The Vesey, Private clinic in Sutton Coldfield & Birmingham.

Tenex, a minimally invasive non-surgical procedure for chronic tendon pain in Birmingham

The Tenex procedure is a minimally invasive non-surgical procedure that help those who are suffering from chronic tendon pain by non-surgically removing damaged scar tissue and calcifications in the tendons. This procedure, developed by Tenex Health in collaboration with a world-renowned US Clinic, is particularly effective on the tendons of the elbow, shoulder, knees, and ankle. It is an ultrasound-guided percutaneous needle tenotomy (PCNT) for treating tendinopathy.

Many people suffer from chronic tendon pain that affects daily activities, such as participating in exercise and sports activities, picking up heavy objects, walking and even shaking hands.  Tendon pain is typically caused by continued trauma or over usage of joints and muscles.

This procedure can be used to treat many different kinds of tendon and soft-tissue injuries, including rotator cuff tendonitis, Achilles tendonitis, patellar tendonitis (jumper’s knee), plantar fasciitis and both lateral and medial epicondylitis (tennis elbow or golfers elbow). By removing scar tissue, the procedure helps restore mobility and circulation to the tendon site, as well as encouraging regrowth of healthy tissue

Before your procedure:

Your consultant will ask you to stop taking any nonsteroidal anti-inflammatory drugs (NSAIDs) at least one week before and after your procedure to reduce the risk of bleeding.

This includes such common over-the-counter and prescriptions NSAIDs as:

  • Ibuprofen (also known as Brufen®; Calprofen®; Cuprofen®; Fenpaed®; Ibucalm®; Ibular®; Mandafen®; Nurofen®).
  • Naproxen
  • Diclofenac (also known as Voltarol®)
  • Celecoxib
  • Mefenamic acid
  • Etoricoxib
  • Indomethacin
  • High-dose aspirin (Anadin®)

You should wear something comfortable that you can change into and out of easily if needed and leave jewellery and any valuables at home.

There are no food and drink restrictions as the procedure is done under local anaesthetic.

If you are having your ankle or foot treated, then please arrange transport after your procedure, as walking on a numb foot can be problematic.  Do not try and drive until the local anaesthetic has completely worn off (which could be a few hours).

During your procedure

Ultrasound imaging is used before the procedure to visualise the affected area. During the procedure, your clinician uses this imaging technique to get a continuous view of the damaged tendon as they work.

The clinician cleans and numbs the skin of the area. When this is done, they’ll make a tiny incision.

A small probe is inserted into the incision. The needle-like tip of this probe vibrates very rapidly, producing ultrasonic energy. This energy causes the damaged tissue to break down, while healthy tissue remains intact.

As damaged tissue breaks down, a system within the probe works to remove it from your body.

When all of the damaged tissue has been removed, the probe is removed. Your clinician then closes the incision and covers it with a plaster/bandage (depending on location).  The procedure should take less than 30 minutes to complete.

Recovery from the procedure is short, typically taking between 4 and 6 weeks. Your consultant may also recommend physical therapy as a part of your recovery, please ensure you discuss this.

After your procedure

Expect up to 6 weeks of total healing time that includes extra rest, painkillers as needed, and icing for any swelling or tenderness. Your consultant may recommend the use of a walking boot for the first one or two weeks of recovery (if foot or ankle treated) or a brace for the knee.  You may also be recommended to rest and relax for a few days, especially if lower limbs are treated.

A gently range of motion exercises for the first 48 hours is recommended.

After your incision has fully healed and you are back on your feet you’ll want to take steps to ensure you are back to full recovery, to rebuild strength and restore joint mobility and to keep your pain from returning.  Your consultant and a physiotherapist/rehabilitation specialist will advise you on your recovery and can help design the appropriate home-based program.

Though many people who undergo the procedure may remain symptom-free for years those who developed tendinitis due to repetitive stress or extreme sports may experience a relapse unless certain behaviours are modified.    For instance, if you had plantar fasciitis and it was caused by the repetitive strain of long days on your feet for work, or the stress of high-impact sports, consider wearing heel cups to support your plantar fascia, and making a new commitment to giving your feet enough rest throughout the day or activity.

Modifications may include the use of braces or splints in occupations that involve repetitive motions (such as a wrist brace). Athletes may require joint-specific strengthening exercises or the modification of sports techniques (such as moving from a one-handed to two-handed tennis backhand) to avoid recurrence.

By adjusting behaviours that contribute to tendinitis, you stand a far better chance of remaining pain-free over the long run.

It is important to remember that the procedure relieves the pain associated with chronic tendinitis but doesn’t necessarily correct the underlying cause.

More information

The procedure offers patients a non-surgical option that is faster than traditional surgeries, creates a smaller incision resulting in less dermal scarring, and allows for a quicker and less painful recovery.

This procedure is known in medical terminology as focused aspiration of scar tissue, percutaneous (via needle puncture) tenotomy, and percutaneous fasciotomy (easing tension by removing scar tissue that causes pain). The procedure uses a small instrument that is inserted through the skin into the damaged tendon and vibrates at ultrasonic frequencies to break up and remove damaged scar tissue.

Before the procedure patients are typically given a local anaesthetic that is used to anesthetize the affected area. Ultrasound imaging identifies and precisely locates the patient’s damaged scar tissue within the tendon.

A small incision is made along the affected area. The “Tenex Tissue Removal System” utilizes a small instrument with a needle-like point (the TX MicroTip) that is inserted into the area and high-frequency vibrations break up the damaged scar tissue.

The instrument uses ultrasound frequency that is designed not to damage the surrounding healthy tissue. The Tenex system then gently removes the broken up fragments of scar tissue. Instead of applying stitches, the incision is closed using an adhesive bandage/plaster and the procedure is complete.

Patients generally experience a recovery period of four to six weeks. Most patients say they feel little to no pain during the treatment. Many patients are able to drive home the same day.

Since Tenex was developed and approved in 2013 (in the US), more than 80,000 procedures have been performed worldwide.


From £3000

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Mr Gunaratnam Shyamalan
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Mr Gunaratnam Shyamalan