The short answer
When tennis elbow hasn't improved with bracing and physical therapy, two ultrasound-guided, non-surgical options remain. PRP injects concentrated platelets from your own blood to stimulate tendon healing. Tenex (percutaneous tenotomy) removes degenerated scar tissue through a tiny opening, with no stitches and recovery in about 4–6 weeks. Dr. Marc Gruner, DO, in Bethesda, MD, performs both and uses an in-office ultrasound to decide which fits.
Written by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship
Tennis Elbow Diagnosis and Treatment — Dr. Marc Gruner
Tennis elbow (lateral epicondylitis) is a degenerative overuse injury of the common extensor tendon on the outside of the elbow. Most cases improve over 4–6 weeks with activity changes, a counterforce brace and a structured physical therapy program. The cases that linger for months are where PRP and Tenex come in.
Both are done in the office under ultrasound guidance and local anesthesia, and both avoid open surgery. They work in opposite ways.
How Tenex and PRP compare
| PRP | Tenex (percutaneous tenotomy) | |
|---|---|---|
| What it does | Adds concentrated growth factors to stimulate the tendon's own repair | Uses ultrasonic energy to break up and remove degenerated scar tissue, leaving healthy tendon intact |
| How it is done | A blood draw, about 15 minutes in a centrifuge, then an ultrasound-guided injection | A tiny opening under local anesthesia and live ultrasound guidance; a bandage, no stitches |
| Recovery | A few days of soreness; improvement builds over 4–6 weeks | Return to normal tendon function typically in 4–6 weeks |
| Who it suits | Chronic tennis elbow that hasn't responded to bracing and therapy | Patients who have already tried injections, rest, immobilization and therapy without lasting relief |
Which one is right for you
The answer comes from looking at the tendon. Dr. Gruner confirms the diagnosis with diagnostic ultrasound at the first visit, which shows the state of the tendon and whether other structures are involved. PRP is one of the better-studied options for chronic tennis elbow. Tenex is for patients who have already tried injections, rest, immobilization and physical therapy without lasting relief.
Either way, rehabilitation afterward matters. A progressive loading program is what restores grip strength and keeps the pain from coming back.
Frequently asked questions
- Is Tenex or PRP better for tennis elbow?
- They do different things. PRP stimulates the tendon to heal; Tenex removes the degenerated tissue driving the pain. PRP is a well-studied option for chronic tennis elbow, and Tenex is for patients who have not improved with injections, rest and therapy. An ultrasound exam shows which fits.
- How long is recovery after a Tenex procedure for tennis elbow?
- There are no stitches, just a bandage, and most patients return to normal tendon function within about 4–6 weeks.
- Who performs Tenex and PRP for tennis elbow in Bethesda?
- Dr. Marc Gruner, DO, a Mayo Clinic–trained sports medicine physician registered in musculoskeletal sonography (RMSK), performs both at OrthoBethesda in Bethesda, MD.
This article is for general education and is not a substitute for individualized medical advice. Please consult a qualified clinician about your specific condition.