Introduction to the Tenex Tennis Elbow Procedure - Dr. J. Michael Bennett

Author: Dr. J. Michael Bennett

- Hello. My name is Dr. J.

Michael Bennett. I'm an Orthopedic Sports Medicine Specialist, who works primarily with shoulder, elbow and knee injuries. And today, I want to talk a little bit about tennis elbow, and one of the newer technologies that's available for the treatment of tennis elbow.

You have the elbow here, and the lateral lasp of the elbow, which is the outside portion of the joint. You're looking at the right arm here, this is the outside area. You've got these groups of muscles and tendons, called the common extensor tendon, that inserts right here at the lateral epicondyle here. Okay, so usually in people that present with tennis elbow, they'll have a repetitive activity or an injury that creates small micro tears in that lateral elbow, in that tendonis insertion here, that fills in with degenerative tissue. It's not necessarily inflammatory, but it can be very painful, because of the nerve endings within that degenerative tissue. And it leads to chronic tennis elbow, or chronic lateral epicondylitis. Typically, our conservative options for that would include rest, anti-inflammatories, a counter force brace, physical therapy.

Sometimes even a steroid injection can be offered as well. You do not want to rely on these steroid injections, particularly multiple steroid injections, because there are complications associated with that, such as skin atrophy, where the skin starts to thin on the outside aspect of the elbow, or even discoloration of the skin. So steroid injections aren't necessarily the best option for that, but it can help temporarily with pain, to get you through the therapy and through that process of at least initially treating it conservatively. Typically, if you have tennis elbow pain for three months to six months, that's when it's termed as chronic tennis elbow, and you definitely want to be evaluated and see an orthopedic specialist, just to get the diagnosis, and also to see exactly how bad that tendinosis is. Sometimes you can have the severity of the tendinosis that actually involves not only the tendon, but it actually goes into the lateral collateral ligaments, which are the ligaments that help stabilize this lateral aspect of the joint. So if it gets to that point, then it actually it becomes more of a complicated solution where this type of option may not be a good option for that patient.

Introduction to the Tenex Tennis Elbow Procedure - Dr. J. Michael Bennett

However, for those specific patients that have tendinosis or degeneration within the common extensor tendon, this procedure, it's called Tenex, is a very good procedure. The idea behind Tenex is to use a smaller incision than the typical incision for an elbow scope, which is one of the options we do for tennis elbow, and definitely a smaller incision than an open debridement. Of the lateral elbow. This is actually what we call a micro incision, where we make a small poke hole, or a small little poke hole or an incision into the lateral elbow, and identify the degenerative tendon in the tendinosis with this little pinpoint needle here, and specifically debride that area of tendinosis, removing the pain generating tissue. The benefit of this is that you're preserving all the healthy tissue around that area, and you're specifically going after the diseased tissue, and we do that by identifying it with ultrasound guidance. So I drew over here, a picture, showing you exactly what the elbow looks like, and what we're seeing with the elbow.

This, again, here is the elbow, looking at it from the anterior aspect. This is the lateral side. These are the common extensor tendons coming up here in the lateral epicondyle. And then usually you'll get the degenerative tissue right here at the, what we call the, extensor carpi radialis brevis, which is this tendonis insertion here in the lateral side of the elbow. That extensor carpi radialis brevis actually is underneath a healthy layer of fascia and soft tissue. So it makes it very beneficial to be able to go in there with these micro incisions, and this pinpoint accuracy with this little device, and find this little area here with ultrasound, and just debride it. And the beauty of this device is that it not only debrides the degenerative tissue, but it also irrigates it and sucks it out.

So it not only just debrides it, but it actually removes it at the same time by sucking it out and removing it at the site. So we'll evaluate it in ultrasound, and we'll actually debride that whole area. This here is a larger picture showing you the tendonis insertion, this capitellum or the lateral epicondyle. Once again, that degenerative tissue's right here. With a needle we go in and debride extensively. And looking at it from a side view here, the radiocapitellar joint, once again, there are the common extensor tendons that are responsible for the repetitive activities of the wrist, and extension here. We go in there, and we actually find this area and actually debride that area where the tendinosis is.

This is the console itself here that actually gives us the setting and the cutting power for the device. With this specific device, it's nearly impossible to damage the healthy tissue, because it only really breaks off the degenerative tissue, because of the ultrasonic frequency. It actually vibrates and actually creates a fragmentation of the diseased tissue, whereas the healthy tissue doesn't respond in the same way. So that's another benefit that this comes into play. This is also a quicker procedure. It takes about 20 to 30 minutes. Sometimes you can just do it under local, where you just kind of use a little conscious sedation, and you numb up the area.

We typically prefer to do it in a sterile environment, but some doctors are probably using this in their office, as well. But I just wanted to do a quick video, just showing you the benefits of using the Tenex procedure. There's more information on this on our website. If you have any questions or any uncertainties, I highly recommend getting it evaluated by an upper extremity specialist or a sports medicine specialist that can kind of show you the right thing to do, and how to wear the brace, and where to go for your rehab. Thank you.

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