Hamstring Tendon Ultrasound Guided
Percutaneous Tenotomy (Tenex) Guideline
The ultrasound guided percutaneous tenotomy procedure allows what was once major
surgery to be performed quickly through a small incision. Although post-procedure care
will be tailored to fit your individual needs, the following guidelines are designed to help
you and your physical therapist after the procedure.
Please note that the following guidelines are just that; guidelines. The instructions may
differ from provider to provider and patient to patient. All patients are different and
circumstances are different.
Things to Avoid Before and After Your Procedure
● Anti-inflammatory medicine like ibuprofen (Advil™, Motrin™) and naproxen
(Aleve™, Naprosyn™): Avoid 2 weeks before and 1 week after your procedure.
● Acetaminophen (Tylenol™) is okay to take before and after your procedure
● Alcohol: Avoid 48 hours before your procedure. Do not consume alcohol while
you are taking prescription pain medication.
● Tobacco & nicotine: Consider talking to your physician about stopping. These
products impair your ability to heal and might reduce the beneficial effects of the
procedure.
● Diet: There is no need to fast before the procedure. You may eat normal meals
before your procedure and resume your regular diet when you feel able.
Make sure you have the following before or at your
procedure:
• Crutches, if needed
• Physical therapy appointment times or home exercises
• Follow-up appointments (1, 6, 12 weeks post Tenex procedure)
• Optional: Roho cushion or Purple cushion (16x16 or 18x18 size is sufficient)
Post-Operative Information
Crutches ● Weight-bearing: It is OK to toe-touch weight bear as tolerated
after the procedure.
● You can use crutches as needed for pain control.
Discomfort ● Some pain after the procedure is expected for the first few weeks.
Anticipate pain about 6-8 hours after the procedure once the
anesthetic medicine wears off. Please take Acetaminophen
(Tylenol™) about 6 hours after the procedure.
● Use ice on the painful area for 15 minutes as needed. Consider 3
times a day for the first few days.
● Contact your care team if you have any concerns about your pain.
Bandage ● Remove dressing after 24-48 hours. Replace it with a simple
bandage.
● Steri strips can be removed after 7 days or when they start to peel
Bathing ● Do not soak/submerge the treatment area in water for 1 week.
● Showering is OK, but keep the incision site covered for the first
week.
When to call ● If you notice increasing redness, warmth, pain, fever, drainage
Provider from the wound or other problems that concern you, please call
our office during normal clinic hours. Otherwise seek care at your
local emergency room.
Post-Tenex Rehabilitation Timeline
Day 1 (day of your procedure)
● Plan to have a family member or friend drive you home after your procedure.
● Bring crutches to the appointment if you received one before.
● Weight-bearing: Toe-touch weight bearing with crutches
● Activity & Rehab: Rest to minimize irritation of the tendon
Days 2 - 7
● Ambulation: Toe-touch weight bearing with crutches
o After 3 days you can put about 50% of your body weight on your treated leg
● Activity & Rehab: Begin gentle hip range of motion exercises to increase hip flexion.
● Avoid stretching your tendon.
Week 2 (Days 8 - 14)
● Weight-bearing: 50% partial weight bearing with crutches
● Activity & Rehab: Continue daily hip range of motion 3 times a day. Add isometric
strengthening of the quadriceps (quad squeeze) and glute squeezes
● You should have an appointment scheduled during this week. If not, please
schedule it.
Week 3 - 4 (Start PT and home strengthening exercises)
● Weight-bearing: Beginning weaning off of crutches
o No crutches with walking at home
o Partial weight bearing with crutches in the community
● Activity & Rehab: Continue hip range of motion and isometric exercises.
o Incorporate core stability exercises.
o Begin straight leg raises and heel slides
● You can start swimming & pool exercise when the wound is healed.
Week 5 - 6
● Weight-bearing: Walk normally in the community
● Activity & Rehab
o Continue hip range of motion exercises.
o Start gentle hamstring stretching.
o Begin knee flexion and hip extension strengthening exercises.
o Begin balance exercises.
● You should have an appointment scheduled during this week. If not please schedule
it.
Week 7-11
● Weight-bearing: Ambulate as tolerated
● Activity & Rehab
o Continue to progress range of motion and balance exercises.
o Increase intensity and complexity of strengthening exercises.
o Begin low impact aerobic activity (biking, swimming, elliptical, walking).
o Can initiate a return-to-running program if able to perform low impact aerobic
exercises and strengthening exercises (single leg deadlifts, split squats,
etc…) with minimal reactive pain (3/10).
Week 12
● Activity & Rehab: Once you are working hard at the activities above without pain,
progress to higher impact activities (like jogging, running, sprinting & jumping) as
directed by your care team.
● You should have an appointment scheduled during this week. If not please schedule
it.
Criteria to Progress to Unrestricted Activity
1. Pain free during rehabilitation exercises throughout week 11-12
2. No reactive pain
3. Good dynamic control in multiple planes
4. Physician approval