Pain Relief Without Major Surgery: How Patricia Got Her Life Back

Finding Relief for Hip Pain

When pain from all that activity started in her hips, Patricia knew she couldn’t give up on the active life she loved.

First, she met with an orthopedic surgeon who tried giving her cortisone shots, but they didn’t provide enough relief.

Her doctor knew Patricia needed a different solution. He recommended she see Ferheen Shamim, M.D., an expert in sports medicine at Hackensack Meridian Health, whose goal is to help people heal and recover.

After meeting with Dr. Shamim in 2022, Patricia embarked on a path that would help her regain her active lifestyle.

Pinpointing the Issue: Diagnosis

“Patricia is very active; working in retail, she was always on her feet, but standing all day was tough, causing pain on the side of her hip,” says Dr. Shamim. “With some evaluation, we realized it was not sciatica, and that it was actually a gluteus tendon that was causing her pain. She had tendinosis, or dead ends of tendon tissue that were irritating the bursa around her hip.” 

Think of your hip joint like this: 

• Bones: You have your hip bone.
• Tendons: Strong, rubber band-like tissues called gluteal tendons connect your butt muscles to your hip bone.
• Bursa: A small, fluid-filled cushion called a bursa sits between the tendons and the bone to prevent rubbing.

For a long time, when people had pain on the side of their hip, doctors called it "trochanteric bursitis." They thought the main problem was that the bursa, or cushion, was swollen and inflamed.

“Now with the use of MRIs and ultrasound, we see that it's actually micro tears in the gluteal tendons,” says Dr. Shamim. 

“This type of injury can happen in one of two categories of people: it happens from overuse, but also when you’re asking the tendon to do more than it’s capable of doing,” Dr. Shamim explains. 

When you ask the tendon to work harder than it's ready for, it gets tired and sore. It's like a rubber band starting to get tiny, little tears because it was stretched too much, too fast. 

Dr. Shamim shares that most patients with this injury experience a few common symptoms:

• Pain on the outer side of the hip.
• Difficulty and pain when climbing stairs.
• Pain that gets worse at night, making it hard to sleep on that side or even waking them up.

A New Way to Heal: Tenex and PRP

For Patricia, Dr. Shamim suggested treatments that didn’t require major surgery, starting with a percutaneous ultrasonic tenotomy procedure, commonly known by the brand name Tenex.

The Tenex procedure is simple and doesn’t require a big incision. Here’s how it works:

• Finding the damage: First, the doctor will use an ultrasound to find the damaged tissue. 
• Numbing: The doctor then numbs the area using a local anesthetic. 
• Clearing the area: The doctor then makes a small incision. A small tool is then inserted to gently break up and remove the damaged tissue that is causing the pain. This stimulates blood flow and healing of the tendon.

“I had no pain at all during or following the procedure. The results were incredible!” Patricia says. 

Health insurance often covers this treatment, and it typically resolves the issue for good. “When you’ve already tried cortisone shots once or twice, it’s time to stop calming the problem, and actually heal it,” Dr. Shamim says. 

“Patricia is a great example of how this procedure can be curative – she’s never needed an area treated twice.”

Healing Her Elbow

A year later, in 2023, Patricia started having pain in her right elbow. She knew exactly who to call: Dr. Shamim. 

This time, Dr. Shamim recommended two procedures to heal the tear in her elbow: PRP injections (Platelet-Rich Plasma) and a second Tenex procedure. Using them together would give her the best chance to heal and avoid a big surgery.

PRP injections work by using your own blood to help the body heal itself.

• Collecting a blood sample: First, a doctor takes a small amount of your blood.
• Creating the PRP: Second, they use a machine to gather all the tiny healers from your blood, called platelets. This makes the platelet-rich plasma (PRP). 
• Injecting the PRP: Then, the PRP is injected into the part of your body that is injured.
• Natural healing: These platelets get to work, telling your body to repair itself, which helps reduce pain and heal the injury naturally. 

When to use PRP vs. Tenex

“The first step is coming to the office and doing a thorough assessment of your strength and function. An ultrasound and X-ray can also help put the pieces together to see what’s the most logical, quickest way to full healing,” says Dr. Shamim.

A Tenex procedure is best for partial tears, and a PRP injection is best for nearly full-thickness tears. However, for a complete, full-thickness tear where the tendon is torn in two, PRP cannot reattach it. In severe cases, surgery is usually the necessary treatment to physically reattach the tendon.

“If I see dead tissue and small, micro-tears, then Tenex is going to be the answer. But if I see a large partial tear that’s nearly fully torn, we don’t want to remove anything from this tendon since it’s already almost detached; that’s where PRP comes in,” says Dr. Shamim.

These treatments worked wonders for Patricia’s elbow. 

The pain from her injuries had stopped Patricia from exercising and doing the things she loved. However, the Tenex and PRP procedures provided her with almost immediate results and a very smooth recovery.

Back to Doing What She Loves

Thanks to these treatments, Patricia is back to a healthy, active lifestyle. While she isn’t running 10 miles a day anymore, she and her husband enjoy taking their dog for long walks every day.

She was so happy with her results that she and Dr. Shamim are now considering another PRP treatment to help her right elbow, which has started to have some pain.

Patricia is so thankful for the care she received that she even recommended Dr. Shamim to a customer at the store where she works.

“Everybody is awesome, the staff is top-notch,” reflects Patricia.

Next Steps & Resources

• Meet our source: Ferheen Shamim, M.D.
• Make an appointment online with an orthopedic expert, or call 800-822-8905.
• Learn more about sports medicine services at Hackensack Meridian Health.