Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: A Randomized Clinical Trial

Góngora-Rodríguez²,

Lomas‐Vega

et al. 2020

JCM

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.

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

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

Góngora-Rodríguez²,

Lomas‐Vega

et al. 2020

JCM

“…In fact, controlled tendon loads with exercise will be clearly needed to be combined with percutaneous electrolysis to facilitate the process of collagen tissue proliferation, thus improving the biomechanical properties of the tendon. This hypothesis is partially supported by randomized clinical trials showing that combining percutaneous electrolysis with a progressive exercise program represents a promising management strategy for tendinopathies of the elbow [ 19 ], shoulder [ 21 ], or knee [ 17 ]. Future trials determining the biological effects of combing percutaneous electrolysis with active therapies such as exercise would help to elucidate the underlying mechanisms of the clinical benefits of this intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, current results should be considered in the investigated scenario. Finally, the application of percutaneous electrolysis is usually ultrasound-guided [ 16 , 17 , 18 , 19 , 20 , 21 ]. In the current study, the technique was not ultrasound-guided, which could have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

Changes in Gene Expression Associated with Collagen Regeneration and Remodeling of Extracellular Matrix after Percutaneous Electrolysis on Collagenase-Induced Achilles Tendinopathy in an Experimental Animal Model: A Pilot Study

Sánchez-Sánchez

Calderón-Díez

Herrero-Turrión

et al. 2020

JCM

Self Cite

Percutaneous electrolysis is an emerging intervention proposed for the management of tendinopathies. Tendon pathology is characterized by a significant cell response to injury and gene expression. No study investigating changes in expression of those genes associated with collagen regeneration and remodeling of extracellular matrix has been conducted. The aim of this pilot study was to investigate gene expression changes after the application of percutaneous electrolysis on experimentally induced Achilles tendinopathy with collagenase injection in an animal model. Fifteen Sprague Dawley male rats were randomly divided into three different groups (no treatment vs. percutaneous electrolysis vs. needling). Achilles tendinopathy was experimentally induced with a single bolus of collagenase injection. Interventions consisted of 3 sessions (one per week) of percutaneous electrolysis or just needling. The rats were euthanized, and molecular expression of genes involved in tendon repair and remodeling, e.g., Cox2, Mmp2, Mmp9, Col1a1, Col3a1, Vegf and Scx, was examined at 28 days after injury. Histological tissue changes were determined with hematoxylin–eosin and safranin O analyses. The images of hematoxylin–eosin and Safranin O tissue images revealed that collagenase injection induced histological changes compatible with a tendinopathy. No further histological changes were observed after the application of percutaneous electrolysis or needling. A significant increase in molecular expression of Cox2, Mmp9 and Vegf genes was observed in Achilles tendons treated with percutaneous electrolysis to a greater extent than after just needling. The expression of Mmp2, Col1a1, Col3a1, or Scx genes also increased, but did not reach statistical significance. This animal study demonstrated that percutaneous electrolysis applied on an experimentally induced Achilles tendinopathy model could increase the expression of some genes associated with collagen regeneration and remodeling of extracellular matrix. The observed gene overexpression was higher with percutaneous electrolysis than with just needling.

“…There are few studies on the effectiveness of PE [ 3 , 17 , 18 , 20 ]. Furthermore, only two studies approach the treatment of pain in conditions affecting the shoulder [ 3 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial

Góngora-Rodríguez²,

et al. 2020

JCM

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up.