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Surgical Tenotomy uses either traditional open surgery methods or arthroscopic methods to remove scarred or damaged tendon tissue. Arthroscopic Needle Tenotomy is a form of surgery that involves an incision (or two) And perhaps larger incision(s) than for the techniques mentioned earlier

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Baseline: CBC, B12, folate, iron studies Repeat B12 levels 1 month after loading dose Annual checks for chronic therapy Monitor potassium during initial treatment Neurological exams for neuropathic symptoms B12 injections can "mask" megaloblastic anemia from folate deficiency while allowing neurological damage to progress

But their consistency is what separates short-term weight loss from lasting change