Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial

Blanca De-la-Cruz-Torres, Vanesa Abuín-Porras, Emmanuel Navarro-Flores, César Calvo-Lobo, Carlos Romero-Morales, Blanca De-la-Cruz-Torres, Vanesa Abuín-Porras, Emmanuel Navarro-Flores, César Calvo-Lobo, Carlos Romero-Morales

Abstract

Objective: The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE).

Methods: Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength-duration curve were evaluated.

Results: Both groups showed no differences in the baseline measurements (all p = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment (p = 0.001). However, chronaxie values always reported similar values with no differences between groups (p >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population.

Keywords: chronic pain; lateral epicondylalgia; neuromodulation; percutaneous nerve stimulation; radial nerve; rehabilitation; ultrasound.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
US-Guided PNM: (a) PES intervention in the radial nerve; (b) Ultrasound image of the intervention. B: brachialis muscle; BR: brachioradialis muscle, RN: radial nerve, H: humerus; and (c) ultrasound-guided invasive approach of the radial nerve.

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