Download PDF
Semin Musculoskelet Radiol 2013; 17(01): 085-090
DOI: 10.1055/s-0033-1333942
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound-Guided Tendon Fenestration

Mary M. Chiavaras
1   Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
,
Jon A. Jacobson
2   Department of Radiology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
13 March 2013 (online)

Also available at
   Permissions and Reprints

Abstract

A potential treatment for chronic tendinosis or tendinopathy is percutaneous ultrasound-guided tendon fenestration, also termed dry needling or tenotomy. This procedure involves gently passing a needle through the abnormal tendon multiple times to change a chronic degenerative process into an acute condition that is more likely to heal. This article reviews the literature on tendon fenestration and describes the technical aspects of this procedure including postprocedural considerations. Although peer-reviewed literature on this topic is limited, studies to date have shown that ultrasound-guided tendon fenestration can improve patient symptoms. Several other percutaneous treatments for tendinopathy that include prolotherapy, autologous whole-blood injection, and autologous platelet-rich plasma injection are often performed in conjunction with fenestration. It is currently unknown if these other percutaneous procedures have any benefit over ultrasound-guided tendon fenestration alone.

Keywords

elbow - ultrasound - tendinosis - epicondylitis
 

  • References

  • 1 Buck FM, Grehn H, Hilbe M, Pfirrmann CW, Manzanell S, Hodler J. Magnetic resonance histologic correlation in rotator cuff tendons. J Magn Reson Imaging 2010; 32 (1) 165-172
    CrossrefPubMedGoogle Scholar
  • 2 Kjellin I, Ho CP, Cervilla V , et al. Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 1991; 181 (3) 837-841
    CrossrefPubMedGoogle Scholar
  • 3 Potter HG, Hannafin JA, Morwessel RM, DiCarlo EF, O'Brien SJ, Altchek DW. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 1995; 196 (1) 43-46
    CrossrefPubMedGoogle Scholar
  • 4 Khan KM, Bonar F, Desmond PM , et al; Victorian Institute of Sport Tendon Study Group. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Radiology 1996; 200 (3) 821-827
    CrossrefPubMedGoogle Scholar
  • 5 Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res 2010; 468 (7) 1838-1844
    CrossrefPubMedGoogle Scholar
  • 6 Aström M, Gentz CF, Nilsson P, Rausing A, Sjöberg S, Westlin N. Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 1996; 25 (7) 615-620
    CrossrefPubMedGoogle Scholar
  • 7 Lee KS, Wilson JJ, Rabago DP, Baer GS, Jacobson JA, Borrero CG. Musculoskeletal applications of platelet-rich plasma: fad or future?. AJR Am J Roentgenol 2011; 196 (3) 628-636
    CrossrefPubMedGoogle Scholar
  • 8 Jacobson JA, Lancaster S, Prasad A, van Holsbeeck MT, Craig JG, Kolowich P. Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. Radiology 2004; 230 (1) 234-242
    CrossrefPubMedGoogle Scholar
  • 9 Opsha O, Malik A, Baltazar R , et al. MRI of the rotator cuff and internal derangement. Eur J Radiol 2008; 68 (1) 36-56
    CrossrefPubMedGoogle Scholar
  • 10 Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 2001; 9 (4) 233-238
    CrossrefPubMedGoogle Scholar
  • 11 Zanetti M, Metzdorf A, Kundert HP , et al. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US. Radiology 2003; 227 (2) 556-560
    CrossrefPubMedGoogle Scholar
  • 12 de Vos RJ, Weir A, Cobben LP, Tol JL. The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 2007; 35 (10) 1696-1701
    CrossrefPubMedGoogle Scholar
  • 13 Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376 (9754) 1751-1767
    CrossrefPubMedGoogle Scholar
  • 14 Zissen MH, Wallace G, Stevens KJ, Fredericson M, Beaulieu CF. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010; 195 (4) 993-998
    CrossrefPubMedGoogle Scholar
  • 15 Labrosse JM, Cardinal E, Leduc BE , et al. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol 2010; 194 (1) 202-206
    CrossrefPubMedGoogle Scholar
  • 16 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252 (3) 647-661
    CrossrefPubMedGoogle Scholar
  • 17 Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R 2011; 3 (6) (Suppl. 01) S78-S81
    CrossrefPubMedGoogle Scholar
  • 18 Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. AJR Am J Roentgenol 2007; 189 (4) W215-W220
    CrossrefPubMedGoogle Scholar
  • 19 Kampa RJ, Connell DA. Treatment of tendinopathy: is there a role for autologous whole blood and platelet rich plasma injection?. Int J Clin Pract 2010; 64 (13) 1813-1823
    CrossrefPubMedGoogle Scholar
  • 20 Sheth U, Simunovic N, Klein G , et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am 2012; 94 (4) 298-307
    CrossrefPubMedGoogle Scholar
  • 21 Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med 2011; 39 (10) 2130-2134
    CrossrefPubMedGoogle Scholar
  • 22 Finnoff JT, Fowler SP, Lai JK , et al. Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection. PM R 2011; 3 (10) 900-911
    CrossrefPubMedGoogle Scholar
  • 23 James SL, Ali K, Pocock C , et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med 2007; 41 (8) 518-521; discussion 522
    CrossrefPubMedGoogle Scholar
  • 24 Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009; 28 (9) 1187-1192
    CrossrefPubMedGoogle Scholar
  • 25 McShane JM, Shah VN, Nazarian LN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary?. J Ultrasound Med 2008; 27 (8) 1137-1144
    CrossrefPubMedGoogle Scholar
  • 26 McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med 2006; 25 (10) 1281-1289
    CrossrefPubMedGoogle Scholar
  • 27 Housner JA, Jacobson JA, Morag Y, Pujalte GG, Northway RM, Boon TA. Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases. Clin J Sport Med 2010; 20 (6) 488-490
    CrossrefPubMedGoogle Scholar
  • 28 Joines MM, Motamedi K, Seeger LL, DiFiori JP. Musculoskeletal interventional ultrasound. Semin Musculoskelet Radiol 2007; 11 (2) 192-198
    Article in Thieme ConnectPubMedGoogle Scholar