Utility of Percutaneous Needle Tenotomy to Reduce Pain and Improve Function in Common Extensor Tendinosis of the Lateral Epicondyle

Nicolas S. Hatamiya; Yuka Kobayashi; Andrew W. Gottschalk

doi:10.31486/toj.21.0044

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Details of Tenotomy Procedures

Study	Procedure Description
McShane et al, 2006¹³	Ultrasound-guided percutaneous needle tenotomy was performed using an 18- or 20-gauge needle to repeatedly fenestrate the tendon with concomitant corticosteroid injection (6 mg betamethasone [Celestone Soluspan] or 40 mg triamcinolone acetonide). The tendon was treated until palpable softening of the tissue occurred and sonographic visualization showed that the entire tendon had been treated. The needle was then reinserted to abrade the periosteum of the lateral epicondyle.
Lakhey et al, 2007¹⁴	The common extensor tendon was infiltrated with 10 mL 0.2% ropivacaine using a 30-gauge needle, and then percutaneous needle tenotomy was performed by dividing the origin of the common extensor tendon at the site of maximal tenderness using the bevel of an 18-gauge needle.
McShane et al, 2008¹⁵	Subcutaneous tissues overlying the lateral epicondyle were infiltrated with 0.5% bupivacaine and 1% sodium bicarbonate using a 22-gauge needle, and then ultrasound-guided percutaneous needle tenotomy was performed using a 20-gauge needle to repeatedly fenestrate the tendon until palpable softening of the tissue occurred and sonographic visualization showed that the entire tendon had been treated. The needle was then reinserted to abrade the periosteum of the lateral epicondyle.
Zhu et al, 2008¹⁶	Percutaneous needle tenotomy was performed using a 16-gauge needle to repeatedly fenestrate the common extensor tendon with subsequent corticosteroid injection, a 1 mL mixture of 25 mg prednisone acetate and 1% lidocaine.
Stenhouse et al, 2013¹⁷	Percutaneous needle tenotomy alone was compared to percutaneous needle tenotomy with autologous conditioned plasma injection, for which whole blood was drawn and centrifuged once at 1,500 rpm for 5 minutes, and then the platelet-containing plasma layer was drawn and injected. Percutaneous tenotomy was performed using a 23-gauge needle to pepper the tendon 40 to 50 times.
Barnes et al, 2015¹⁸	Ultrasound-guided percutaneous needle tenotomy was performed with the TX1 system (Tenex Health Inc), a proprietary needle-like device that uses ultrasonic energy to rapidly oscillate an 18-gauge tip to debride diseased tissue and remove it through an inflow-outflow circuit. To anesthetize the subcutaneous and insertion region, 3 mL 1% lidocaine was used.