Treatment of chronic lateral epicondylosis: a randomized trial comparing the efficacy of ultrasound-guided tendon dry needling and open-release surgery

Bureau, Nathalie J.; Tétreault, Patrice; Grondin, Philippe; Freire, Véronique; Desmeules, François; Cloutier, Guy; Julien, Anne–Sophie; Choinière, Manon

doi:10.1007/s00330-022-08794-4

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…This prospective ancillary study, employing a randomization ratio of 1:1, addresses the secondary objectives of the clinical trial that compared the therapeutic efficacy of US-guided tendon fenestration with open-release surgery in 64 patients with chronic LET [ 18 ]. The Institutional Ethics Committee approved the study (CE 15.327), and all participants signed informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…One of two fellowship-trained musculoskeletal radiologists (N.J.B., V.F.) with 23 and 10 years of experience conducted the US-guided tendon fenestration on patients in a supine position using a standardized technique [ 18 , 19 ]. The procedure followed an aseptic technique and started by administering 3 mL of 1% lidocaine to anesthetize the skin and subcutaneous tissues.…”

Section: Methodsmentioning

confidence: 99%

“…The two orthopedists used a standardized open-release surgery technique, which involved incising the skin, reclining the extensor carpi radialis longus (ECRL) tendon, excising the pathological tissue of the extensor carpi radialis brevis tendon, suturing back the ECRL tendon, and ending with skin closure [ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

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Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography

Tobaly,

Tétreault,

Cloutier

et al. 2024

Insights Imaging

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Objective To investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy. Methods Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models. Results Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome. Conclusions Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity. Critical relevance statement Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity’s potential for quantitatively monitoring tendon elasticity during healing. Key Points Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment. Graphical Abstract

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography

Tobaly,

Tétreault,

Cloutier

et al. 2024

Insights Imaging

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“…When treatment fails, US-guided techniques play an important role. There are three possible treatments 2,3,8,18,19 : a. Corticosteroid infiltrations. In the initial stages of tendinopathy.…”

Section: Treatment Of Epicondylitismentioning

confidence: 99%

Ultrasound-guided interventional procedures in the musculoskeletal system

Cura¹

2023

JMEXFRI

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Ultrasound (US) has gained importance in musculoskeletal imaging. One of the reasons is that it is the best technique to guide interventional procedures. These procedures have grown unstoppably. A recent review found more than 80 different procedures, the vast majority with US guidance. Shoulder pain treatments were the first introduced. They include treatment of calcific tendinitis, infiltrations of bursa and rotator cuff, joint injections, and nerve blocks. Tendons and fasciae are also targets of these procedures, including infiltrations, several treatments for tendinosis and fasciitis, trigger finger and palmar fibromatosis treatment. Musculoskeletal cysts (ganglions and Baker´s) and fluid collections can also be treated with ultrasound-guided techniques, as well as conditions at joints and nerves. Finally, foreign bodies can be removed also using US. This article reviews these applications. The list of procedures cannot be exhaustive, given the large number of procedures and their complexity, but it will serve to give a glimpse of how these techniques can solve specific musculoskeletal problems.

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“…In the remaining included studies, dry-needling was superior to Ibuprofen with arm bracing 32 and Kinesio taping or stretching exercises. 33 However, it was found to have equivalent efficacy to open surgery, 34 autologous plasma injection 35 or PRP injection 31 and the study suggested it to be inferior to percutaneous electrolysis. 36 A large randomised controlled trial reported by Mishra (2014), 27 in 230 patients, reported dry-needling to be equivalent to PRP at 12 weeks but inferior at 24 weeks.…”

Section: Should Dry-needling Be Offered To Patients With Let?mentioning

confidence: 99%

BESS patient care pathway: Tennis elbow

Singh,

Watts,

Bateman

et al. 2023

Shoulder & Elbow

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This article provides a guidance summary for the management of lateral elbow tendinopathy (LET) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of the rating quality of the literature and grading the strength of available evidence. The process began by assembling a guideline development group of volunteers including orthopaedic surgeons, trainees, physiotherapists, rheumatologists, radiologists and patients. Virtual meetings were organised to set out explicit PICO questions, including specification of all important outcomes (including patient reported tennis elbow evaluation (PRTEE) as an important primary outcome) to determine the clinical effectiveness of common treatment options for LET compared with no treatment or placebo. Clinical librarian searched (date 31 April 2022) for available systematic reviews and randomised controlled trials reviewing the management of the LET January 2011 onwards and evidence was collected and summarized using explicit GRADE criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations were characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of alternative management options. This informative summary provides the quality of available evidence for the management of LET.

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Treatment of chronic lateral epicondylosis: a randomized trial comparing the efficacy of ultrasound-guided tendon dry needling and open-release surgery

Cited by 5 publications

References 30 publications

Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography

Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography

Ultrasound-guided interventional procedures in the musculoskeletal system

BESS patient care pathway: Tennis elbow

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