Added value of ultrasound-guided percutaneous needle tenotomy over hydrodissection and physiotherapy in chronic lateral elbow tendinopathy: a pilot randomized controlled trial

Laurens Koonen1, Martin van Amerongen2, Katrijn Smulders1, Stephanie Mangesius3, Gabriella Cerna4, Andrea Klauser3, Erich Mur4, Marina Obradov2

Affiliation and address for correspondence
J Ultrason 2023; 23: e358–e364
DOI: 10.15557/JoU.2023.0040
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Aim of the study: There is no consensus on the most suitable non-surgical treatment of chronic lateral elbow tendinopathy. The aim of this pilot randomized controlled trial was to evaluate the size of effect of ultrasound-guided percutaneous needle tenotomy. Material and methods: Three intervention arms were formed: 1) percutaneous needle tenotomy, hydrodissection, and physiotherapy; 2) hydrodissection and physiotherapy; and 3) physiotherapy alone. Patients with chronic lateral elbow tendinopathy were randomized. Clinical endpoints included multiple questionnaires after three months: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Numeric Rating Scale (NRS) pain at rest and during activity, and EuroQol 5D-5L (EQ-5D-5L). Results: Thirty patients were included of 128 screened. The QuickDASH score improved in the percutaneous needle tenotomy and physiotherapy group, but not in the hydrodissection group. The NRS pain at rest and during activity improved more in the percutaneous needle tenotomy (resp. –2 and –2) and hydrodissection (resp. –3 and –3) groups than in the physiotherapy (resp. +1 and –1) group. The EQ-5D-5L improved similarly in all groups. Conclusions: Patients receiving percutaneous needle tenotomy and/or hydrodissection may show better results in terms of pain but not in their functional outcomes compared to those who received physiotherapy alone. The size of effect, however, is small, so a large sample size is needed for a future randomized controlled trial to further investigate these results.

physiotherapy; hydrodissection; lateral elbow tendinopathy; percutaneous needle tenotomy; ultrasound