Percutaneous ultrasound guided needle tenotomy, or PUNT, can significantly improve pain and function for patients suffering from chronic resistant tendinopathy.
Shomal Zadeh
Firoozeh Shomal Zadeh, MD, post-doctoral research fellow at the University of Washington, Seattle and her team were planning to expand the clinical service of ultrasound-guided tenotomy and were reviewing available options, but had research questions about the best approach. For example, they questioned if assisted manual tenotomy was superior to manual tenotomy when both are done under ultrasound guidance and if PUNT would improve the pain intensity and functioning of chronic tendinopathy and if yes, how effective it is.
To find those answers, they conducted a literature review searching for terms including, tendinopathy, tenotomy, needling, tenex, fasciotomy, ultrasound guided and percutaneous. Studies that assessed the pain and disability improvement using the Visual Analog Scale (VAS), or the Disability of the Arm, Shoulder and Hand (DASH) Index after PUNT, were included.
Of 21 studies with a total of 806 subjects, the meta-analysis found that PUNT significantly alleviated pain and disability. Improvement was more significant during the short-term three-month follow-up. Additionally, these studies showed an overall positive outcome for quality of life, patient satisfaction and sonographic findings.
“We have learned that PUNT can improve pain (measured by VAS score) and disability (measured by DASH score) caused by chronic tendinopathy,” Dr. Shomal Zadeh said. “We found that there was no significant difference between wet and dry tenotomy, and also between manual and assisted manual tenotomy, although further studies are required to support these findings. Our analysis also showed that the best improvement was achieved during the short-term follow-up and persisted to intermediate-term and long-term follow-ups. So maybe 3 months of clinical follow-up after PUNT might be enough.”
Dr. Shomal Zadeh said extended use of PUNT may also qualify as a good replacement to open surgical tenotomy. PUNT can be done in an outpatient setting under local anesthesia, meaning it is a quicker and easier procedure with a shorter recovery time than surgery.
“We hope that our study can motivate radiologists to use more ultrasound-guided procedures for musculoskeletal complaints when it's possible,” Dr. Shomal Zadeh said. “It can enhance the efficiency of the procedure by targeting the specific pathologic parts and preventing damage to the adjacent healthy structures that might happen in a blinded approach. The addition of ultrasound guidance to these procedures could potentially reduce the complications and duration of the procedures and would lead to better outcomes.”
Access the presentation, “Percutaneous Ultrasound Guided Needle Tenotomy for Treatment of Chronic Tendinopathy: A Systematic Review and Meta-analysis,” (SPR-MK-27) on demand at Meeting.RSNA.org.
Severe tendinosis with heterogeneity at the insertion of common extensor tendon origin on lateral epicondyle with areas of microcalcification (arrows) and hypoechogenicity (arrowhead) of the common extensor tendon origin with disarrangement of normal fibrillar pattern.
Intra-procedural US showing Tenex needle (arrows) approaching area of tendinopathy with marked oscillation artifact deep to the needle.
