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      Efficacy of Fu's Subcutaneous Needling on Myofascial Trigger Points for Lateral Epicondylalgia: A Randomized Control Trial

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          Abstract

          Lateral epicondylalgia (LE), a common overuse syndrome of the extensor muscle and tendons on the lateral epicondyle, causes persistent severe musculoskeletal pain on the outer part of the elbow. Fu's subcutaneous needling (FSN), a newly invented subtype of acupuncture and dry needling, is a new trend and potential treatment of LE by targeting the myofascial trigger points (MTrPs). However, no scientific evidence is available to support this method. This study aims to evaluate the distal FSN treatment on the LE by measuring pain-related scales, such as visual analog scale (VAS), pressure pain threshold (PPT), muscle tissue hardness (TH), pain-free grip (PFG), and the functional outcome by a patient-rated tennis elbow evaluation (PRTEE) questionnaire study. A total of 60 LE patients were randomly divided into FSN ( n = 30) and transcutaneous electrical nerve stimulation (TENS, n = 30) as the control group. Every subject was treated with three regimens and followed up for 15 days. Results showed that FSN has an immediate effect on VAS, PPT, TH, and PFG. Moreover, sustained effects on pain relief were followed up to 15 days. Pain remission was consistent with long-term PRTEE results. Overall, FSN is a safe and efficient therapy option for LE, significantly improving pain relief and activity difficulty with immediate, short-term, and long-term effectiveness. This trial is registered with ClinicalTrials.gov NCT03605563.

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          Most cited references49

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

          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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            Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture.

            The mechanism of action of acupuncture remains largely unknown. The reaction to acupuncture needling known as 'de qi', widely viewed as essential to the therapeutic effect of acupuncture, may be a key to understanding its mechanism of action. De qi includes a characteristic needling sensation, perceived by the patient, and 'needle grasp' perceived by the acupuncturist. During needle grasp, the acupuncturist feels pulling and increased resistance to further movement of the inserted needle. We hypothesize that 1) needle grasp is due to mechanical coupling between the needle and connective tissue with winding of tissue around the needle during needle rotation and 2) needle manipulation transmits a mechanical signal to connective tissue cells via mechanotransduction. Such a mechanism may explain local and remote, as well as long-term effects of acupuncture.
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              A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia.

              A systematic review of the literature on the effectiveness of physical interventions for lateral epicondylalgia (tennis elbow) was carried out. Seventy six randomised controlled trials were identified, 28 of which satisfied the minimum criteria for meta-analysis. The evidence suggests that extracorporeal shock wave therapy is not beneficial in the treatment of tennis elbow. There is a lack of evidence for the long term benefit of physical interventions in general. However, further research with long term follow up into manipulation and exercise as treatments is indicated.
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                Author and article information

                Contributors
                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi
                1741-427X
                1741-4288
                2022
                14 March 2022
                14 March 2022
                : 2022
                : 5951327
                Affiliations
                1Department of Chinese Traumatology Medicine, China Medical University Hospital, 404332 Taichung, Taiwan
                2School of Chinese Medicine, College of Chinese Medicine, China Medical University, 406040 Taichung, Taiwan
                3Lin Clinic, 404332 Taichung, Taiwan
                4Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, 406040 Taichung, Taiwan
                5Institute of Fu's Subcutaneous Needling, Beijing University of Chinese Medicine, 100029 Beijing, China
                6Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 404332 Taichung, Taiwan
                7Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, 406040 Taichung, Taiwan
                8Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, 413505 Taichung, Taiwan
                Author notes

                Academic Editor: Jianliang Zhang

                Author information
                https://orcid.org/0000-0002-3540-6225
                Article
                10.1155/2022/5951327
                8938053
                35321501
                9e21140e-9a27-44b4-b703-116fd1ba6b40
                Copyright © 2022 Ching-Hsuan Huang et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 November 2021
                : 30 December 2021
                : 12 February 2022
                Funding
                Funded by: China Medical University Hospital
                Award ID: DMR-110-123
                Award ID: DMR-111-089
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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