Regenerative Medicine
REGENERATIVE MEDICINE

Percutaneous Needle Tenotomy (PNT)

Ultrasound-Guided Percutaneous Needle Tenotomy (PNT) is a procedure where a needle is advanced through the skin, under the direct visual guidance of using Ultrasound, to make small holes and slices in a tendon.  This is done in order to treat tendinopathy and its tendon-related pain via causing microtrauma and breaks in the scar tissue. This causes local inflammation and thus increases the circulation to the area, which is the first steps of the Healing cascade. This process will ultimately repair/heal the degenerated tendons.

This procedure can be safely done in the office, or may be done under anesthesia in an outpatient surgery center setting.

  • Tendinopathy (disease of the tendon) or tendinosis is a non-inflammatory degeneration of the tendon, usually due to excessive repetitive strain and injury. There are a couple of theories that try to explain the development of tendinopathies (or tendinosis): (1) The Mechanical/Trauma Theory:  mechanical trauma or microtrauma caused by overuse and (2) The Vascular Theory: since tendons have less blood supply and consumes less oxygen than muscle, repetitive increased stress/demand on the tendon will lead to decreased blood/O2 delivery, which over time, leads to degeneration/breakdown of the normal tendon tissue.  Whether Mechanical, Vascular, or some combination thereof, the final result is that tendon is damaged, dysfunctional, and can no longer heal itself completely after repetitive trauma.

  • Tendons often affected are located at the shoulders, elbows, knee, ankle and foot.

  • Conservative management (therapies, medications, splinting) are tried first and if they fail to resolve the problem, PNT are a good option.

  • The musculoskeletal ultrasound identifies the affected tendon.  The Ultrasound makes the procedure more accurate as we are able to see the deep tissue and place the needle in the correct location.

  • An informed consent is obtained. Then the area is properly cleaned and prepared. A needle of suitable gauge and length depending on the location is inserted through the skin. Local anesthetic is used to make the procedure relatively painless. Then the needle is advanced through the tendon until it contacts bone (the tendon attaches to the bone, this is called the enthesis). The enthesis is poked with the needle multiple times.

  • Pain medication is given to help ease the pain which can occur after this procedure.