Background & Aims
Tennis elbow (TE) primarily involves muscles such as extensor carpi radialis brevis and other extensor muscles. However, a comprehensive understanding of muscle interactions, associations, and the extent of involvement remains essentia to a more personalized decision regarding diagnosis and treatment of TE [1]. Ultrasound-guided dry needling (DN-US) of trigger points has proven effective in treating myofascial hand and wrist pain [2,3].
This study aims to identify muscles contributing to TE, providing precise guidance for dry needling (DN) interventions. The focus includes extensor carpi radialis brevis, along with other muscles (e.g., extensor pollicis longus, supinator), shoulder muscles, and overall posture assessment.
Methods
Five patients with TE symptoms, manifesting tendinopathies in forearm muscles, were included. Ultrasound (US) evaluation assessed tendinopathy symptoms, measuring thickness and length. Trigger points for DN were identified, and a specific protocol was employed under US guidance [2].
Results
All patients demonstrated a remarkable 90% reduction in pain (VAS score) immediately after one month, with improvements in neurodynamic test scores and symptoms of neuropathic pain and arm numbness. Shoulder involvement, particularly impingement, saw effective treatment through DN-US of shoulder rotator muscles.
One noteworthy outcome of this study was the swift and effective response observed during the application of dry needling (DN) under ultrasound guidance. The targeted muscle, with diagnosed trigger points, was visualized and precisely needled using DN. In real-time, during the procedure, we monitored the area for changes. Remarkably, within 10-30 minutes, a rapid and substantial decrease in fluid around the tendons was observed, with measurements dropping from 3 to 0.5-1 mm, and length reducing from 40 to 10 mm. This immediate response underscores the efficacy of the DN-US protocol in providing fast relief for individuals with tennis elbow, showcasing its potential as a prom
Conclusions
This study suggests that DN targeting trigger points can immediately eliminate fluid around tendons in tendinopathy. Comprehensive identification of all involved muscles is crucial, and subtyping TE based on major muscle involvement, such as extensor carpi radialis brevis, extensor pollicis longus, and supinator, is recommended for accurate clinical diagnosis and stratification.
References
1. Szyluk, K.; Bubnov, R.; Jarosz, A.; Regu?a, R.; Grabowski, P.; Iwanicka, J.; Iwanicki, T.; Gierek, M.; Siero?, D.; Christe, A.; et al. The Impact of Blood Morphological Parameters on Treatment Outcomes in Tennis Elbow Patients Receiving Platelet-Rich Plasma (PRP) Therapy: A Prospective Study. J. Clin. Med. 2024, 13, 77. https://doi.org/10.3390/jcm13010077
2. Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13.
3. Bubnov R, Kalika L, Pilecki G, Pilecki Z. Ultrasound-guided dry needling for wrist tenosynovitis and carpal tunnel syndrome: efficacy and outcomes. Neurologie und Rehabilitation 29(S1):S81.