TENex for TENnis Elbow
/At times, tennis elbow, also known as lateral epicondylitis, can be so stubborn that an advanced procedure is needed to overcome this condition. There are two basic types of surgeries used to treat this condition. The first and by far our favorite is a percutaneous tenotomy under ultrasound guidance, commonly referred to as the Tenex procedure. The other is an open release of the tendon which involves cutting the tendon off the bone. Let’s briefly highlight the differences between the two:
Anesthesia
Tenex: Local-lidocaine injection only
Open: General- patient is put to sleep
Incision Size
Tenex: 1/4 inch
Open: 1-2 inches
Trauma To Tissue
Tenex: Minimal
Open: Moderate
Infection Risk
Tenex: Minimal
Open: Mild
Sutures/Stitches
Tenex: None
Open: 1-2 layers required
Recovery Time
Tenex: 2-6 months
Open: 4-12 months
Success Rate
Tenex: 90-95%
Open: 75-90%
Are we biased towards the Tenex? You better believe it! Look at those comparisons above. In our mind, it’s an obvious choice: the Tenex procedure is the better overall option. Why do more physicians not perform the Tenex procedure? Because you are required to have proficiency in musculoskeletal ultrasound to perform this procedure. Not many physicians have taken the time and made the investment in ultrasound-guided procedures, so they tend to revert to the more traditional, sometimes higher-risk and less successful options.
We’ve performed more Tenex procedures in Middle Tennessee than any other physician. So, if you, a loved one or friend has tennis elbow, then come see us!
F. Clarke Holmes, M.D.
Frozen Shoulder... More Than Just a Winter Occurrence
/We’ve talked a lot about PIO (Proactive Interventional Orthopedics) recently and this concept really applies when it comes to a frozen shoulder, also known as adhesive capsulitis. This is a condition most commonly seen in middle-aged women around the time of menopause with the average age of a frozen shoulder being 51.
It starts as shoulder pain, often unrelated to a particular injury or overuse situation, and is followed by a very stiff shoulder with loss of motion. Although a frozen shoulder can be a self-limiting condition, with our interventions, we can greatly expedite the recovery process while alleviating pain.
Other risk factors for adhesive capsulitis include thyroid disease, diabetes and recent shoulder surgery. In the early “pain” stage, it’s often difficult to determine whether a patient has a frozen shoulder, osteoarthritis, or rotator cuff and/or biceps tendon problem. An MRI can be helpful, especially to see tendon or joint pathology, but in the presence of isolated adhesive capsulitis, the MRI can be normal or near normal. The next stage is the “stiff” or “frozen” stage, highlighted by the loss of motion both actively (what the patient can do) and passively (how someone else can move the shoulder). The final stage is the “thawing” or “recovery” stage. Each stage typically last 2-6 months, and early treatment often shortens these stages.
Being proactive and interventional often means an ultrasound-guided steroid injection into the joint. Without ultrasound guidance, it is often very difficult to achieve accuracy. This tends to be a very inflammatory condition, and thus, the potent anti-inflammatory effects of the steroid can provide rapid relief of pain. Early treatment within the first few weeks or months of the onset of the shoulder pain is the optimal path to a faster and more complete recovery. After that steroid injection, a rehab program, often made much more effective by the steroid injection, is the mainstay of treatment. 20% of patients with a frozen shoulder develop the same condition on the opposite shoulder within 5 years, so if pain in the other shoulder develops, it’s wise to seek treatment early.
Check out this brief article:
Steroid injection may be the best medicine for frozen shoulder - Harvard Health
If you think you may have a frozen shoulder, let us use PIO to help you!
F. Clarke Holmes, M.D.