Treatment of tennis elbow can be challenging, especially when non-surgical methods fail. To help this group of patients, the Singapore General Hospital (SGH) has introduced a novel procedure which involves ultrasonic guided percutaneous ultrasound energy to cut and remove the tissue now increasingly believed to be responsible for persistent pain and functional disturbance in refractory musculoskeletal tendinopathy.
The procedure, now technically termed “percutaneous ultrasonic tenotomy”, can be performed in approximately 15 to 20 minutes. The introduction of this minimally invasive procedure comes after a joint study between the Hospital and the renowned Mayo Clinic in Rochester, Minnesota, USA on patients who were treated for tennis elbow with the new technique.
This procedure is performed under local anaesthesia. Using ultrasound imaging, the specific location of the damaged tendon tissue is identified and a small instrument about the size of a toothpick is inserted into the area. Ultrasonic energy then cuts, breaks up and removes the damaged tissue sparing the surrounding healthy tendon tissue. No sutures or stitches are needed when the procedure is completed. Only a small adhesive bandage is used.
“SGH sees about 20 to 30 patients with tennis elbow every month and we understand how frustrating it can be for patients when their conditions do not improve after non-surgical therapies. The procedure provides patients who are hesitant or fearful of surgery another treatment option as it is performed in an outpatient clinic setting. Recovery is also much shorter as compared to traditional open surgery,” said Dr Joyce Koh, Senior Consultant, Department of Orthopaedic Surgery, SGH who is also the Principal Investigator of the local study.
Since the procedure was introduced in August 2012, close to 20 patients at SGH has undergone percutaneous ultrasonic tenotomy for the treatment of tennis elbow. This is in addition to the 20 patients who underwent the clinical trial from June 2011 to November 2011 for a study to explore its safety, tolerability and effectiveness.
The study found that all patients took to the procedure very well without any complications. Ninety-five per cent of the patients expressed satisfaction with the procedure and had no recurrence during the one-year follow-up period.
To date, almost 9,000 patients in North America have undergone the procedure for various tendinopathic conditions involving the elbow, foot, ankle and knee. SGH is the only centre in Asia offering this procedure currently. Locally, the technological basis and findings were also presented at the Singapore Orthopaedic Association Annual Scientific Meeting held recently in October 2013. In the United States, presentations have also been held at the Mayo clinic, Harvard, Cleveland clinic, Rothman Institute and numerous local and regional meetings, while internationally, our findings were also presented at the European Federation of National Associations of Orthopedics and Traumatology (EFORT) annual meeting this June as well as the Canadian Orthopedic Association Meeting.
Tennis elbow is a painful condition that occurs when tendons in the elbow are overworked, usually by repetitive motions of the wrist and arm. Despite its name, most cases of tennis elbow occur in people who do not play tennis. The pain of tennis elbow occurs primarily where the tendons of the forearm muscles attach to a bony bump on the outside of the elbow. Pain can also spread into the forearm and wrist. Although the condition affects people of all ages, it is most commonly seen in adults between 35 and 55 years of age.
Besides the elbow, tendinopathy can involve other parts of the musculoskeletal system such as the knee and ankle. Predisposing factors include chronic repetitive activities and inappropriate techniques during work and recreation. In combination, tendinopathy of the upper and lower extremities have resulted in significant disturbances in activities of daily living, absenteeism from work and inability to partake in recreational activities locally and world-wide. With a tendency toward an economically active population, it introduces a significant socioeconomic burden due to loss of productivity and consumption of healthcare resources.