Needle Tenotomy and Fenestration

Needle fenestration is the repeated passage of a needle through a degenerate area of tendon under ultrasound guidance, intended to restart a stalled healing response.

The terms overlap and are worth separating:

• •Needle fenestration: repeated manual needle passes through the abnormal tissue
• •Percutaneous needle tenotomy: used variably, and often the same procedure as fenestration
• •Powered ultrasonic devices: a probe that breaks up and removes tissue, a different intervention with a similar rationale

In sport and exercise medicine (SEM) it is used for persistent tendinopathy at sites such as the common extensor origin at the elbow, the patellar tendon, the gluteal tendons and the plantar fascia. This page covers the rationale, what the procedure involves, and how strong the evidence is.