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Bridging the Treatment Gap

Ultrasound guided minimally invasive procedures now allow for the non-surgical treatment of tendinopathy and arthritis

In the past, patients suffering from chronic tendon problems or arthritis had three basic treatment options: cortisone injections, physical therapy and surgery. Those days are long gone.

The sports medicine specialists at Emory Orthopaedics & Spine Center now have a variety of non-surgical procedures and advancing technologies at their disposal to help increase healing, decrease pain, and improve function of painful tendons and joints. That means an entire population of active adults who have learned to live with it can now find relief without having to consider surgery.

Ultrasound has played a large role in this evolution. The primary care sports medicine doctors at Emory Healthcare have received high-level ultrasound training and use it for more than just diagnostics. They also rely on it to provide precise guidance during office procedures so they can treat diseased tissue with pinpoint accuracy.

Here are just a few of the non-surgical treatment options offered at Emory Orthopaedics & Spine Center that use ultrasound guidance to bridge the gap between old-school remedies and invasive surgery:

Tenex Procedure

Tenex is a branded non-surgical treatment used to stimulate healing and eliminate pain for patients with chronic tendon problems, such as Achilles tendonitis, patellar tendinitis/jumper’s knee, golfer’s/tennis elbow, or rotator cuff pain that doesn’t involve a massive tear. During this one-time, 15 to 20-minute procedure, ultrasound is used to visualize the damaged tendon. A special injection-based tool is then used to deliver ultrasonic energy directly to the diseased tissue, flush the area with saline, and remove the damaged tissue. This procedure helps reset the healing process so the tendon can heal itself. Patients receive guided therapy and begin feeling significantly better within six to eight weeks. When fully healed, patients are able to return to normal activities without limitation.

Non-surgical Trigger Finger Release

A minimally invasive ultrasound-guided percutaneous trigger finger release can be completed with local anesthesia in less than 10 minutes right at the doctor’s office. Live ultrasound imaging is used to guide the release of the first annular (A1) pulley with an 18-gauge needle and inject anti-inflammatory medication into the tendon sheath to help heal the diseased tissue. No incision is made with a scalpel and no stitches are needed. The patient will experience mild soreness from the procedure but should be able to use the hand normally within a week as opposed to four or five weeks with the traditional trigger finger release surgery.


COOLIEF* is an ultrasound-guided nerve ablation procedure for knee osteoarthritis. During the 30-minute procedure, a needle is used to deliver radiofrequency current directly to the nerves around the knee. COOLIEF* uses water-cooled technology to safely deactivate pain-transmitting sensory nerves, allowing a larger treatment area and greater chance at targeting pain-causing nerves. Patients may experience mild pain at the injection sites that can be controlled with acetaminophen and ice. No pain medicine, like opioids, is needed. Patients generally start feeling better–and moving more freely–within one to two weeks after the procedure. Relief from pain can last 12 months on average.

Carpal Tunnel Release Without Surgery

A carpal tunnel release can now be completed through a single micro-incision (4-5mm) using the SX-One MicroKnife™ and ultrasound guidance. This equipment allows the transverse carpal ligament to be cut while protecting nerves, blood vessels, tendons and other sensitive anatomy. The procedure is performed in an office setting using local anesthesia and takes less than an hour. Patients may experience soreness from the procedure itself but should have minimal symptoms within a week or two.

Platelet-rich Plasma (PRP) Injection

An ultrasound-guided PRP injection is another option for those suffering from arthritis and chronic tendinopathy. It helps create a healthier environment for diseased tissue to repair itself. During this short office procedure, blood is drawn from the patient and placed in a centrifuge to separate the platelets. The platelet-rich plasma is then injected directly into the diseased tendon or arthritic joint to stimulate healing, provide pain relief, and improve function. Guided therapy follows and the patient usually begins feeling long-lasting relief within six to twelve weeks.

Who to Refer

Any patient who likes to be active but suffers from tendinopathy or arthritis may benefit from the wide variety of non-surgical options offered at Emory Orthopaedics & Spine Center. Many patients have sought out the new and emerging treatments at Emory after finding little relief with cortisone injections and physical therapy. Others have come to Emory without an official diagnosis after being sidelined with chronic pain. The Emory team is happy to help patients at any stage of their journey. And if surgery is determined to be necessary, the well-respected orthopedic surgeons at Emory can help with that as well.

To refer a patient for a non-surgical consultation with a sports medicine specialist, call the Emory Orthopaedics & Spine Center at 404-778-3350. A representative from Emory Healthcare will help schedule an appointment.

Emory Orthopaedics & Spine Center is committed is committed to the continued health and safety of all patients. During this time, we are taking all necessary precautions to screen for coronavirus (COVID-19) and to prevent its potential spread. We continue to monitor the evolving COVID-19 pandemic and are working with experts throughout Emory Healthcare to keep your patients safe. For the most up-to date information for our referring partners, click here.