Trigger Point (Dry-Needling)

Surgical tenotomy is a procedure where the tendon is divided and abnormal tissue is removed to promote healing. It is most commonly done to treat chronic tendinopathy (abnormal tendons) such as golfer’s elbow or jumper’s knee. Percutaneous needle tenotomy is a less invasive procedure where a needle is used to make multiple perforations in the abnormal tendon, which promotes healing and ultimately pain relief.

Dry needling is a technique where a needle is used to break up trigger points (tender knots in muscle). These are often found in the shoulders and neck region. No medication is typically injected, thus the term “dry” needling. It has been shown in studies to provide short-term relief of musculoskeletal pain, though the exact mechanism of how it works is still unclear.

Procedure Details

Percutaneous needle tenotomy – The physician will use ultrasound to identify the area for the procedure. The skin overlying this area will be injected with a numbing medication. Then, a needle will be used to break up the abnormal tendon tissue while also injecting a numbing medication for pain control at the same time. The needle will be passed several times through the tissue until all regions of abnormality have been passed through at least once.

Dry Needling – The healthcare provider will insert a sterile acupuncture needle about 5-10mm into the trigger point. He or she may make slight adjustments to the needle to cause a twitch response in the muscle. The needle will then be removed after about 30-60 seconds.

Post-Procedure Guidance

After tenotomy, there might be minimal bleeding at the injection site, which should be covered with a bandage.There also may be some local soreness, which could be treated with ice or pain medications as needed.The athlete should rest from sports activity, but may continue to do routine activities for the next few days.
Following dry needling there may be some redness or soreness in the area that can be treated by using ice.

Return to Play

After the first week following tenotomy, the athlete may gradually increase activity as tolerated. It is important to focus on early, but gradual range of motion and strengthening.Not everyone needs physical therapy afterward, but some may need it as recommended by their physician.It typically takes several weeks before the patient is able to return to full unrestricted activity.

The athlete may return to play right after the dry needling procedure.Care should be taken to identify and address what caused the trigger points, and focus on stretching tight muscles.