Tenex Therapy: Uses, Evidence, Risks and What to Expect

Written and medically reviewed by
Dr Dinesh Sirisena
Consultant in Sports, Exercise & Musculoskeletal Medicine
Triaxis Sports & Joint Clinic

Tenex therapy is a minimally invasive procedure that uses ultrasound guidance and ultrasonic energy to remove selected abnormal soft tissue through a small skin opening. It is mainly used for persistent tendon and fascia conditions that have not improved with appropriate conservative care. Studies report improvements in pain and function in selected patients, but much of the available evidence is based on observational studies rather than large comparative trials.

What is Tenex therapy?

Tenex therapy is a minimally invasive procedure used to remove selected abnormal tendon or fascia tissue through a small skin opening. The Tenex Health TX system uses ultrasonic energy together with irrigation and aspiration, while imaging helps the clinician identify and treat the intended area.

The formal medical terms are usually:

• Percutaneous ultrasonic tenotomy for tendon procedures
• Percutaneous fasciotomy for fascia procedures

The Tenex Health TX system is classified by the U.S. FDA as an ultrasonic surgical instrument. FDA records describe it as an ultrasonic surgical aspirator that fragments, emulsifies and removes soft tissue.

How does Tenex therapy work?

Tenex uses a small ultrasonic instrument placed into the treatment area under image guidance. The device delivers ultrasonic energy to fragment selected tissue while fluid irrigates the area and aspiration removes the fragmented material. The aim is to remove targeted abnormal tissue rather than simply inject medication into it.

The basic process involves three functions:

Ultrasonic energy
The device tip vibrates at ultrasonic frequency and interacts with the selected tissue.

Irrigation
Fluid is delivered to the treatment area.

Aspiration
Fragmented tissue and fluid are removed through the device.

This makes Tenex different from steroid injections, prolotherapy or PRP.

Tenex works by removing selected tissue that is not healing. Recovery is then supported by the body’s natural healing, rehabilitation and a gradual return of tendon capacity.

What conditions has Tenex therapy been studied for?

Tenex has primarily been studied for chronic tendinopathy and selected fascia conditions that remain symptomatic despite conservative treatment. Published studies include several tendon regions, although the amount and quality of evidence vary significantly between anatomical sites.

Research has included:

• Tennis elbow or lateral elbow tendinopathy
• Golfer’s elbow or medial elbow tendinopathy
• Achilles tendinopathy
• Patellar tendinopathy
• Gluteal tendinopathy
• Rotator cuff-related tendon disease
• Plantar fasciopathy
• Other selected chronic tendon disorders

A 2024 systematic review identified studies across 11 tendon sites and found that published reports generally showed improvements in pain and function after percutaneous needle tenotomy or Tenex.

This is why results from one tendon should not automatically be applied to another.

What is tendinopathy and why can it become persistent?

Tendinopathy is a disorder of a tendon that can cause pain, reduced function and difficulty tolerating physical load. It commonly develops after repeated loading, sudden changes in activity or a combination of mechanical and individual factors. Persistent tendinopathy is more complex than simple inflammation.

Tendons connect muscles to bones and transfer force during movement.

For example:

• The Achilles tendon transfers calf muscle force during running and jumping.
• The patellar tendon helps transmit force through the knee.
• The common extensor tendon at the elbow is heavily loaded during gripping.
• The gluteal tendons help stabilise the hip during walking and running.

Persistent tendon symptoms may be associated with changes in tendon structure and load tolerance.

Therefore, treatment usually needs to address more than pain alone.

Who may be considered for Tenex therapy?

Tenex may be considered in selected patients with persistent tendon or fascia symptoms when the diagnosis is reasonably clear and appropriate conservative management has not provided sufficient improvement. It is not normally a first-line procedure for every episode of tendon pain.

Clinical assessment may consider:

• Duration of symptoms
• Exact anatomical diagnosis
• Severity of pain and functional limitation
• Previous rehabilitation
• Exercise and tendon-loading history
• Occupational demands
• Sporting requirements
• Relevant imaging
• Other medical conditions
• Alternative treatment options

A person with six weeks of tendon pain may therefore be managed very differently from someone with longstanding symptoms despite structured rehabilitation.

Does Tenex therapy actually work?

Studies of Tenex and similar percutaneous ultrasonic tenotomy procedures report improvements in pain and function for many patients with persistent tendinopathy. As a newer procedure, it continues to be studied, with larger comparative trials ongoing.

A 2021 systematic review found promising results for percutaneous ultrasonic tenotomy across a range of tendon conditions.

A newer 2024 systematic review included 10 studies covering 11 tendon sites. It reported improvements in:

• Pain
• Function
• Quality of life

with relatively few reported adverse effects.

For most patients, Tenex is best considered as one option within a broader plan for persistent tendon pain.

Is Tenex the same as tendon surgery?

Tenex is a percutaneous surgical procedure, but it differs from conventional open tendon surgery. It is performed through a small skin opening and uses ultrasonic instrumentation rather than a larger surgical exposure. The exact procedure, anaesthesia and recovery plan depend on the tendon and amount of tissue involved.

It is sometimes described as “non-surgical,” and Tenex themselves describe their underlying procedures as percutaneous tenotomy or fasciotomy.

Therefore, a more accurate patient description is:

“A minimally invasive percutaneous procedure” — i.e. treating a tendon through a small puncture in the skin rather than open surgery.

How is Tenex different from steroid injections, PRP and prolotherapy?

Tenex physically removes selected tissue using ultrasonic instrumentation, whereas steroid injections, PRP and prolotherapy involve introducing substances into or around musculoskeletal structures. Their mechanisms, evidence and clinical uses are different, and none should be assumed to be universally superior.

Steroid injection
Uses corticosteroid medication to reduce inflammation in selected conditions.

PRP
Uses a platelet-containing preparation derived from the patient’s blood.

Prolotherapy
Commonly uses a dextrose-containing solution.

Tenex
Uses ultrasonic instrumentation to fragment and remove selected tissue.

The choice, if any, should depend on the diagnosis and evidence for the specific tendon problem rather than simply choosing the newest procedure.

Why is musculoskeletal ultrasound used with Tenex?

Musculoskeletal ultrasound can help identify the affected tendon or fascia, assess surrounding structures and guide the Tenex instrument toward the intended area during the procedure. Ultrasound provides real-time imaging, but it does not by itself determine whether Tenex is necessary or guarantee a successful outcome.

Ultrasound may help assess:

• Tendon thickness
• Tendon structure
• Partial tears
• Calcification
• Surrounding bursae
• Nearby nerves and blood vessels
• Plantar fascia

During the procedure, imaging helps the clinician monitor the instrument relative to the target anatomy.

However, an abnormal ultrasound image does not automatically mean tissue should be removed.

Clinical symptoms and examination findings remain important.

Do I need an MRI before Tenex therapy?

Not everyone being assessed for Tenex needs an MRI. The appropriate imaging depends on the tendon, symptoms and clinical question. Musculoskeletal ultrasound is commonly useful because it can assess many superficial tendons dynamically, while MRI may be considered when deeper anatomy or another diagnosis needs clarification.

Possible imaging includes:

X-ray
May help identify calcification, bone spurs or other bone-related findings.

Musculoskeletal ultrasound
Can assess many tendons and guide the procedure in real time.

MRI
May be useful for deeper structures, more complex injuries or when another diagnosis is suspected.

Imaging should be used when it helps answer a clinical question, rather than as an automatic prerequisite.

What happens during a Tenex procedure?

During a Tenex procedure, the clinician identifies the treatment area using imaging, prepares the skin and administers anaesthesia as appropriate. A small opening is made, and the ultrasonic instrument is introduced toward the selected tissue under image guidance. The device then fragments and removes targeted tissue using ultrasonic energy, irrigation and aspiration.

A typical process may include:

1. Review of the diagnosis and treatment indication.
2. Ultrasound assessment of the tendon or fascia.
3. Discussion of benefits, limitations and risks.
4. Skin preparation and local anaesthesia.
5. Small skin opening.
6. Image-guided placement of the instrument.
7. Ultrasonic treatment and removal of selected tissue.
8. Dressing of the treatment site.
9. Post-procedure instructions.
10. Rehabilitation planning.

The exact steps vary according to the anatomical area.

Is Tenex therapy painful?

Tenex is commonly performed with local anaesthesia, so discomfort may be reduced during the procedure. However, patients may still experience pressure, soreness or discomfort during recovery. The amount varies with the treatment site, amount of tissue treated and individual response.

The manufacturer describes local anaesthesia as commonly used during the procedure.

After treatment, temporary symptoms may include:

• Local soreness
• Tenderness
• Mild swelling
• Bruising
• Discomfort with movement

Patients should receive clear advice about what to expect and when symptoms warrant further medical assessment.

The procedure should not be advertised as “pain-free”.

What are the possible risks of Tenex therapy?

As a percutaneous procedure, Tenex carries potential risks such as temporary pain, bleeding, bruising, infection and injury to surrounding structures. The exact risks depend on the anatomical area and individual medical circumstances. Published studies generally report few complications, but the available evidence is still limited.

Potential considerations include:

• Bleeding
• Bruising
• Infection
• Temporary pain flare
• Irritation of surrounding tissues
• Nerve or blood vessel injury
• Incomplete improvement
• Persistent or recurrent symptoms

Patients should also tell the clinician about:

• Blood-thinning medication
• Diabetes
• Allergies
• Active infection
• Previous procedures
• Relevant medical conditions

No procedure should be described as risk-free.

How long does recovery take after Tenex?

Recovery varies according to the tendon or fascia treated, severity of the original condition, physical demands and rehabilitation plan. Some activities may be restricted initially, followed by progressive movement and strengthening. A fixed return-to-sport timeline should not be promised because tendon recovery varies between individuals.

The manufacturer describes recovery instructions as varying by condition and notes that range-of-motion and strengthening exercises may be introduced after an initial period of rest.

A sensible rehabilitation plan may assess:

• Pain during daily activities
• Range of motion
• Strength
• Tendon load tolerance
• Work requirements
• Running or jumping ability
• Sport-specific function

Return to activity should therefore be based on progress, not simply the number of weeks since the procedure.

Do I still need rehabilitation after Tenex?

Yes, rehabilitation may remain important because removing selected tendon tissue does not automatically restore strength, movement or load tolerance. Progressive exercise can help the affected tendon and surrounding muscles adapt to everyday, occupational and sporting demands during recovery.

Rehabilitation may include:

• Education
• Temporary activity modification
• Range-of-motion exercises
• Progressive strengthening
• Tendon loading
• Movement retraining
• Return-to-running progression
• Sport-specific exercises

The exact programme depends on the anatomical site.

For example, Achilles rehabilitation differs substantially from elbow or gluteal tendon rehabilitation.

Tenex should therefore be viewed as one part of a broader management pathway where appropriate.

Can athletes have Tenex therapy?

Tenex may be considered for selected athletes with persistent tendinopathy, but sporting participation alone is not a reason to undergo the procedure. Diagnosis, previous rehabilitation, tendon function, competition demands and the available evidence should guide whether an intervention is appropriate.

Relevant sports may include:

• Running
• Tennis
• Golf
• Badminton
• Football
• Rugby
• Swimming
• Cricket
• Weightlifting

Different sports also load different tendons.

A runner with Achilles tendinopathy, for example, requires different assessment and rehabilitation from a tennis player with lateral elbow tendinopathy.

The objective should be restoring appropriate function rather than simply reducing pain quickly.

When should I seek assessment for persistent tendon pain?

Consider medical assessment when tendon pain persists, repeatedly returns or limits work, exercise or sport despite appropriate load modification and rehabilitation. Prompt assessment is particularly important after sudden injury, significant weakness, inability to bear weight or concern about a tendon rupture.

Assessment may be helpful when there is:

• Persistent pain over several weeks or months
• Reduced strength
• Repeated flare-ups
• Difficulty returning to sport
• Failure to progress with rehabilitation
• Sudden loss of function
• Significant swelling or bruising
• Concern about a partial or complete tendon tear

The first priority is establishing the diagnosis rather than deciding on a procedure.

How is Tenex therapy considered at Triaxis Sports & Joint Clinic?

At Triaxis Sports & Joint Clinic, Tenex may be considered for selected persistent tendon or fascia conditions following Sports Medicine and musculoskeletal assessment. The decision depends on the diagnosis, previous rehabilitation, functional limitations, imaging where appropriate, available evidence and alternative management options.

Assessment may include:

• Sports Medicine evaluation
• Musculoskeletal examination
• Sports ultrasound where appropriate
• Review of previous imaging
• Assessment of strength and tendon loading
• Review of rehabilitation already attempted
• Patient education
• Rehabilitation planning
• Shared decision-making

Where Tenex is considered, patients can discuss:

• Why the procedure is being considered
• Which structure is being treated
• Current evidence
• Potential risks
• Recovery expectations
• Rehabilitation afterwards
• Other treatment options

Depending on the individual’s condition and clinical assessment, certain procedures may be considered as part of a broader management plan.

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Frequently Asked Questions About Tenex Therapy

Does Tenex therapy cure tendinopathy?

No. Tenex should not be described as curing tendinopathy. It uses ultrasonic instrumentation to remove selected tissue, but pain and function depend on multiple factors including tendon load, strength, rehabilitation and the underlying condition. Current studies report improvements in selected patients, but the evidence base remains largely observational and does not establish guaranteed or permanent results.

Is Tenex therapy FDA approved?

A more accurate term is FDA cleared, rather than “FDA approved.” The Tenex Health TX System has received U.S. FDA 510(k) clearance as an ultrasonic surgical instrument. FDA records describe the system as an ultrasonic surgical aspirator. Clearance of the device does not mean Tenex has been proven superior to other treatment options for every tendon disorder.

Is Tenex better than open surgery?

Tenex is less invasive because it uses a small percutaneous approach, but surgical decisions depend on the type and severity of tendon pathology, previous treatment and individual needs. Some conditions may not require surgery at all, while others may require conventional surgical assessment.

Can Tenex treat tennis elbow?

Tenex has been studied for chronic lateral elbow tendinopathy, commonly called tennis elbow, and published observational studies have reported improvements in selected patients. However, exercise-based rehabilitation remains an important management option, and Tenex should be undertaken as part of a combined treatment plan.

Can Tenex be used for Achilles tendinopathy?

Percutaneous ultrasonic tenotomy has been studied for Achilles tendinopathy. Not all Achilles problems are suitable for the procedure. Insertional tendinopathy, mid-portion tendinopathy, partial tearing and other causes of posterior ankle pain may require different management.

Does Tenex remove healthy tendon?

The intention is to identify and remove selected abnormal tissue while preserving surrounding structures, using imaging to guide the procedure. The procedure still depends on appropriate diagnosis, imaging interpretation and clinical technique.

How soon can I return to sport after Tenex?

There is no universal return-to-sport timeline. Progress depends on the tendon treated, symptoms, strength, sporting demands and rehabilitation. Patients may need a period of activity modification followed by progressive strengthening and gradual reintroduction of sport-specific loads. A fixed promise such as returning to sport within a particular number of weeks would not be appropriate.

Can Tenex replace physiotherapy or rehabilitation?

Not necessarily. Tenex addresses selected tissue but does not automatically restore strength, movement or tendon capacity. Rehabilitation may remain important before and after the procedure. Depending on the tendon involved, this may include progressive strengthening, load management, mobility work and sport-specific rehabilitation.

About the Author

Dr Dinesh Sirisena is a Consultant in Sports, Exercise & Musculoskeletal Medicine. His clinical work includes assessment and management of sports injuries and musculoskeletal conditions affecting tendons, muscles, joints, ligaments and related structures.

Medical Disclaimer

This page provides general educational information and does not replace individual medical advice. Tenex therapy is not necessary or appropriate for every tendon or fascia condition. Decisions about imaging, rehabilitation or percutaneous procedures should be based on individual symptoms, diagnosis, medical history, clinical findings and treatment goals.