should discuss the potential benefits, limitations, alternatives, and risks before treatment.
Can Tenex Prevent Surgery?
Tenex may allow selected patients with chronic tendon or plantar fascia problems to improve without traditional open surgery.
That does not mean it should be described as a guaranteed way to avoid surgery.
If the underlying problem is a complete tear, significant structural injury, advanced joint disease, or another condition requiring repair or reconstruction, a different procedure may be more appropriate.
The purpose of evaluation is to identify the treatment that fits the diagnosis—not simply choose the least invasive procedure.
Am I a Candidate for Tenex?
You may be considered for Tenex when:
symptoms have persisted despite appropriate conservative treatment
the problem involves a chronic tendon or plantar fascia condition
imaging and examination identify tissue that can reasonably be targeted
symptoms continue to interfere with activity or function
and your provider believes percutaneous treatment is appropriate
You may not be a candidate when another diagnosis better explains the symptoms or when the problem requires a different type of treatment.
A complete tendon rupture, significant instability, fracture, active infection, or advanced joint condition may require another approach.
Which Specialist Should I See About Tenex?
The right provider depends first on where your symptoms are located.
Arthritis & Sports includes specialists in sports medicine, shoulder and knee care, hand and elbow care, hip care, and foot and ankle care.
Because Tenex availability and appropriateness can vary by body area and provider, the first step is scheduling an orthopedic evaluation for the painful tendon or plantar fascia.
Our team can determine the diagnosis and whether continued rehabilitation, Tenex, another nonsurgical procedure, or surgery should be considered.
Meet our orthopedic specialists.
Tenex Treatment in Northern Virginia
Arthritis & Sports provides orthopedic evaluation and minimally invasive treatment options for patients throughout Loudoun County and Northern Virginia.
Our Sterling and South Riding locations serve patients from Sterling, Ashburn, Leesburg, Reston, Herndon, Chantilly, South Riding, Aldie, and surrounding communities.
Tenex availability may vary by provider and body area.
Contact our office to determine which specialist should evaluate your condition and whether the Tenex procedure is currently available for the area being treated.
Visit our South Riding location.
Frequently Asked Questions About Tenex
Is Tenex surgery?
Tenex is generally described as a minimally invasive percutaneous procedure rather than traditional open surgery. A small treatment instrument passes through the skin to remove selected abnormal tissue. It is still an invasive medical procedure and requires appropriate postoperative care.
Is Tenex the same as a cortisone injection?
No. Cortisone involves injecting medication. Tenex uses ultrasonic energy to break down and remove selected abnormal tissue.
Is Tenex the same as PRP?
No. PRP involves injecting a platelet-rich preparation made from your own blood. Tenex physically removes selected abnormal tendon or plantar fascia tissue.
How long does recovery from Tenex take?
Recovery varies by treatment area and patient. Many patients gradually return to normal activities over several weeks, and Tenex currently describes approximately 6–12 weeks as a typical general range. Higher-level athletics may take longer. Your provider's instructions should determine your individual progression.
How many Tenex procedures will I need?
Tenex is commonly performed as a single procedure. However, a single treatment cannot be guaranteed to resolve symptoms. Your response should be reassessed before any additional procedure is considered.
Does Tenex remove healthy tendon?
The procedure uses ultrasound guidance to target selected abnormal tissue while limiting disruption of surrounding structures. However, I would not describe it as physically incapable of affecting healthy tissue. As with any invasive procedure, appropriate technique and accurate targeting are important.
Can Tenex treat plantar fasciitis?
Percutaneous ultrasonic fasciotomy may be considered for selected chronic plantar fascia pain that has not improved adequately with nonsurgical treatment. Most patients with plantar fasciitis do not need a procedure.
Does Tenex work for tennis elbow?
Percutaneous ultrasonic tenotomy has been studied for chronic lateral epicondylitis, or tennis elbow, with multiple studies reporting improvement in pain and function. It is generally considered after appropriate nonsurgical treatment has not provided enough relief.
Does Tenex work immediately?
Some patients may notice improvement relatively early, but Tenex should not be marketed as providing immediate pain relief. The treated tissue still undergoes recovery after the procedure, and improvement may occur gradually over several weeks.
Schedule a Tenex Evaluation
If chronic tendon or plantar fascia pain continues to interfere with exercise, work, sports, or everyday activities despite appropriate nonsurgical treatment, an orthopedic evaluation can help determine why symptoms are persisting.
Tenex may be an option for selected chronic tendon and plantar fascia conditions, but it is not the right procedure for every patient.
Our team can confirm your diagnosis, review previous treatment and imaging, and determine whether Tenex, continued rehabilitation, another nonsurgical option, or surgery is appropriate.
Request an appointment with Arthritis & Sports Orthopaedics in Northern Virginia.
