TENOTOMY New nonsurgical treatment of chronic tendon and joint pain

TENOTOMY is a revolutionary new percutaneous procedure which cures chronic tendinitis and bursitis. The Tenotomy and fasciotomy treatment uses physical needle stimulation which breaks down adhesions, scar tissue and calcifications and at the same time uses normal saline perfusion to wash out and remove broken tissue and debris from the tendons and joints. This precise mechanical “cleaning” and solution “suction fluid vacuuming” technique targets and eliminates the source of chronic tendon and joint pain.

Tenotomy is performed under ultrasound guidance. A trained physician sees the needle in the proper location within the tissue and observes the tissue changes during the procedure. The technique uses a precise 11 or 12 gauge needle to deliver a controlled supersonic stream of normal saline (sterile salt water solution). Along with a precise delicate suction mechanism to differentiate between a diseased and a healthy tendon, then removes the fragments which are not supposed to stay within the healthy tissue. Using the principle of flow dynamics, it creates an in-line Venturi suction effect to debride and evacuate diseased tissue. Ultrasound guidance enables continuous visualization of the tissue and visible changes in tendon anatomy are being observed during the procedure. Percutaneous Tenotomy is performed in an outpatient setting. It is performed under local anesthesia (similar to dental procedure numbing with Lidocaine or other local anesthetic). The procedure lasts about 15 minutes. A follow up appointment is scheduled within 2 to 7 days. Recovery time is 3-7 days. Results are fast and long lasting. Patients avoid surgery and lengthy recovery times.

The Tenotomy procedure is used to treat shoulder (rotator cuff tendinopathy), elbow (tennis elbow and golfer’s elbow), hip (trochanteric bursitis and tendinitis), knee (Patellar tendinitis, osteoarthritis, meniscal tear), foot and ankle (plantar fasciitis, calcaneal spurs) and more.  Tenotomy is covered by most insurance plans.

It is often combined with PRP (Plateletss Rich Plasma) injections.

For further information and to make an appointment please call:


 Dorota M Gribbin, M.D.


toll free 1-844-866-4488

369 Applegarth Road, Suite #4, Monroe Township, NJ 08831

181 North Harrison Street, Princeton, NJ 08540

2333 Whitehorse-Mercerville Road, Suite #8, Mercerville, NJ 08619

Common Arthritis Pain Conditions

Hip Arthritis?  Osteoarthritis?

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis. It occurs more frequently as people get older.

Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes, such as knobby finger joints.

Here are some of the most common arthritis conditions:

  • Degenerative Arthritis

Osteoarthritis is the most common type of arthritis. When the cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic.

Osteoarthritis is common in the knees because the knees bear the weight of the body. Osteoarthritis of the knee is more common in older people, in women, and in people who have occupations that place increased stress on the knees. People who have certain diseases, bone deformities or a genetic predisposition are also at a higher risk. Obesity can also raise a person’s risk for osteoarthritis of the knee, because extra body weight increases stress on the knee joints.  Do you KNOW if you lose 10 lbs. your knee pain improves by up to 50%!

Knee Osteoarthritis Symptoms

Symptoms of osteoarthritis of the knee may include pain, swelling and stiffness of the joint. The knee may become weak, and it may lock or buckle when walking. A person with osteoarthritis may have trouble bending or straightening the knee. Standing or walking for long periods may worsen this pain.

Treatment for Osteoarthritis

Treatment options depend on the severity of the arthritis. In the early stages, the knee may be treated with non-steroidal anti-inflammatory medications, corticosteroid injections, and injections of medications that lubricate the joint. The physician may recommend physical therapy, a knee brace and weight loss to relieve stress on the joint. If these methods are not helpful and if the knee continues to deteriorate, surgery may be needed to repair the joint

  • Inflammatory Arthritis

A healthy immune system is protective. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can go awry, mistakenly attacking the joints with uncontrolled inflammation, potentially causing joint erosion and may damage internal organs, eyes and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes.

Hip Arthritis is a condition that is an irritation of the hip joint that can cause inflammation, pain, and limited mobility.

Hip Arthritis Treatment 

The most preferable treatment is PRP, for the right candidate, or Prolotherapy.

Alternate treatment options include rest, non-steroidal anti-inflammatory medications, cortisone injections, disease modifying agents, antibiotics, and modification of daily activities. Severe cases may require surgery.

In some cases, a virus or bacteria may trigger an immune system response that attacks the joint in people with genetic predisposition. However, the exact cause of the condition is unknown. Other types of inflammatory arthritis include rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus.

Diagnosing Arthritis

Arthritis diagnosis often begins with a physical exam and may do blood tests and imaging scans to help determine the type of arthritis.

What Can Be Done About Arthritis?

There are many things that can be done to preserve joint function, mobility and quality of life. Learning about the disease and treatment options, making time for physical activity and maintaining a healthy weight are essential.


An Innovative Therapy for Chronic Pain

Prolotherpay is a method of injection treatment designed to stimulate healing. Various irritant solutions are injected into the ligaments, tendons, and joins to encourage repair, of damaged tissue.

Works for a Wide Variety of Conditions

Prolotherapy has been successfully treating patients with arthritis, rotator cuff problems, recurrent knee pain, whiplash injuries, sciatic pain, and other conditions.

Prolotherapy is a nonsurgical treatment which stimulates healing. Short for “proliferation therapy,” Prolotherapy is also known as nonsurgical ligament and tendon reconstruction, or regenerative injection therapy. Prolotherapy works by getting the body to use its own natural healing mechanisms to repair injured and painful joint areas and musculoskeletal tissue.


Prolotherapy, developed 40 years ago by George S. Hackett, MD, a surgeon from Canton, Ohio, is based on the premise that much musculoskeletal pain is due to weakness of the ligaments and tendons. Ligaments and tendons are tough, fibrous bands of tissue that connect bone to bone, or bone to muscle. They are the stabilizers of the musculoskeletal system. As long as they are strong and taut, they keep bones, joints and muscles in place and allow for pain-free, smooth movement.

When the joints or ligaments become injured, weak or lax, these other structures become unstable and move out of position. The areas where the ligaments attach to the bones, called the fibro-osseous junctions, are rich in nerve endings, so the resulting misalignment can be quite painful and pain signals may be transmitted to nearby areas. Nerves and blood vessels may be compressed or pinched, and cartilage may be damaged.

Hackett describes prolotherapy as “strengthening the weld of disabled ligaments and tendons to bone by stimulating the production of new bone and fibrous tissue cells.”

This isn’t a new concept. Hippocrates reportedly inserted hot needles into the shoulder joint capsules of javelin throwers in Sparta to treat chronic dislocation. A precursor to prolotherapy, scar therapy or sclerotherapy (not to be confused with an unrelated treatment of the same name for varicose veins) has been used to treat damaged tendons since the 1930s. Dr. Hackett simply refined and renamed the procedure.  This form of treatment is also referred to as “proliferant injection therapy”. He defines it as”the rehabilitation of an incompetent structure by the generation of new cellular tissue”. The Prefix “prolo” refers to “proliferate”.

Benefits Are Often Permanent

Prolotherapy is an effective treatment for all joints and ligaments and all age patients. It corrects  by strengthening and stabilizing the ligaments and tendons. A solution is injected into the affected ligament, tendon, and/or joint capsule, causing inflammation. As the structures heal, they regain strength and stability. Pain goes away, and because the underlying problem has been corrected, it stays away. No corticosteroids are used.

Explanation of treatment

Types of Prolotherapy include Dextrose ProlotherapyPlatelet Rich Plasma Prolotherapy (Referred to as “PRP”) or bone marrow and/or fat (adipose) tissue from an individual’s own body which contain adult stem stromal cells (known as Biocellular Prolotherapy).

Dextrose Prolotherapy – A 25% Dextrox (solution of sugar with local anesthetic) is injected into the tendon/ligament area. This method heals the ligaments and tendons by making them stronger and thicker. No corticosteroids are used. Depending on the body part.  Depending on the body part, ultrasound and/or fluoroscopy guidance may be used. The use of diagnostic musculoskeletal ultrasound imaging is to detect and direct injections to the correct injury site.

Do you experience numbness, weakness and pain in your hand ?

It may be related to carpal tunnel syndrome or other entrapment neuropathy. It may be related to pinch nerve in your neck, wrist or elbow. The condition is not only the matter of discomfort; it may destroy your nerve leading to loss of function of your limb.

Diagnostic methods and treatment modalities are available and very effective now.

We specialize in diagnosis and nonsurgical treatment of carpal tunnel syndrome and other neuropathies.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel . The median nerve controls movement and feeling  in your thumb and first three fingers (not your little finger).

What causes carpal tunnel syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:

  • Illnesses such as hypothyroidismrheumatoid arthritis, and diabetes.
  • Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
  • Pregnancy.

What are the symptoms?

Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger.

You may first notice symptoms at night. You may be able to get relief by shaking your hand.

How is carpal tunnel syndrome diagnosed?

Your doctor will ask if you have any health problems-such as arthritishypothyroidism, or diabetes-or if you are pregnant. He or she will ask if you recently hurt your wrist, arm, or neck. Your doctor will want to know about your daily routine and any recent activities that could have hurt your wrist.

During the exam, your doctor will check the feeling, strength, and appearance of your neck, shoulders, arms, wrists, and hands. Your doctor may suggest tests, such as blood tests or nerve tests. Schedule the consultation NOW !

Call: Dr Dorota Gribbin, MD  609-588-0540 Toll free: 1-844-866-4488