title: Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study.
abstract: BACKGROUND
  Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator.
  
  
  METHODS
  Nineteen patients, aged 38 to 67 years, in whom >6 months of conservative management for medial (7) or lateral (12) elbow tendinopathy had failed were prospectively studied. All patients were treated with percutaneous ultrasonic tenotomy of the elbow by a single operator. Visual analog scale (VAS) for pain, the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) index, and the Mayo Elbow Performance Score (MEPS) were assessed by an independent observer before treatment and at 6 weeks, 3 months, 6 months, and 12 months after treatment.
  
  
  RESULTS
  No procedural complications occurred. Total treatment time was <15 minutes, and ultrasonic energy time averaged 38.6 ± 8.8 seconds per procedure. Average VAS scores were significantly improved from 6.4 to 2.6 at 6 weeks and were 0.7 at 12 months (P < .0001). Similar improvement occurred with the Quick DASH (pretreatment, 44.1; 12 months, 8.6, P < .0001) and MEPS (pretreatment, 59.1; 12 months, 83.4; P < .0001).
  
  
  CONCLUSIONS
  Percutaneous ultrasonic tenotomy performed under local anesthesia appears to be a safe and effective treatment option for chronic, refractory lateral or medial elbow tendinopathy up to 1 year after the procedure.
authors.affiliation: Department of Orthopedics and Sports Medicine, Mayo Clinic Health System, Austin, MN, USA.
authors.forename: Darryl E
authors.initials: DE
authors.lastname: Barnes
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic and Mayo School of Medicine, Rochester, MN, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Beckley
authors.affiliation: Departments of Physical Medicine & Rehabilitation, Radiology, and Anatomy, Mayo Clinic and Mayo School of Medicine, Rochester, MN, USA. Electronic address: smith.jay@mayo.edu.
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003646:Debridement; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052256:Tendinopathy / Q000601:surgery*; D013716:Tennis Elbow / Q000601:surgery*; D058971:Tenotomy / Q000379:methods*; D014464:Ultrasonic Therapy
keywords: Tennis elbow; golfer's elbow; tendinopathy; tenotomy; ultrasonic; ultrasound