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Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow

Is a Corticosteroid Necessary?

McShane Sports Medicine, Villanova, Pennsylvania USA (J.M.M.); and Department of Radiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (V.N.S., L.N.N.).

Address correspondence to John M. McShane, MD, McShane Sports Medicine, 734 E Lancaster Ave, Villanova, PA 19085 USA. E-mail: bjmcshane{at}pol.net

Objective. Chronic refractory common extensor tendinosis of the lateral elbow has been shown to respond to sonographically guided percutaneous needle tenotomy (PNT) followed by corticosteroid injection. In this analysis, we attempted to determine whether the corticosteroid is a necessary component of the procedure. Methods. We performed PNT on 57 consecutive patients (age range, 34–61 years) with persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the tendon, and the tip of the needle was used to fenestrate the tendinotic tissue, break up any calcifications, and abrade the adjacent bone. After the procedure, patients underwent a specified physical therapy protocol. During a subsequent telephone interview, patients answered questions about their symptoms, the level of functioning, and perceptions of the procedure outcome. Results. Of the 52 patients who agreed to participate in the study, 30 (57.7%) reported excellent outcomes, 18 (34.6%) good, 1 (1.9%) fair, and 3 (5.8%) poor. The average follow-up time from the date of the procedure to the telephone interview was 22 months (range, 7–38 months). No adverse events were reported, and 90% stated that they would refer a friend or close relative for the procedure. Conclusions. Sonographically guided PNT for refractory lateral elbow tendinosis is an effective procedure, and subsequent corticosteroid injection is not necessary.

Key Words: common extensor tendon • elbow • needle • sonography • tendinosis • tennis elbow

Abbreviations: CET, common extensor tendon • PNT, percutaneous needle tenotomy