Tendon needling for treatment of tendinopathy: A systematic review

Objective. To summarize the best available evidence to determine if tendon needling is an effective treatment for tendinopathy. Data source. Medline and Cochrane Databases through November 2013. Review methods. Utilizing the search terms tendinopathy, needle, needling, tenotomy, dry needling, needling tendon, needle fenestration, and tendon fenestration, 17 articles were identified through our systematic literature search. Of these, 4 studies met the inclusion criteria. Four independent reviewers reviewed the articles. The study results and generated conclusions were agreed upon. Results. The studies that were included in this review suggest that tendon needling improves patient reported outcomes in patients with tendinopathy. In 2 studies evaluating tendon needling in lateral epicondylosis, one showed an improvement in a subjective visual analogue scale score of 34% (significant change > 25%) from baseline at 6 months. The other showed an improvement of 56.1% in a visual analogue scale score from baseline. In 1 study evaluating tendon needling in addition to eccentric therapy for Achilles tendinosis, the subjective Victorian Institute of Sport Assessment-Achilles (VISA-A) score improved by 19.9 (significant change > 10) (95% CI, 13.6-26.2) from baseline. In 1 study evaluating tendon needling in rotator cuff tendinosis, the subjective shoulder pain and disability index showed statistical significant improvement from baseline at 6 months (P < 0.05). Conclusions. The evidence suggests that tendon needling improves patient-reported outcome measures in patients with tendinopathy. There is a trend that shows that the addition of autologous blood products may further improve theses outcomes.