Over 30 million doctor visits are attributed to chronic refractory tendinopathy each year (2013). Despite the significant burden of sickness caused by this syndrome, there is no unanimity on treatment or even what constitutes a chronic refractory state. The notion of a chronic refractory process has been refined by recent research. More importantly, a revolutionary new technique looks to offer a potential treatment for the majority of patients at all anatomic locations of involvement. In over 70,000 treatments over the last 6 years, the use of an ultrasonic device directed to diseased tissue under ultrasound picture guidance has proven to be extremely safe and effective. As more clinical trials become available, documented experience suggests that this treatment is conducted with the same difficulty and safety as a cortisone injection, but without the cost or morbidity of surgery.