Revolutionary treatment of tennis elbow
20 minutes to relief
Nagging, chronic elbow pain can interfere with a person's livelihood or favorite pastime — in fact, it's commonly called tennis elbow, golfer's elbow, shooter's elbow or archer's elbow. For Chad Apel, a 36-year-old carpenter from Blooming Prairie, Minn., time and physical therapy didn't resolve his elbow pain.
Apel wore a brace on his elbow and rested the joint, which helped for a few months. But in spring 2011, the pain returned worse than ever. Like 10 percent of people with elbow overuse injuries, Apel found out he would need surgery.
Mayo doctors invent minimally invasive FAST procedure
Highly invasive surgery requiring a 2-inch incision used to be the only answer. But, Darryl Barnes, M.D., a sports medicine physician at Mayo Clinic Health System in Austin, Minn., and his colleague Jay Smith, M.D., a Physical Medicine and Rehabilitation physician practicing at the Sports Medicine Center at Mayo Clinic in Rochester, Minn., have developed a new minimally invasive treatment.
"Surgery for tennis elbow is invasive...cutting through a lot of healthy tissue to get to a very small, diseased tendon," says Dr. Smith. "Using state of the art ultrasound equipment, we felt that we could find a way to treat the diseased tendon without having to cut down to it."
So Drs. Barnes and Smith combined efforts to develop a better way to treat this common problem.
The anatomy of the problem
According to Dr. Barnes, doctors used to think inflammation caused tennis elbow pain, but more recently they've discovered that the problem is actually scar tissue deep within the tendon. "We've found that if you don't remove the bad tissue, the patient doesn't heal."
Using expanded capabilities of ultrasound, Drs. Barnes and Smith can clearly visualize where the bad tissue is located in the tendon. So, the doctors created a TX-1 micro tip — which is the size of a toothpick — to insert into skin that has been numbed with a local anesthetic.
"We only have to make a small nick in the skin — less than 5 millimeters," explains Dr. Barnes.
When the tip has reached the scar tissue, a computer console delivers precise ultrasonic energy to break up the scar tissue. The micro tip also houses a saline delivery system and a hollow needle to extract fluid and the broken-up scar tissue.
Drs. Barnes and Smith successfully patented the TX-1 machine and the FAST procedure, which stands for Focused Aspiration of Scar Tissue. Today, patients of more than 20 medical centers throughout the U.S. can access the FAST procedure.
Once the 20-minute procedure is complete, all the patient needs is an adhesive bandage and some over-the-counter pain medication.
"The promise of a faster recovery time that made me want to try the FAST procedure," says Apel, who was one of Dr. Barnes' first clinical patients after the device was manufactured. "I felt confident in Dr. Barnes, since he was one of the inventors." Within three months after his FAST procedure, Apel's elbow was as "good as new," and he now has full use of it with no restrictions.
"Early data are showing that ... results with FAST are equivalent to and may be better than the open surgical option," says Dr. Smith. He points out that though the device is new, the idea isn't. "Available evidence suggests that you probably need to remove the scar tissue to most effectively treat the problem. That's why FAST is so successful. It's just a better way to do what we already know works."
The FAST procedure was developed for tennis elbow, but it has potential applications wherever tendon scar tissue is found. Drs. Barnes and Smith said that the procedure could be used for certain types of rotator cuff problems, runner's knee, plantar fasciitis and Achilles tendinosis.
"It's very satisfying to offer something to a patient that is effective, low risk and offers a short recovery time, but then to know that you've played a part in bringing it into being...that's beyond words. It's exciting, to say the least," says Dr. Barnes.
Mayo Clinic and Drs. D. Barnes and J. Smith have a financial interest in the technology referenced in this article. In accordance with the Bayh-Dole Act, this technology has been licensed by Mayo Clinic to Tenex in exchange for equity and royalties.