MINIMALLY INVASIVE TENDINOPATHY TREATMENT
Chronic tendinopathy is often not simply an inflammatory condition. It may involve structural changes and altered mechanical properties of the tendon, which can explain why pain persists despite rest, medication, or physiotherapy.
Ultrasound-guided percutaneous tendon fenestration is a minimally invasive technique that precisely targets the abnormal area of the tendon without the need for a surgical incision.
Under continuous ultrasound guidance, a fine needle is accurately positioned within the degenerated portion of the tendon. A series of controlled needle passes are then performed to create a targeted healing stimulus. This is not open surgery, does not require general anaesthesia, and is performed through a small percutaneous needle puncture.
The procedure may be considered in selected cases of chronic tendinopathy, including:
It is not appropriate for every type of tendon pain or every abnormal ultrasound finding. Careful correlation between the patient’s symptoms, clinical examination and ultrasound findings is essential.
Ultrasound-guided tendon fenestration may be considered when: symptoms have persisted for several months, the diagnosis has been clearly established, appropriate conservative treatment has failed, pain significantly limits function/work/activity, there is no complete/extensive tear, and the patient can follow rehabilitation.
Ultrasound provides considerably more than needle guidance. It allows real-time assessment of tendon structure, precise localisation of the pathological area, identification of partial tears or calcifications, and visualisation of adjacent nerves and blood vessels. It enhances precision and safety, but does not replace accurate clinical diagnosis.
The procedure is performed in the clinic under sterile conditions and local anaesthesia, without the need for hospital admission. The patient is able to return home the same day.
Tendon fenestration and Platelet-Rich Plasma (PRP) are related but distinct treatment approaches. Fenestration provides a controlled mechanical stimulus, whereas PRP aims to enhance the biological environment through autologous factors. They are not interchangeable and may be used in combination depending on the clinical profile.
Temporary local tenderness or discomfort may occur and usually subsides progressively. A short period of reduced loading is followed by an individualised, progressive rehabilitation programme (mobility → isometric strengthening → progressive resistance exercises → return to work/sport).
This procedure is not an immediate pain-relieving injection. Clinical improvement typically develops gradually over weeks as the tendon responds to treatment and rehabilitation.
Serious complications are uncommon when performed with proper indication. Potential risks include temporary pain/swelling, minor bruising/haematoma, local inflammation, infection, injury to adjacent nerve/vessel, progression of pre-existing partial tear, rarely tendon rupture, or inadequate improvement.
