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Tenuous Tendons?

Posted 6/26/2017 by UHBlog

Is inflammation in your elbows and shoulders taking its toll? Ask us about ways to relieve the pain.

Tenuous Tendons?

Sports can be hard on the tendons that connect your muscles to your bones. While problems can occur in any of your body's tendons, it's your shoulders, elbows, wrists, knees and/or heels that are most often impacted.

In fact, you may know of or suffer from one of these common tendonitis problems:

  • Tennis elbow
  • Golfer’s elbow
  • Pitcher’s shoulder
  • Swimmer’s shoulder
  • Jumper’s knee

“Typically most people will get better with rest, changes in activity, oral over-the-counter anti-inflammatory medications – such as ibuprofen or naproxen – and support bracing,” says sports medicine specialist Robert Flannery, MD. “If you still have tendonitis after three months of conservative treatment, that is a good indication that you aren’t going to get better quickly and you should consider more aggressive treatment options.”

In the past, your next treatment was surgery to remove bone spurs or other prominences on the undersurface of the bone, take out chronically inflamed and thickened tissue, and/or look at the tendons to repair tears if needed. Now, however, there's a minimally invasive option available at University Hospitals’ Westlake location. Known as the Tenex® procedure, it offers the possibility of relief from tendonitis with much quicker recovery and much less pain, according to Dr. Flannery.

“The goal is to remove diseased tissue and then let the body heal the tendon naturally,” he says. “When you have an injury that doesn’t go down the right healing path, we take everything back to a blank slate and allow the body to heal properly.”

Not everyone is a candidate for this procedure, Dr. Flannery says. The four things he looks for when deciding if Tenex is a good option are:

  1. A history of pain for more than 90 days that hasn’t responded to more conservative treatment
  2. Your ability to point to a very specific place on your body that hurts
  3. The area of interest is visible on ultrasound and shows specific markers to the physician
  4. Your injury location, which needs to be near the skin surface

If you're a candidate, the procedure is done on an outpatient basis. After either a local anesthetic or light sedation depending on your preference, the area will be cleaned and a very small incision made.

Next, a small needle is inserted. This uses high frequency vibrations to break up any scar tissue along the tendon. Saline water is used to both cool the needle and remove debris.

“It works in a way similar to a dentist’s drill,” says Dr. Flannery. “The dentist sets the drill to a certain amount of resistance and when it gets into healthy stronger tissue, it stops.”

After the diseased tissue is removed, the wound is closed. Instead of stitches, usually two or three small adhesive strips are applied. This keeps scarring to a minimum.

If you have elected to have the procedure done using just local anesthesia, you are usually discharged soon after completion and can drive yourself home. If you had light sedation, you will need to have someone with you to make the drive. Generally, you'll see Dr. Flannery around three days after surgery to make sure there is no infection.

For the first three days, you will have an elastic bandage on the area. You will want to protect the area of the tendon and slowly increase activity under the direction of your medical team, Dr. Flannery says. For most people, they'll be back to work after a week or 10 days of rest, and will be able to return to full activity within six weeks.

This procedure doesn’t burn any treatment bridges, either. If there is residual pain, you can still have open incision surgery. Also, the area could be reinjured, but there are no indications that the tendon is weakened or at higher risk for injury following this intervention.

“This is a very safe procedure,” Dr. Flannery says. “It's minimally invasive with very little scarring and can be done on an outpatient basis. And you can get back to pre-injury levels of functioning fairly quickly. Around 80 percent (of patients) do better, and none have been made worse.”

Robert Flannery, MD, is a sports medicine specialist at University Hospitals Cleveland Medical Center and a medical team physician for the Cleveland Browns. You can request an appointment with Dr. Flannery or any other doctor online.

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