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

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.

Keywords: SPORTS MEDICINE; ULTRASONOGRAPHY.

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.

Figures

Figure 1

(A) Long-axis grey-scale ultrasound image displaying the origin of the extensor tendon during needle placement showing the echogenic needle (arrowheads) with the distal tip in the area of tendinosis. (B–D) Percutaneous needle electrolysis was performed with continual sonographic guidance. A white area is observed in the tissue approximately 30 min post-intervention. LE, lateral epicondyle.

Figure 2

Detail of cathode (modified electrosurgical scalpel with the needle) and anode (handheld electrode) electrodes for percutaneous needle electrolysis.

Figure 3

Needle approach. (A) In-plane approach. The transducer is placed on the lateral epicondyle and the needle is inserted in the centre of the transducer in a long axis position at an angle of about 30–45° to the skin surface, depending on the target area, and then advanced parallel to the sound beam. (B) Out-of-plane approach. The transducer is placed over the humeroradial joint and the needle is positioned at the centre of the transducer in a short axis position at an angle of about 80° to the skin surface and advanced perpendicular to the sound beam. LE, lateral epicondyle; RH, radial head; yellow line, lateral ulnar collateral ligament; blue line, capsule of the humeroradial joint; pink structure, common extensor tendon.

Figure 4

Lateral epicondylitis in a patient with a history of chronic right lateral elbow pain. (A) At baseline, long-axis grey-scale ultrasound (US) image reveals an irregular structure and a hypoechoic focus (asterisks) in the deep fibres of the extensor carpi radialis brevis. (B) At 6 weeks follow-up, US image of the same patient shows structural changes inside the initial area (arrowheads). (C) Power Doppler imaging demonstrates a striking hypervascular pattern composed of a series of tiny vessels. (D) Power Doppler imaging shows no blood flow inside the initial area. LE, lateral epicondyle; RH, radial head.