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

Objective Evaluate the efficacy of ultrasound-guided dry needling and open-release surgery in reducing pain and improving function in workers with lateral epicondylosis refractory to at least 6 months of nonsurgical management. Methods We randomly assigned participants in a 1:1 ratio to receive dry needling or surgery. The primary outcome was the Patient Rated Tennis Elbow Evaluation (PRTEE) score at 6 months. Secondary outcome measures examined the impact of these techniques on professional activity, grip strength, and Global Rating of Change and Satisfaction scales. Statistical analyses included mixed-effects models and Fisher's exact tests. Results From October 2016 through June 2019, we enrolled 64 participants. Two participants were excluded, and data from 62 participants (48 +/- 8 years, 33 men) with a mean duration of symptoms of 23 +/- 21 months were analyzed. Baseline characteristics were similar in both groups. In the intention-to-treat analysis, no treatment-by-time interaction was observed (F-(4,(201)) = 0.72; p = .58). The least-squares mean difference from baseline in PRTEE scores at 6 months was 33.4 (CI 25.2 - 41.5) in the surgery group and 26.9 (CI 19.4 - 34.4) in the dry needling group (p = .25). The proportion of successful treatment was 83% (CI 63 - 95%) and 81% (CI 63 - 93%) in the surgery and dry needling groups, respectively (p = 1.00). Changes in secondary outcomes were in the same direction as those of the primary outcome. No adverse event occurred. Conclusions Ultrasound-guided dry needling resulted in comparable improvement in outcome scores on scales of pain, physical function, and global assessment of change and satisfaction than open-release surgery.

Automated summary

This study evaluated the efficacy of ultrasound-guided dry needling and open-release surgery in treating refractory lateral epicondylosis. The results showed that both treatments had comparable effects in reducing pain and improving function.