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      Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results

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          Abstract

          Background

          Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle.

          Objective

          To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time.

          Methods

          A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates.

          Results

          All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks.

          Conclusions

          Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term.

          Trial registration number

          ClinicalTrials.gov identifier: NCT02085928.

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          Most cited references36

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          Prevalence and determinants of lateral and medial epicondylitis: a population study.

          Helena Varonen, Rahman Shiri, Eira Viikari-Juntura … (2006)
          Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.
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            Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.

            T Pavelko, Allan Mishra (2006)
            Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention. Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem. Cohort study; Level of evidence, 2. One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5). Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001). Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.
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              Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.

              Peter Brooks, Bill Vicenzino, Leanne Bisset … (2006)
              To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow. Single blind randomised controlled trial. Community setting, Brisbane, Australia. 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months. Eight sessions of physiotherapy; corticosteroid injections; or wait and see. Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks. Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections. Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.
              Article 0 comments Cited 115 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acupunct Med
                Journal ID (iso-abbrev): Acupunct Med
                Journal ID (hwp): acupmed
                Journal ID (publisher-id): aim
                Title: Acupuncture in Medicine
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0964-5284
                ISSN (Electronic): 1759-9873
                Publication date (Print): December 2014
                Publication date (Electronic): 13 August 2014
                Volume: 32
                Issue: 6
                Pages: 446-454
                Affiliations
                [1 ]MVClinic , Madrid, Spain
                [2 ]Fremap Hospital , Majadahonda, Madrid, Spain
                [3 ]Faculty of Medicine, San Pablo CEU University , Madrid, Spain
                [4 ]Department of Physiotherapy, University of Murcia , Murcia, Spain
                Author notes
                [Correspondence to ] Dr Fermín Valera-Garrido, Department of Physical Therapy, MVClinic, Juan Antonio Samaranch Torelló 6B, St., Edif Fitness Sports Valle de Las Cañas, Pozuelo de Alarcón, Madrid 28223, Spain; ferminvalera@ 123456mvclinic.es
                Article
                Publisher ID: acupmed-2014-010619
                DOI: 10.1136/acupmed-2014-010619
                PMC ID: 4283658
                PubMed ID: 25122629
                SO-VID: 9baf3ff5-4ca2-42d4-a2dc-3f04055a5914
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 20 June 2014
                Date revision received : 21 July 2014
                Date accepted : 24 July 2014
                Categories
                Subject: 1506
                Subject: Original Paper
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                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: sports medicine,ultrasonography
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: sports medicine, ultrasonography

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