1. What is percutaneous needle fenestration?

It is a minimally invasive intervention performed under ultrasound guidance (sonogram), utilized in the treatment of chronic tendon problems known as tendinosis or tendinopathy. A small needle is introduced through the skin, and small incisions are performed in the damaged tendon, ultimately creating an enhanced healing response resulting in tendon repair. It is a cost effective intervention with good results, minimal morbidity and can facilitate early return to work/play.

2. When is the procedure indicated?

Most of the time, tendon related problems can be treated conservatively. Usually physical therapy, bracing, proper training exercises, adequate rest, analgesics, anti-inflammatory medications and rehabilitation, can improve or resolve the symptoms altogether. When conservative therapy fails and there is significant morbidity, a percutaneous needle fenestration can be considered.

3. Which are the most commonly treated conditions?

Tennis elbow, Golfer’s elbow, plantar fasciitis, gluteal tendinopathy, hamstring tendinopathy, achilles tendinopathy and others.

4. How is the procedure performed?

Percutaneous needle fenestration is an office based intervention. After consent is obtained, the skin is cleansed and under ultrasound guidance the affected tendon site is identified and marked. Local anesthetic is infiltrated in the skin and over the affected tendon to numb the area. A small needle is then advanced through the tendon and multiple perforations are performed under ultrasound guidance. The procedure usually takes 10-15 minutes and patients are able to leave the office shortly after.

5. Post procedure instructions

Active range of motion is encouraged during the first 48 hours. Mild analgesics are usually prescribed, along with ice and electrical stimulation (if available). The use of non-steroidal anti-inflammatory medications are avoided for 2 weeks post procedure. Avoidance of forceful resistance exercises is recommended. Physical therapy in the form of eccentric strength and stretching is highly recommended for 4-8 weeks post procedure.