In this video Dr. R. Jeffrey Cole presents the Tenex FAST procedure for Tennis Elbow surgery. See also: Tennis Elbow Surgery: When Is It Time? – (Five Key Points)
“This minimally invasive, percutaneous procedure uses ultrasound to identify and then emulsify and aspirate diseased tissue under local anesthesia and in 15 minutes or less.” FAST Procedure for Tennis Elbow (Lateral epicondylitis)_Cole – YouTube
Dr. Cole explains that most cases resolve with conservative measures and without surgery, but sometimes there are physical changes to the tendon.
“Rather than inflammation or Tendonitis, degeneration and scarring are present withing the deep under surface of the tendon, near the bony attachment – This is due to chronic micro tearing and poor healing and is more appropriately called Tendinosis.”
And he explains why, from a surgical standpoint, this is so important to understand.
“The surface of the tendon is normal. It’s the under surface of the tendon near it’s bony attachment where the degenerative changes; fraying and scarring occur. On ultrasound this area of unhealthy tendon is readily identifiable and visible.”
And in the video he shows us side by side pictures of Tennis Elbow sufferers elbows taken from Sonogram imaging and an MRI, both showing dark areas suggestive of damaged, degenerative tendon tissue.
“The goal is removal of the degenerative tissue or zone of chronic micro-tearing. Unfortunately the gold-standard, open surgical procedure requires an invasive “dismantling of the elbow” just to get to the tissue that needs to be removed.”
As an alternative to this more invasive, standard surgery, Dr. Cole presents the Tenex FAST procedure.
If the Sonogram / Ultrasound examination reveals a degenerative lesion in the tendon this type of surgery requires only a tiny incision and takes only a few minutes to perform.
(And it sounds like an in-office Sonogram scan may be all that’s typically needed, which would avoid the time, cost and hassle of getting an MRI)
The claim is that the advantages of this type of surgery are:
- Faster recovery
- Far less post-operative pain
- Far less dependence on formal rehabilitation
- Earlier return to normal, daily activities, and
- Earlier return to sports (6-8 weeks vs. 36 months)
I can’t vouch for this relatively new, but promising-looking procedure, and the point of sharing this video with you is not to recommend it, per se – Only to present it as an option to consider.
And to share some observations I gleaned from it that I think are important. My impression is that:
- Surgeons seem to know what’s really going on in the tendons of chronic Tennis (and Golfer’s Elbow) sufferers, much more so than any other type of Doctor.
- They know that the problem is Tendinosis / tendon degeneration and NOT inflammation because they encounter it and have to remove it (along with torn, frayed tissue.)
Although I wonder if they think that only the most stubborn, chronic cases they see, (which end up needing surgery) have this kind of injury – and perhaps the ones that recover without needing surgery have “classic Tendonitis” / as in an inflammatory condition…
I haven’t seen any evidence of that in the medical literature, though (studies and research – not WebMD) or in my own experience treating Tennis Elbow sufferers…
In the hundreds of people I’ve treated over the years, I don’t think I’ve ever seen someone who had classic Tendonitis – at least not anyone with inflammation bad enough that there was any significant heat or swelling.
I think it’s very safe to say that the VAST majority of cases are degenerative in nature. There is no inflammation and therefore no healing –
There is a failure of healing and degenerative process taking place – rather than repair as Dr Cole states.
- He also reveals something I’ve suspected for some time but hadn’t yet seen supporting evidence for, which is that the “degeneration and scarring are present within the deep under surface of the tendon”
I’m still wondering if sometimes it’s more on the surface of the tendon (and perhaps those people recover more easily.)
But when the damage is on the under surface, where circulation is poorer and it’s harder to reach and manipulate (You are getting or performing your own hands-on therapy on those tendons, if you have Tennis Elbow – aren’t you!? – Check out my self-help home program, if you’re not.)
Are those are the cases that most often end up failing to recover and end up needing surgery?
For comparison, see this video with a surgeon explaining the standard “open” surgery
As well as this one on Platelet-Rich Plasma Therapy for Tennis Elbow (Does it work?)
See also the main page on Treatment for Tennis Elbow for an overview on the standard treatments – The good, the bad and the ugly.