percutaneous needle tenotomy
Started by oreosandsake
US is now so good I use it to drive my car.
(Or so the experts would have us believe)
Where did you see the presentation? Would love to lean the technique myself. I am attending a few advanced ultrasound workshops at AAPM&R so hopefully get to learn tenotomy techniques. DOctorJay did you learn these at Mayo?
Even Batman used US for finding Joker so soon it will replace GPS!
Finnoff published a tenotomy technique in purple PM&R 2011 for lateral epicondylosis which standardized the method and is applicable to patellar tendonosis, greater trochanter(osis), hamstrings, plantar fasc, etc. Saboeiro just published a lavage/tenotomy technique for supraspinatus calcific tendinitis in this month's journal of US which I've been using for over 3 years now with good success. It seems to be more efficacious with blood or PRP, but not enough published data to say for certain. I will tell you NO insurance will reimburse for tenotomy codes if done in office. Take it to your ASC and maybe you'll get it covered but out of pocket for patient will probably be too much for them. The IR guys have better luck with reimbursement because they do it all in IR suites.
Finnoff published a tenotomy technique in purple PM&R 2011 for lateral epicondylosis which standardized the method and is applicable to patellar tendonosis, greater trochanter(osis), hamstrings, plantar fasc, etc. Saboeiro just published a lavage/tenotomy technique for supraspinatus calcific tendinitis in this month's journal of US which I've been using for over 3 years now with good success. It seems to be more efficacious with blood or PRP, but not enough published data to say for certain. I will tell you NO insurance will reimburse for tenotomy codes if done in office. Take it to your ASC and maybe you'll get it covered but out of pocket for patient will probably be too much for them. The IR guys have better luck with reimbursement because they do it all in IR suites.
yes we learn this at Mayo. I've done US guided tenotomy for lateral epicondylosis and I've seen it done in sports with Big Jay for other tendon problems and prior to PRP. It's fantastic for breaking up and lavaging calcific tendonopathies as you can see the calcification on ultrasound and then aspirate the calcium.
they will teach you this at AIUM (held every July at Mayo), AAPM&R's course should be solid but they probably won't have cadaver experience like AIUM does.
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I was sure you guys did this at mayo. seems like all the papers come out of there.
Jay, I couldn't find the July course at the AIUM website. any info from your end?
I guess they don't have it listed for next year yet. Here is a link from last year's course.
http://www.aium.org/cme/events/pg2012_7/brochure.pdf
Do you use a different gauge needle when performing the tenotomy. I am unsure of how tenotomy is different from fenestration? Was the protocol at Mayo to repeat the u/s guided injection with PRP at a later time vs the time of the tenotomy?
Found this on mayo.edu
"Needle tenotomy of the common extensor tendon origin
a. Patient position
i. Supine
ii. Elbow in 20-40 degrees of flexion
iii. Palm facing the table (ie: forearm pronated)
b. Transducer position
i. Longitudinal relative to the common extensor tendon origin
ii. Over the region of tendinopathy
c. Needle Orientation Relative to the Transducer
i. In plane/long-axis/longitudinal/in-plane
ii. Intermittently switch to a out of plane/short-axis/transverse view in order to determine the anterior-posterior/radial-ulnar position of the needle within the region of tendinopathy
d. Needle Approach
i. Distal to proximal
ii. Alternatively, proximal to distal
e. Target
i. Repetitively fenestrate the entire region of tendinopathy
ii. Consider treatment of intratendinous calcifications and enthesophytes
f. Pearls/Pitfalls
i. Identify and avoid the radial nerve, PIN, radial recurrent artery, and lateral collateral ligament complex
ii. Use a large gauge (18 gauge or 19 gauge) needle
iii. Try not to withdraw the needle from within the tendon while performing fenestrations"
Guass, how can you even bill for a tenotomy when most of the ICD 9 codes specifically say "open tenotomy". Do you bill it as an unlisted procedure? How do the orthopods feel about calling it a tenotomy?
