Percutaneous Needle Tenotomy

Percutaneous Needle Tenotomy

What is Percutaneous Needle Tenotomy?

Percutaneous needle tenotomy (PNT) is a newer treatment for a condition called tendinopathy (cartilage breakdown in the tendon) or chronic tendinosis (cellular degeneration of a tendon). Percutaneous means “through the skin” and tenotomy refers to cutting. PNT is a minimally invasive non-surgical procedure in which a needle is passed through the skin to repeatedly pierce the abnormal tendon area under ultrasound guidance to induce bleeding in order to stimulate tendon healing and regrowth. The goal of the procedure is to produce inflammation, break up any scar tissue present and increase oxygenated blood flow to the tendon to allow the body’s own cells to begin the process of rebuilding the tendon.

Anatomy

Tendons are tough, cord-like tissues made up of collagen protein that connect your muscles to your bones. Tendinopathy is a breakdown of collagen in the tendon resulting in chronic pain and degeneration of the tendon with reduced range of motion and flexibility, affecting your ability to carry out daily routines and recreation. Tendinopathy can occur in any of your tendons, but is mostly seen in the elbows, shoulders, wrists, heels, and knees. Some commonly affected tendons include:

• Patellar tendon
• Achilles tendon
• Rotator cuff tendons
• Hamstring tendons

Common causes of tendinopathy include: 

• Too much stress on the tendons 
• Overuse of the tendons 
• Aging
• Repetitive small injuries, called microtrauma
• Inflammation

Indications for Percutaneous Needle Tenotomy

Non-surgical treatment methods such as medications, physical therapy, activity modification, ice/heat therapy, and corticosteroid injections are usually the first line of treatment for tendinopathy and tendinosis. However, if these measures are ineffective and patients cannot or will not undergo invasive surgery, percutaneous needle tenotomy is an effective alternative.

Percutaneous needle tenotomy is indicated for the treatment of injuries and pain affecting a variety of tissues and tendons, including:

• Achilles tendonitis
• Hip tendonitis
• Patellar tendon injuries
• Plantar fasciitis
• Rotator cuff injuries
• Elbow tendon injuries, including golfer’s elbow and tennis elbow

Preparation for Percutaneous Needle Tenotomy

In general, preparation for percutaneous needle tenotomy involves the following steps:

• Do not eat or drink for at least 6 hours prior to the procedure, except for sips of water to take any medications approved by your doctor.
• Arrange for someone to drive you home as you may feel groggy from the effects of the sedation.
• Contact lenses and jewelry items need to be removed prior to the procedure.
• You will be asked if you have allergies to any specific medications, anesthesia, or latex.
• You should inform your doctor of any medications you are taking, as you need to refrain from blood-thinners and anti-inflammatories for a week or two before and after the procedure.
• A written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Percutaneous Needle Tenotomy

Percutaneous needle tenotomy is a simple outpatient procedure that is performed with the assistance of ultrasound technology. Ultrasound is a common imaging technique that employs high-frequency sound waves to create clear images of the internal structures of the body.   

In general, percutaneous needle tenotomy involves the following steps:

• You will be asked to lie or sit down on a table, depending on the site of the injection.
• Ultrasound is utilized to identify the treatment area for the procedure.
• The site for the insertion of the needle is cleaned with an antibacterial agent.
• Local anesthetic with lidocaine is administered near the injured or damaged tendon. Conscious sedation may also be used if required.
• A needle is passed through the skin into the affected area under ultrasound guidance, and tiny holes are made to break up the abnormal tendon tissue while simultaneously aspirating any damaged tissue and leaving healthy tissue intact.
• This action results in bleeding within the tendon, triggering an inflammatory cascade that assists the body’s own cells to start rebuilding the tendon and promote healing.
• Once adequate tenotomy is achieved, the needle is withdrawn, and a bandage is placed over the site of injection.

Post-procedure Care and Instructions

Following the procedure, you may be kept under observation for a few hours. The entire procedure takes about 20 minutes, and you can go home the same day. You may experience some soreness and pain at the injection site and maybe advised to rest for a couple of days. Your doctor will prescribe medication and recommend ice pack applications as needed for soreness at the injection site. You are advised not to drive or operate any machinery after the procedure. Do not perform any strenuous activities for a few days. You can resume your normal activities in a day or two with certain activity restrictions.

Risks and Complications

Percutaneous needle tenotomy is a relatively safe procedure; however, as with any injection procedure, the following risks and complications may occur:

• Pain
• Bleeding
• Infection
• Swelling
• Damage to surrounding tissue structures
• Allergic/anesthetic reactions