Dry Needle Fenestration of Tendon
This can be thought of as acupuncture for tendons.
When a tendon undergoes repetitive strain or trauma over a long period of time, the body responds by putting up “patches”. These areas are referred to as tendinosis, and the irregular array of the patches leads to pain. The idea behind fenestration to target these patches and poke small holes into them. In a controlled way, this is very safe, as the tendon acts as a sponge as the needle is passed. By doing this, the body assigns a new priority to the previously patched-up area, into a more acute, inflammatory condition. This eventually leads into the tendon regeneration and healing that is required for proper repair.
The medical research for this procedure is continually evolving. It does not work for everybody. Please speak with your physician if this is the right treatment for you.
What are the benefits?
Pain relief and tendon repair/regeneration. The added benefit of doing this under ultrasound-guidance is that the exact areas of tendinosis can be visualized. So instead of fenestrating the entire tendon, only the areas which require it are targeted.
How long will my pain be reduced?
As pain is thought to be reduced through the healing response, this can take up to 6-8 weeks. The overall length of relief is variable, and an accurate average cannot be provided. The goal is to completely heal the tissue, if possible.
How often can I have this done?
The treatment protocol consists of 2-3 injections every 2-3 weeks. The idea is to stimulate an inflammatory response first, followed by organized tissue repair. The goal is to completely heal the tissue, if possible.
Who can’t have this done?
Any patient who may appear to have:
Infection within the body, near the site of administration, or the actual joint itself
What should I do in advance of my injection?
If possible, and safe:
Avoid corticosteroid medications 2-3 weeks prior to the procedure
Avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil), 1 week before
What are the side effects?
Common, but not severe
Pain after injection: A post-injection flare occurs in approximately 10% of patients. Like other injections, it usually settles within 2 days. Application of ice and Tylenol can help, if desired. Please avoid any anti-inflammatories, such as Advil (Ibuprofen) afterwards, as this can reduce how well the procedure works.
Pain during the procedure: The skin is the most sensitive part when it comes to any injection. We minimize this by using local anesthetic and/or a vapocoolant spray on the skin. Pain associated with the injection is usually brief and well-tolerated.
Not common, but potentially severe
Infection: When a needle is passed through the skin into the body, there is a very small chance of introducing a joint infection. The chance of this occurring is extremely low, less than 0.002%, or equivalent to being struck by a car as a pedestrian and experiencing a catastrophic event. To minimize this risk, we not only follow the WHO minimum best practice standards for injections, but use sterile gloves, sterile ultrasound probe covers, and sterile ultrasound gel.
Bleeding: This is a greater risk if you have a known bleeding disorder or are taking blood thinners. By using ultrasound guidance, there is less “poking” around to get to the target tissue of interest, and thus less theoretical risk of bleeding. Pressure is maintained over the skin afterwards to reduce bleeding.
Systemic Side Effects
No specific reactions have been described.
Can I drive afterwards?
We recommend bringing a driver with you if you’re scheduled for an ankle or foot injection. Otherwise, most people can drive afterwards. Nonetheless, we ask all patients to remain in the clinic waiting room for a minimum of 15 minutes afterwards to observe for any adverse reactions to the medication.
Can I play sports afterwards?
This depends on the type of sport and intensity, but we generally recommend taking it easy for 2 days as post-injection flares may occur. Overall, please be mindful with anything you do and listen to your body.