Background: Definitive management of chronic refractory epicondylitis is problematic to say the least.
Rationale: With increased accuracy of pathology localization by ultrasound guidance, a minimally invasive percutaneous procedure using ultrasound energy has been developed. With ultrasound guidance the procedure simultaneously cuts and removes the degenerated tissue.
Procedure: After identifying the pathology by ultrasonic imaging, the elbow is prepared in a manner similar to a cortisone injection. The percutaneous procedure is carried out under a local anesthesia, through a puncture site and usually takes only about 60 s of treatment time. Patients tolerate the procedure extremely well, and the puncture site is closed with a 5 mm Steri-Strip.
Aftercare: Recovery is rapid. No additional adjunctive modalities have been employed.
Results: With over 20,000 cases performed, recovery has been consistent with a success rate of 80–90%. Lateral involvement does slightly better than medial tendinopathy. One permanent ulnar nerve injury has occurred. No other complications have been reported.
Conclusions: The ultrasound-guided percutaneous tenotomy using ultrasound energy is performed with the complexity of a cortisone injection and with the efficacy of a surgical procedure but without the cost or morbidity.
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