Learn about two advanced ultrasound-guided procedures that can treat chronic tendon pain by removing damaged tissue while preserving healthy structures—an alternative to traditional surgery.
Tendon pain, called tendinopathy, affects people of all ages and activity levels. It occurs when tendons—the thick cords that attach muscle to bone—become damaged or inflamed, especially from overuse or repetitive activities. While many cases improve with physical therapy and rest, some people have long-lasting pain that doesn't respond to standard treatments.
For these difficult cases, two minimally invasive procedures called Tenex and TenJet offer a promising solution. Both use ultrasound guidance to precisely remove damaged tendon tissue while leaving healthy tissue intact—working as a middle ground between conservative (non-surgical) treatment and full surgical removal.
Tendon problems fall into two main categories. Tendinitis is inflammation (swelling) that develops after small tears in the tendon. Tendinosis, which is more common in chronic cases, is a degenerative condition where the tendon structure breaks down and fails to heal properly. This distinction matters because anti-inflammatory medications help tendinitis but may not address the underlying damage in tendinosis.
When tendinosis develops, the tendon's organized fiber structure becomes disorganized, abnormal tissue buildup occurs, and new blood vessels form haphazardly. Your body's healing response essentially gets stuck, which is why rest and medication alone often don't solve the problem.
The Tenex system uses high-frequency ultrasonic vibrations to treat damaged tendons. Here's what happens during the procedure:
Your doctor uses ultrasound to locate the damaged tendon tissue precisely. A small probe is inserted through a tiny incision. The probe vibrates at high frequency, breaking down the diseased tissue into small particles. As this happens, saline solution flushes the area while a suction mechanism removes the broken-down tissue.
The vibration selectively targets only the damaged tissue—healthy tendon fibers are preserved. The procedure also creates small controlled injuries that trigger your body's natural healing response, increasing blood flow and stimulating new collagen formation.
The TenJet system uses a different approach but achieves similar results. Instead of ultrasonic vibrations, it uses a high-pressure stream of saline (salt water) delivered through a handheld instrument.
Your doctor guides the pressurized saline jet to the damaged area under ultrasound visualization. The high-velocity stream cuts away degenerative tissue while simultaneously suctioning out the debris. Like Tenex, this system preserves healthy tendon and creates a controlled healing response.
These minimally invasive treatments are appropriate for you if you have chronic tendon pain that hasn't improved after trying conservative approaches, including:
Your doctor will confirm tendinosis using ultrasound, looking for signs such as tendon thickening, areas of damage, loss of the normal organized fiber pattern, calcifications, or increased blood vessel formation.
These procedures work best for conditions like tennis elbow (lateral epicondylitis), Achilles tendon pain, patellar tendinopathy (knee tendon pain), plantar fasciitis (heel pain), and rotator cuff tendinopathy (shoulder tendon pain).
Both procedures are performed in an outpatient setting, meaning you go home the same day. Local anesthesia is used to numb the area, so you remain awake but don't feel pain. The entire procedure typically takes 15–30 minutes.
After the procedure, you can usually walk immediately. Mild soreness is normal for a few days, similar to the discomfort after an injection.
Most people notice gradual improvement over the first few weeks. The greatest improvement in pain relief and function typically occurs within the first three months. Many people maintain these benefits long-term.
Recovery is much faster than with traditional surgery because the procedure uses only a small incision and doesn't require extensive tissue removal. You'll likely be able to resume light activities within a few days and return to more demanding activities as tolerated over the following weeks.
Both Tenex and TenJet have shown favorable safety profiles in published studies. Serious complications such as tendon rupture or infection are rare. The most common side effect is mild, temporary discomfort during or immediately after the procedure.
Research shows consistent improvements in pain, function, and quality of life. The strongest evidence supports use in tennis elbow, where studies demonstrate significant and lasting improvement with low complication rates. Results for other tendon conditions are also promising, though long-term studies are still ongoing.
No definitive evidence shows that one procedure is superior to the other, so your doctor will recommend the best option based on your specific situation.
Contact your healthcare provider if you experience:
Your sports medicine physician or orthopedic specialist can evaluate whether Tenex, TenJet, or another treatment is right for your condition.
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