The Tenex Health Technique is a non-invasive, outpatient procedure that effectively treats tennis elbow, plantar fasciitis, bone spurs and other issues leading to chronic joint and tendon pain.
Ultrasound technology guides a probe that removes diseased tissue from tendons.
The benefits are many: The procedure can be done in the doctor’s office, healing times are much shorter than traditional surgical techniques, no scarring and long-lasting results.
Listen in as Dr. Thomas Plut is here as one of the first doctors in the region to offer this technique.
Tennis Elbow and The Tenex Procedure
From the Show: Lourdes Health Talk
Summary:
Air Date: 3/10/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): As interventions for conditions of the joint, bones, and muscles improve, more people are availing themselves of care for conditions that might have once been written off as inevitable or permanent and if you've been suffering from tendonitis or tennis elbow, there is help available. My guest today is Dr. Thomas Plut. He's a sports medicine physician with Lourdes Health System. Welcome to the show, Dr. Plut. Tell us about tennis elbow. People hear about it; they think it's limited to tennis players but really a lot of people suffer from this condition.
Dr. Thomas Plut (Guest): Well, Melanie, thank you for having me on the show today. Tennis elbow is a common injury involves the outside part of the elbow. Most people that get it don't play a racquet sport. It's often related to overuse of some type of activity, whether it's manual labor or someone that does play a racquet sport. It also can occur from just doing day in and day out activities of daily living at a home, doing chores and whatnot. So, it is usually a chronic overuse injury and not always involving tendonitis. Tendonitis is usually a more acute injury but a classic, chronic, tennis elbow is where the tendon becomes thickened and degenerated.
Melanie: Okay. So, the muscles and tendons that are involved in this, what actually happens to them? Do they get inflamed? Do they have trauma? What's going on in there?
Dr. Plut: Well, that's a great question. Basically, initially, when a patient develops more acute tennis elbow, there is an element of inflammation and that is within days or weeks. As the body tries to heal itself, the body's bringing in natural healing factors and as it tries to heal itself, the tendon can become thickened or the fibers can be disarrayed and not running nice and parallel with one. That can cause pain and that's known as “tendonitis” or “tendinopathy”. So, initially, you can have inflammation but as time goes on, it will become thickened and degenerative.
Melanie: So then, what might people notice about the feeling so that they know that this is what's going on or at least they have a general idea that this is something that's starting to become chronic?
Dr. Plut: Well, I mean, just to complete simple tasks in their life from lifting a coffee cup or lifting small objects, doing dishes, pulling or pushing anything, you can develop pain on the outside part of the elbow. If it continues to be persistent, then there's obviously a problem there and they can seek medical attention and they can get treated.
Melanie: Can you see it on an MRI? Is this something that you can spot when you're trying to diagnose it?
Dr. Plut: Yeah. So, often tennis elbow, initially, it's a clinical diagnosis. You treat it conservatively and that can be with physical therapy. If indicated, you can always use the traditional steroid injection. If the patient failed conservative treatment, then advanced imaging is necessary. One imaging modality would be an ultrasound as well as you can use an MRI to evaluate the tendon. So, ultrasound and MRI can be used to diagnose tendinosis, chronic tennis elbow.
Melanie: Dr. Plut, before we get into the Tenex procedure, I just would like to ask you about the braces that when they start to feel that tennis elbow, they put these braces on their forearms. Sometimes they put them quite tight and for some people, they seem to help. Are you an advocate of bracing as one of the initial lines of defense?
Dr. Plut: Yes, bracing is another treatment option. The point of the brace is to decrease tension of the tendon where it attaches on the outside part of the elbow. Some people tolerate it quite well and are very happy with the pain relief it gives them; other people it doesn't help. But, it is a reasonable treatment option to help with their symptoms of pain and improve function.
Melanie: So, then let's talk about this Tenex Health. What is this? People have been hearing this term and they think surgery right away, but tell us a little bit about it and why it's different from standard surgery.
Dr. Plut: Well, the nice thing about the Tenex Health technique is it's minimally invasive, number one. Number two, it's safe, and number three, it is effective. I've helped a lot of patients. I've been doing this procedure for over three years now. I believe I was one of the first to do it on the East Coast. I've also trained many doctors, so I know the technique quite well. I'm very comfortable with the technique. The nice thing about the technique is it is minimally invasive. What it involves is the physician making a small incision to gain access to the diseased tendon and from there, they insert a needle-held device, which with the use of ultrasound energy and visualization with an ultrasound machine, the needle-held device is able to debride or take away the bad tissue that is causing the pain. In this case, for tennis elbow, it would be the chronic tennis elbow, the tendinopathy or the tendinosis that I was talking about earlier. But, it's an exciting time for me because I've helped a lot of patients with this technique and it's probably what I call a “game-changer”. Prior to this, I was doing some other procedures that weren't as consistent and didn't provide as much pain relief and didn't improve the function as much as I wanted them to have. So, this has really changed my practice for the better and it has allowed me to, I believe, help more people get back to work, as well as playing their various sports.
Melanie: So, different than repairing a torn tendon or something, this one is breaking down that scar tissue then, and removing it without disturbing that surrounding healthy tendon tissue. Because you're just really removing scar tissue, is it traumatizing the tissue left at all? How long is the recovery?
Dr. Plut: That's the nice thing about the procedure. Recovery is within weeks, not months like the tradition surgery which involved making an incision anywhere from an inch to an inch-and-a-half in length along the outside part of the elbow. So, recovery for tennis elbow is around 4-6 weeks and during that time it's not like the individual--the patient--isn't allowed to do something. They're allowed to do, for the most part, their activities of daily living but we ask them to avoid any repetitive activities or lifting anything greater than or equal to 5 pounds. So, basically, the first 4-6 weeks, you're in what I call a "protective phase" where you're letting the body heal after having a minimally invasive procedure.
Melanie: So, then is there a need to redo this particular procedure? Is this a long-term working thing?
Dr. Plut: Usually, my goal when I do any procedure is “one and done”, is how I look at it. So, I'm always going in there and my goal is to hit a home run and not have to redo the procedure. As we have learned more about the technique, earlier on, I had to do some additional what we call “redo’s” because I was not spending enough time on the diseased tissue. That was because of the time--the company recommended a certain time limit. But, as we have done more and more of these procedures, we realize that you can spend more time treating the diseased tissue and that has helped me definitely decrease what I call the “second” or “third” procedure after having the initial. So, my goal is to do one procedure and one procedure only.
Melanie: Can this be used for other parts of the body? Golfers develop elbow issues from hitting the ground and there are things that go on in our knees and our ankles. Can this be used in other parts?
Dr. Plut: Yes. I've treated patients with shoulder tendon dysfunction and shoulder tendinosis; rotator cuff tendinosis; golfer's elbow, as you mentioned. I've also treated patients with jumper's knees, patella tendinosis or quadriceps tendinosis, in the knee. I’ve also treated ankle tendinosis as well. It is also indicated for plantar fasciitis, but the correct term is “plantar fasciiosis”, where the fascia becomes thickened and as a way of describing, how you mentioned earlier, like a scarring of the tissue.
Melanie: Wow! That is absolutely fascinating and gives hope to so many people. Please give us your best advice for people that are suffering from tennis elbow that think that they've got this chronic condition starting and what you really want them to know.
Dr. Plut: Well, I want them to know that there's hope for them. This procedure has really changed my practice for the better and I feel like I can offer a treatment option that, for the most part, I believe is making a positive impact in their health. It allows them to stay active and to keep moving in a healthy way. That's the goal of the treatment is to lessen their pain and improve their function. First and foremost, if they start developing a chronic tendon issue, they need to seek out a qualified provider that can guide them in the treatment process. Keep in mind this is not the first line treatment. This treatment is for patients that have failed appropriate, conservative treatment, such as physical therapy and bracing, as we mentioned earlier. So, they have to the appropriate steps before we just jump to a minimally invasive procedure. The important thing is to mention is that there's hope for them and this is a reasonable, safe treatment option.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Plut: Well, we were the first in the Philadelphia region to offer the procedure. Between me and Dr. Craig Kimmel, we have a lot of experience and I believe we've helped a lot of patients. Secondly, I've been actively involved in training doctors throughout the country. Often, I've had doctors come and work with me and learn the procedure. In fact, tomorrow I'm doing a teaching session. I'm teaching physicians in the Washington, D.C. area on the technique. So, I'm actively involved in teaching because I believe I have the experience and the skillset to be able to share this great treatment option for people that are battling with chronic tendon pain.
Melanie: Thank you so much, Dr. Plut, for being with us. It is great information. You're listening to Lourdes Health Talk. And for more information, you can go to Lourdesnet.org. That's Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): As interventions for conditions of the joint, bones, and muscles improve, more people are availing themselves of care for conditions that might have once been written off as inevitable or permanent and if you've been suffering from tendonitis or tennis elbow, there is help available. My guest today is Dr. Thomas Plut. He's a sports medicine physician with Lourdes Health System. Welcome to the show, Dr. Plut. Tell us about tennis elbow. People hear about it; they think it's limited to tennis players but really a lot of people suffer from this condition.
Dr. Thomas Plut (Guest): Well, Melanie, thank you for having me on the show today. Tennis elbow is a common injury involves the outside part of the elbow. Most people that get it don't play a racquet sport. It's often related to overuse of some type of activity, whether it's manual labor or someone that does play a racquet sport. It also can occur from just doing day in and day out activities of daily living at a home, doing chores and whatnot. So, it is usually a chronic overuse injury and not always involving tendonitis. Tendonitis is usually a more acute injury but a classic, chronic, tennis elbow is where the tendon becomes thickened and degenerated.
Melanie: Okay. So, the muscles and tendons that are involved in this, what actually happens to them? Do they get inflamed? Do they have trauma? What's going on in there?
Dr. Plut: Well, that's a great question. Basically, initially, when a patient develops more acute tennis elbow, there is an element of inflammation and that is within days or weeks. As the body tries to heal itself, the body's bringing in natural healing factors and as it tries to heal itself, the tendon can become thickened or the fibers can be disarrayed and not running nice and parallel with one. That can cause pain and that's known as “tendonitis” or “tendinopathy”. So, initially, you can have inflammation but as time goes on, it will become thickened and degenerative.
Melanie: So then, what might people notice about the feeling so that they know that this is what's going on or at least they have a general idea that this is something that's starting to become chronic?
Dr. Plut: Well, I mean, just to complete simple tasks in their life from lifting a coffee cup or lifting small objects, doing dishes, pulling or pushing anything, you can develop pain on the outside part of the elbow. If it continues to be persistent, then there's obviously a problem there and they can seek medical attention and they can get treated.
Melanie: Can you see it on an MRI? Is this something that you can spot when you're trying to diagnose it?
Dr. Plut: Yeah. So, often tennis elbow, initially, it's a clinical diagnosis. You treat it conservatively and that can be with physical therapy. If indicated, you can always use the traditional steroid injection. If the patient failed conservative treatment, then advanced imaging is necessary. One imaging modality would be an ultrasound as well as you can use an MRI to evaluate the tendon. So, ultrasound and MRI can be used to diagnose tendinosis, chronic tennis elbow.
Melanie: Dr. Plut, before we get into the Tenex procedure, I just would like to ask you about the braces that when they start to feel that tennis elbow, they put these braces on their forearms. Sometimes they put them quite tight and for some people, they seem to help. Are you an advocate of bracing as one of the initial lines of defense?
Dr. Plut: Yes, bracing is another treatment option. The point of the brace is to decrease tension of the tendon where it attaches on the outside part of the elbow. Some people tolerate it quite well and are very happy with the pain relief it gives them; other people it doesn't help. But, it is a reasonable treatment option to help with their symptoms of pain and improve function.
Melanie: So, then let's talk about this Tenex Health. What is this? People have been hearing this term and they think surgery right away, but tell us a little bit about it and why it's different from standard surgery.
Dr. Plut: Well, the nice thing about the Tenex Health technique is it's minimally invasive, number one. Number two, it's safe, and number three, it is effective. I've helped a lot of patients. I've been doing this procedure for over three years now. I believe I was one of the first to do it on the East Coast. I've also trained many doctors, so I know the technique quite well. I'm very comfortable with the technique. The nice thing about the technique is it is minimally invasive. What it involves is the physician making a small incision to gain access to the diseased tendon and from there, they insert a needle-held device, which with the use of ultrasound energy and visualization with an ultrasound machine, the needle-held device is able to debride or take away the bad tissue that is causing the pain. In this case, for tennis elbow, it would be the chronic tennis elbow, the tendinopathy or the tendinosis that I was talking about earlier. But, it's an exciting time for me because I've helped a lot of patients with this technique and it's probably what I call a “game-changer”. Prior to this, I was doing some other procedures that weren't as consistent and didn't provide as much pain relief and didn't improve the function as much as I wanted them to have. So, this has really changed my practice for the better and it has allowed me to, I believe, help more people get back to work, as well as playing their various sports.
Melanie: So, different than repairing a torn tendon or something, this one is breaking down that scar tissue then, and removing it without disturbing that surrounding healthy tendon tissue. Because you're just really removing scar tissue, is it traumatizing the tissue left at all? How long is the recovery?
Dr. Plut: That's the nice thing about the procedure. Recovery is within weeks, not months like the tradition surgery which involved making an incision anywhere from an inch to an inch-and-a-half in length along the outside part of the elbow. So, recovery for tennis elbow is around 4-6 weeks and during that time it's not like the individual--the patient--isn't allowed to do something. They're allowed to do, for the most part, their activities of daily living but we ask them to avoid any repetitive activities or lifting anything greater than or equal to 5 pounds. So, basically, the first 4-6 weeks, you're in what I call a "protective phase" where you're letting the body heal after having a minimally invasive procedure.
Melanie: So, then is there a need to redo this particular procedure? Is this a long-term working thing?
Dr. Plut: Usually, my goal when I do any procedure is “one and done”, is how I look at it. So, I'm always going in there and my goal is to hit a home run and not have to redo the procedure. As we have learned more about the technique, earlier on, I had to do some additional what we call “redo’s” because I was not spending enough time on the diseased tissue. That was because of the time--the company recommended a certain time limit. But, as we have done more and more of these procedures, we realize that you can spend more time treating the diseased tissue and that has helped me definitely decrease what I call the “second” or “third” procedure after having the initial. So, my goal is to do one procedure and one procedure only.
Melanie: Can this be used for other parts of the body? Golfers develop elbow issues from hitting the ground and there are things that go on in our knees and our ankles. Can this be used in other parts?
Dr. Plut: Yes. I've treated patients with shoulder tendon dysfunction and shoulder tendinosis; rotator cuff tendinosis; golfer's elbow, as you mentioned. I've also treated patients with jumper's knees, patella tendinosis or quadriceps tendinosis, in the knee. I’ve also treated ankle tendinosis as well. It is also indicated for plantar fasciitis, but the correct term is “plantar fasciiosis”, where the fascia becomes thickened and as a way of describing, how you mentioned earlier, like a scarring of the tissue.
Melanie: Wow! That is absolutely fascinating and gives hope to so many people. Please give us your best advice for people that are suffering from tennis elbow that think that they've got this chronic condition starting and what you really want them to know.
Dr. Plut: Well, I want them to know that there's hope for them. This procedure has really changed my practice for the better and I feel like I can offer a treatment option that, for the most part, I believe is making a positive impact in their health. It allows them to stay active and to keep moving in a healthy way. That's the goal of the treatment is to lessen their pain and improve their function. First and foremost, if they start developing a chronic tendon issue, they need to seek out a qualified provider that can guide them in the treatment process. Keep in mind this is not the first line treatment. This treatment is for patients that have failed appropriate, conservative treatment, such as physical therapy and bracing, as we mentioned earlier. So, they have to the appropriate steps before we just jump to a minimally invasive procedure. The important thing is to mention is that there's hope for them and this is a reasonable, safe treatment option.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Plut: Well, we were the first in the Philadelphia region to offer the procedure. Between me and Dr. Craig Kimmel, we have a lot of experience and I believe we've helped a lot of patients. Secondly, I've been actively involved in training doctors throughout the country. Often, I've had doctors come and work with me and learn the procedure. In fact, tomorrow I'm doing a teaching session. I'm teaching physicians in the Washington, D.C. area on the technique. So, I'm actively involved in teaching because I believe I have the experience and the skillset to be able to share this great treatment option for people that are battling with chronic tendon pain.
Melanie: Thank you so much, Dr. Plut, for being with us. It is great information. You're listening to Lourdes Health Talk. And for more information, you can go to Lourdesnet.org. That's Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
