Tenex: A Non-Surgical Treatment for Chronic Tendon Pain
Tenex is a minimally invasive, ultrasound-guided procedure designed to treat chronic tendon pain by removing the damaged tissue that won’t heal on its own. Unlike traditional tendon surgery, the procedure is performed in office through a small puncture site, under local anesthetic, with no stitches and no general anesthesia.
Tenex procedures at this practice are performed by Dr. Jessica Zarndt, a board-certified sports medicine physician and one of the few providers in Las Vegas offering this treatment.
Is Tenex Right for You?
You’ve rested it. You’ve done physical therapy. You’ve tried anti-inflammatories. Maybe you’ve had a cortisone shot or two that worked for a while and then stopped. The pain keeps coming back, or it never really left. You’ve been told to keep waiting or that surgery is next.
Tenex may be the right next step if:
- You’ve had tendon pain for more than three to six months that hasn’t responded to conservative care
- You’ve already tried physical therapy, rest, bracing, or anti-inflammatory medication
- You’ve had cortisone injections that wore off or stopped working
- You’ve been told surgery is the next step and you want to exhaust non-surgical options first
- You’re an athlete or active adult who needs a real return-to-activity plan, not a vague recommendation to rest
- You’ve had previous tendon surgery and still have pain
The patients who tend to do best with Tenex are the ones whose pain has a clear source, has been worked up properly, and hasn’t responded to the standard sequence of treatments. Runners with chronic Achilles or plantar pain. Tennis and pickleball players with stubborn elbow pain. Golfers, hikers, manual laborers, and anyone whose work or sport keeps loading the tendon that won’t heal.
Why Chronic Tendon Pain Doesn’t Heal on Its Own
Most patients use the word “tendinitis” to describe ongoing tendon pain, but what they actually have, six months in, is something different. Understanding the distinction matters because it explains why standard treatments stop working.
Tendinitis vs. tendinosis. Tendinitis is inflammation. It’s what happens in the first few days or weeks after an acute injury, and it usually resolves with rest, ice, and anti-inflammatories. Tendinosis is degeneration of the tendon tissue itself. The collagen fibers that give a healthy tendon its strength break down and heal back disorganized, thickened, and weaker. By the time a tendon problem has been around for more than a few months, what you’re dealing with is almost always tendinosis, not tendinitis.
Why tendons get stuck. Tendons have poor blood supply compared to muscle, which is why a hamstring strain heals in weeks and a chronic Achilles problem can sit unchanged for years. When the tissue breaks down faster than it can rebuild, it ends up in a state of arrested healing. The damaged tissue stays in place, the pain persists, and the body cannot reach the area effectively to fix it.
Why standard treatments stop working. Rest, ice, anti-inflammatories, and even cortisone all target inflammation. They don’t address degenerated tissue. That is why patients can cycle through the same treatments for years, get partial relief that fades, and end up with the same problem they started with. If the issue is damaged tissue that the body cannot clear on its own, the solution has to actually address the damaged tissue.
What the Tenex Procedure Is and How It Works
Tenex is a minimally invasive procedure that uses ultrasonic energy delivered through a small needle-like device to break down and remove damaged tendon tissue while leaving healthy tissue intact. Once the diseased tissue is cleared, the body’s natural healing response can finally take over and the tendon can rebuild with healthier fibers.
What happens during the procedure. A small area of skin over the affected tendon is numbed with local anesthetic. Under live ultrasound guidance, a tiny puncture is made (no formal incision, no stitches). The Tenex device is inserted through the puncture site and used to precisely target and remove the damaged tissue. The procedure itself typically takes about 15 to 20 minutes.
Why ultrasound guidance is essential. Blind procedures are guesswork. With live ultrasound, the device is visible in real time and the damaged tissue is treated directly, sparing the healthy tendon around it. The outcome of a Tenex procedure depends heavily on the physician’s ability to use ultrasound well, which is a core part of sports medicine fellowship training and not a skill every provider performing this procedure has developed equally.
How it differs from traditional tendon surgery. Traditional surgical treatment for chronic tendinosis usually involves a larger incision, general anesthesia, sutures, and weeks of restricted activity. Tenex is performed through a puncture site with local anesthetic, in an office setting, with no stitches and no general anesthesia.
Conditions Tenex Treats
Tenex is used for chronic tendinopathy that has not responded to conservative care. Dr. Zarndt performs the procedure for tendon conditions in the wrist, elbow, shoulder, knee, ankle, and hip.
Upper body
- Tennis elbow (lateral epicondylitis)
- Golfer’s elbow (medial epicondylitis)
- Rotator cuff tendinopathy
- Biceps tendinopathy
Lower body
- Achilles tendinopathy
- Patellar tendinopathy (jumper’s knee)
- Hamstring tendinopathy
- Hip tendinopathy, including gluteal and hip flexor
- Plantar fasciitis
- Posterior tibial tendinopathy
Tenex is not appropriate for every tendon problem. Acute tears, complete ruptures, and pain that hasn’t been properly worked up are not candidates for this procedure. Diagnosis comes first. If you’re not sure whether your specific problem fits, that’s part of what the consultation is for.
What Makes This Different
A Tenex procedure is only as good as the diagnosis behind it, the imaging that guides it, and the plan that follows. The procedure itself is straightforward. The judgment around it is what determines whether you actually get better.
One of the few providers in Las Vegas offering Tenex. For patients who have been told their only remaining options are more cortisone or surgery, having access to a tissue-removing procedure that bridges the two is significant.
Every procedure is ultrasound-guided. Dr. Zarndt trained in musculoskeletal ultrasound during her sports medicine fellowship and uses it daily in clinic. Live imaging is standard for every Tenex procedure performed here, which is not the case at every clinic offering the treatment.
A team physician’s framework for return to sport. Most patients aren’t here because they want to feel better at rest. They’re here because they want to run, lift, play, or work without pain. Treating professional athletes for the Las Vegas Aces, the Raiders, the LA Dodgers, and UCLA Athletics shapes how the post-procedure plan is built. The procedure itself is one piece. The structured loading program afterward is what actually gets people back.
Honest about candidacy. Not every patient with tendon pain is a Tenex candidate. If your problem would respond better to PRP, to a focused loading program, or to surgery, you’ll hear that.
How Tenex Compares to Other Options
Most patients arrive comparing Tenex to whatever they have already tried or been offered.
Tenex vs. continued cortisone. Cortisone reduces inflammation in the short term. It does not address damaged tissue, and repeated injections can weaken the tendon further over time. Tenex removes the damaged tissue itself.
Tenex vs. PRP for tendons. PRP signals healing in tissue that’s struggling to heal. Tenex physically removes the tissue that won’t heal. For some patients, one is clearly the right answer. For others, the two are used in combination, either in the same visit or staged over several weeks. The right call depends on the tendon, the severity of the degeneration, and your goals.
Tenex vs. tendon surgery. Traditional tendon surgery involves a larger incision, often general anesthesia, sutures, and weeks of restricted activity. Tenex is performed through a puncture site, in office, under local anesthetic. Most patients return to light activity within days and full activity within several weeks rather than several months.
Tenex vs. waiting it out. Chronic tendinosis past the three-to-six-month mark rarely improves on its own. Waiting longer usually means more compensation patterns, more deconditioning elsewhere, and a longer return to activity once you do treat it.
Recovery and Return to Activity
Recovery from Tenex is faster than surgical alternatives, but it is not instant. The honest version matters more here than the marketing version.
The first 48 hours. Soreness at the procedure site is normal and expected. The local anesthetic wears off in a few hours, after which most patients use ice and over-the-counter pain relief. No heavy activity.
Weeks one and two. Brief period of relative rest, sometimes with a brace or walking boot, depending on the tendon treated. Light daily activity is usually fine. No formal training during this window.
Weeks two to six. Structured loading program, which is where physical therapy becomes important. The tendon is rebuilding during this phase and needs progressive, controlled load to heal in the right pattern. Skipping this phase is one of the most common reasons Tenex results disappoint.
Three to six months. Most patients see meaningful improvement by six to twelve weeks, with continued improvement out to six months as the tendon fully remodels. Return to sport is individualized based on the tendon treated and the specific demands of the activity.
Realistic expectation: not every patient gets to zero pain, but most patients get back to the activities they had stopped doing. The point of the procedure is function, not perfection.
Cost and Insurance
Tenex is often covered by commercial insurance and Medicare when conservative care has been documented and the indication is appropriate. Coverage and pre-authorization requirements vary by plan. Work comp is accepted for related injuries.
Call the office and we’ll verify your benefits before scheduling.
Frequently Asked Questions
How is Tenex different from a regular tenotomy? Traditional tenotomy involves a surgical incision to release or remove tendon tissue. Tenex achieves a similar goal through a small puncture using ultrasonic energy, with no incision and no stitches. Both are forms of tenotomy, but the recovery and the procedure itself are very different.
Does Tenex hurt? The procedure is performed under local anesthetic, so most patients describe pressure rather than pain during it. Soreness at the procedure site for several days afterward is normal.
How long does the Tenex procedure take? The procedure itself typically takes about 15 to 20 minutes. The full visit, including preparation and post-procedure instructions, usually runs about an hour.
How long until I can return to running, lifting, or playing my sport? Most patients return to light activity within days. Return to full sport-specific activity is generally in the six-to-twelve week range, depending on the tendon and the sport. A structured loading program is part of how that timeline is reached safely.
Can I have Tenex if I’ve already had tendon surgery? Yes. Post-surgical tendon pain is one of the situations where Tenex can be especially useful, because the alternative is often another surgery on already-operated tissue. Ultrasound guidance is particularly important in these cases.
What if I’ve already had multiple cortisone injections in the same tendon? Repeated cortisone is one of the patterns that often leads patients to Tenex. The damaged tissue isn’t going to resolve with more cortisone, and continued injections can make the tendon weaker over time. Tenex addresses what cortisone cannot.
Is Tenex covered by insurance? Often yes, when conservative treatment has been documented and the indication is appropriate. Coverage varies by plan and pre-authorization is usually required. The office will verify benefits before scheduling.
Can I get Tenex and PRP at the same time? For certain conditions, yes. Combining the two means removing the damaged tissue with Tenex and then supporting the healing response with PRP. Whether this combination is right for you depends on the specific tendon and the degree of degeneration.
Why don’t more clinics in Las Vegas offer Tenex? The procedure requires specific equipment and meaningful ultrasound expertise. Many sports medicine and orthopedic practices haven’t invested in either. The result is that patients who would benefit from Tenex often aren’t told it exists.
What happens if Tenex doesn’t work for me? Most patients improve, but not every patient gets the result they hoped for. If the response is incomplete, options include a structured loading progression, an additional procedure, PRP, or, in some cases, referral for surgical evaluation. The plan accounts for the possibility that the first procedure isn’t the final answer.
Ready to Stop Waiting for It to Get Better on Its Own?
Chronic tendon pain doesn’t usually resolve with more time. If you’ve been cycling through rest, therapy, and cortisone without lasting relief, a consultation is the next step. Dr. Zarndt will evaluate the tendon with ultrasound, give you an honest read on whether Tenex is the right call for your situation, and build a plan around getting you back to what you stopped doing.