Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial

Manuel Rodríguez-Huguet, Jorge Góngora-Rodríguez, Rafael Lomas-Vega, Rocío Martín-Valero, Ángeles Díaz-Fernández, Esteban Obrero-Gaitán, Alfonso Javier Ibáñez-Vera, Daniel Rodríguez-Almagro, Manuel Rodríguez-Huguet, Jorge Góngora-Rodríguez, Rafael Lomas-Vega, Rocío Martín-Valero, Ángeles Díaz-Fernández, Esteban Obrero-Gaitán, Alfonso Javier Ibáñez-Vera, Daniel Rodríguez-Almagro

Abstract

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach-trigger point dry needling (TDN)-in patients with LE. A randomized controlled trial was conducted in which 32 participants with LE were randomly assigned to two treatment groups, the PE group (n = 16) and the TDN group (n = 16). Both groups received four therapy sessions and an eccentric exercise program to be performed daily. The numerical pain rating scale (NPRS), pressure pain thresholds (PPT), quality of life, and range of motion were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Significant between-group mean differences were found after treatment for NPRS (p < 0.001) and flexion movement (p = 0.006). At one-month follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.021), and flexion (p = 0.036). At three-months follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.004), and flexion (p = 0.003). This study provides evidence that PE could be more effective than TDN for short- and medium-term improvement of pain and PPTs in LE when added to an eccentric exercise program.

Keywords: elbow tendinopathy; electrolysis; lateral epicondylalgia; lateral epicondylitis; physical therapy; tennis elbow.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Application of percutaneous electrolysis (PE) in the lateral epicondyle.
Figure 2
Figure 2
Ultrasound imaging of lateral epicondyle needling.
Figure 3
Figure 3
Flow diagram.

References

    1. Houck D.A., Kraeutler M.J., Thornton L.B., McCarty E.C., Bravman J.T. Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses. Orthop. J. Sport. Med. 2019;7:1–9. doi: 10.1177/2325967119831052.
    1. George C.E., Heales L.J., Stanton R., Wintour S.A., Kean C.O. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys. Ther. Sport. 2019;40:117–127. doi: 10.1016/j.ptsp.2019.08.011.
    1. Bisset L.M., Vicenzino B. Physiotherapy management of lateral epicondylalgia. J. Physiother. 2015;61:174–181. doi: 10.1016/j.jphys.2015.07.015.
    1. Palaniswamy V., Ng S.K., Manickaraj N., Ryan M., Yelland M., Rabago D., Bisset L. Relationship between ultrasound detected tendon abnormalities, and sensory and clinical characteristics in people with chronic lateral epicondylalgia. PLoS ONE. 2018;13:1–18. doi: 10.1371/journal.pone.0205171.
    1. Unyó C., Chaler J., Rojas-Martínez M., Pujol E., Müller B., Garreta R., Mañanas M.A. A cross-sectional study comparing strength profile of dorsal and palmar flexor muscles of the wrist in epicondylitis and healthy men. Eur. J. Phys. Rehabil. Med. 2013;49:507–515.
    1. Valera-Garrido F., Minaya-Muñoz F., Medina-Mirapeix F. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: Short-term and long-term results. Acupunct. Med. 2014;32:446–454. doi: 10.1136/acupmed-2014-010619.
    1. Luk J.K.H., Tsang R.C.C., Leung H.B. Lateral epicondylalgia: Midlife crisis of a tendon. Hong Kong Med. J. 2014;20:145–151. doi: 10.12809/hkmj134110.
    1. Day J.M., Lucado A.M., Uhl T.L. A Comprehensive Rehabilitation Program for Treating Lateral Elbow Tendinopathy. Int. J. Sports Phys. Ther. 2019;14:818–829. doi: 10.26603/ijspt20190818.
    1. Bordachar D. Lateral epicondylalgia: A primary nervous system disorder. Med. Hypotheses. 2019;123:101–109. doi: 10.1016/j.mehy.2019.01.009.
    1. Dones V.C., Serra M.A.B., Kamus G.O.T., Esteban A.C., Mercado A.M.S., Rivera R.G.A., Vergara A.C.B., Francisco R.J., De Ocampo L.M., De Jesus P.J.P. The effectiveness of Biomechanical Taping Technique on visual analogue scale, static maximum handgrip strength, and Patient Rated Tennis Elbow Evaluation of patients with lateral epicondylalgia: A cross-over study. J. Bodyw. Mov. Ther. 2019;23:405–416. doi: 10.1016/j.jbmt.2018.05.004.
    1. Yelland M., Rabago D., Ryan M., Ng S.K., Vithanachchi D., Manickaraj N., Bisset L. Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: A single-blinded randomised clinical trial. BMC Musculoskelet. Disord. 2019;20:1–10. doi: 10.1186/s12891-019-2905-5.
    1. Shariat A., Noormohammadpour P., Memari A.H., Ansari N.N., Cleland J.A., Kordi R. Acute effects of one session dry needling on a chronic golfer’s elbow disability. J. Exerc. Rehabil. 2018;14:138–142. doi: 10.12965/jer.1836008.004.
    1. Arias-Buriá J.L., Truyols-Domínguez S., Valero-Alcaide R., Salom-Moreno J., Atín-Arratibel M.A., Fernández-De-Las-Penãs C. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial. Evidence-based Complement. Altern. Med. 2015;2015:1–9. doi: 10.1155/2015/315219.
    1. Abat F., Gelber P.E., Polidori F., Monllau J.C., Sanchez-Ibañez J.M. Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy. Knee Surg. Sport. Traumatol. Arthrosc. 2015;23:1046–1052. doi: 10.1007/s00167-014-2855-2.
    1. Stasinopoulos D. The role of proprioception in the management of lateral elbow tendinopathy. J. Hand Ther. 2019;32:e2–e3. doi: 10.1016/j.jht.2018.02.010.
    1. Pandis N., Chung B., Scherer R.W., Elbourne D., Altman D.G. CONSORT 2010 statement: Extension checklist for reporting within person randomised trials. BMJ. 2017;357:1–22. doi: 10.1136/bmj.j2835.
    1. Mintken P.E., Glynn P., Cleland J.A. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J. Shoulder Elb. Surg. 2009;18:920–926. doi: 10.1016/j.jse.2008.12.015.
    1. Jensen M.P., Turner J.A., Romano J.M., Fisher L.D. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83:157–162. doi: 10.1016/S0304-3959(99)00101-3.
    1. Alghadir A., Anwer S., Iqbal A., Iqbal Z. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J. Pain Res. 2018;11:851. doi: 10.2147/JPR.S158847.
    1. Childs J., Piva S., Fritz J. Responsiveness of the Numeric Pain Rating Scale in Patients with Low Back Pain. Spine (Phila. Pa. 1976) 2005;30:1331–1334. doi: 10.1097/01.brs.0000164099.92112.29.
    1. Koçak F.A., Kurt E.E., Şaş S., Tuncay F., Erdem H.R. Short-Term Effects of Steroid Injection, Kinesio Taping, or Both on Pain, Grip Strength, and Functionality of Patients with Lateral Epicondylitis: A Single-Blinded Randomized Controlled Trial. Am. J. Phys. Med. Rehabil. 2019;98:751–758. doi: 10.1097/PHM.0000000000001184.
    1. Kinser A.M., Sands W.A., Stone M.H. Reliability and Validity of a Pressure Algometer. J. Strength Cond. Res. 2009;23:312–314. doi: 10.1519/JSC.0b013e31818f051c.
    1. Kolber M.J., Hanney W.J. The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: A technical report. Int. J. Sports Phys. Ther. 2012;7:306–313.
    1. Keijsers R., Zwerus E.L., van Lith D.R.M., Koenraadt K.L.M., Goossens P., The B., van den Bekerom M.P.J., Eygendaal D. Validity and Reliability of Elbow Range of Motion Measurements Using Digital Photographs, Movies, and a Goniometry Smartphone Application. J. Sports Med. 2018:1–7. doi: 10.1155/2018/7906875.
    1. Vilagut G., Valderas J.M., Ferrer M., Garin O., López-García E., Alonso J. Interpretation of SF-36 and SF-12 questionnaires in Spain: Physical and mental components. Med. Clin. (Barc.) 2008;130:726–735. doi: 10.1157/13121076.
    1. Fernández-De-Las-Peñas C., González-Iglesias J., Gröbli C., Weissmann R. Deep dry needling of the arm and hand muscles. In: Dommerholt J., Fernández-de-las-Peñas C., editors. Trigger Point Dry Needling: An Evidence and Clinical-Based Approach. Elsevier; Edinburgh, UK: 2013. pp. 108–118.
    1. Stasinopoulos D., Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J. Hand Ther. 2017;30:13–19. doi: 10.1016/j.jht.2016.09.001.
    1. Coombes B.K., Bisset L., Vicenzino B. Management of lateral elbow tendinopathy: One size does not fit all. J. Orthop. Sports Phys. Ther. 2015;45:938–949. doi: 10.2519/jospt.2015.5841.
    1. Raman J., MacDermid J.C., Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis—A systematic review. J. Hand Ther. 2012;25:5–26. doi: 10.1016/j.jht.2011.09.001.
    1. Mishra A.K., Skrepnik N.V., Edwards S.G., Jones G.L., Sampson S., Vermillion D.A., Ramsey M.L., Karli D.C., Rettig A.C. Efficacy of platelet-rich plasma for chronic tennis elbow: A double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am. J. Sports Med. 2014;42:463–471. doi: 10.1177/0363546513494359.
    1. de Miguel Valtierra L., Salom Moreno J., Fernández-de-las-Peñas C., Cleland J.A., Arias-Buría J.L. Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: A Randomized Clinical Trial. J. Pain. 2018;19:1201–1210. doi: 10.1016/j.jpain.2018.04.017.
    1. Iborra-Marcos Á., Ramos-Álvarez J.J., Rodriguez-Fabián G., Del Castillo-González F., López-Román A., Polo-Portes C., Villanueva-Martínez M. Intratissue Percutaneous Electrolysis vs Corticosteroid Infiltration for the Treatment of Plantar Fasciosis. Foot Ankle Int. 2018;39:704–711. doi: 10.1177/1071100718754421.
    1. García Bermejo P., De La Cruz Torres B., Naranjo Orellana J., Albornoz Cabello M. Autonomic Responses to Ultrasound-Guided Percutaneous Needle Electrolysis: Effect of needle puncture or electrical current? J. Altern. Complement. Med. 2018;24:69–75. doi: 10.1089/acm.2016.0339.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren