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

Laurens Koonen
Laurens Koonen
, 
Martin van Amerongen
Martin van Amerongen
, 
Katrijn Smulders
Katrijn Smulders
, 
Stephanie Mangesius
Stephanie Mangesius
, 
Gabriella Cerna
Gabriella Cerna
, 
Andrea Klauser
Andrea Klauser
, 
Erich Mur
Erich Mur
 und 
Marina Obradov
Marina Obradov
   | 23. Nov. 2023
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Article Category: Research Paper
Online veröffentlicht: 23. Nov. 2023
Seitenbereich: e358 - e364
Eingereicht: 13. Mai 2023
Akzeptiert: 24. Aug. 2023
DOI: https://doi.org/10.15557/jou.2023.0040
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© 2023 Laurens Koonen et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Ultrasound long-axis view showing the two interventions. A. pre-treatment with focal thickening, hypoechogenicity and calcifications (c) of the extensor tendon. B. pre-treatment with tendon hyperemia on color Doppler. C. Hydrodissection with injection of lidocaine (*) on the whole surface of the common extensor tendon. D. Percutaneous needle tenotomy with a 21G needle perforating the common extensor tendon. r – caput radi; t – common extensor tendon
Ultrasound long-axis view showing the two interventions. A. pre-treatment with focal thickening, hypoechogenicity and calcifications (c) of the extensor tendon. B. pre-treatment with tendon hyperemia on color Doppler. C. Hydrodissection with injection of lidocaine (*) on the whole surface of the common extensor tendon. D. Percutaneous needle tenotomy with a 21G needle perforating the common extensor tendon. r – caput radi; t – common extensor tendon

Fig. 2.

CONSORT Flow Diagram showing patient enrolment, allocation, and follow-up
CONSORT Flow Diagram showing patient enrolment, allocation, and follow-up

Fig. 3.

Boxplot showing median and interquartile ranges for each outcome in each treatment group for every individual patient at baseline (t0) and at three months’ follow-up (t1). A. QuickDASH. B. NRS pain at rest. C. NRS pain during activity. D. EQ5D5L
Boxplot showing median and interquartile ranges for each outcome in each treatment group for every individual patient at baseline (t0) and at three months’ follow-up (t1). A. QuickDASH. B. NRS pain at rest. C. NRS pain during activity. D. EQ5D5L

Inclusion and exclusion criteria

Inclusion criteria Exclusion criteria

Age between 18 and 65 years.

≥12 months with pain in the elbow, unresponsive to conservative (non-surgical) treatment.

Sonographically proven tendinopathy (hypervascularization, deep tendon calcifications, hypoechogenic tendon, erosive cortex).

Concordant pain during compression with a US probe in the region of extensor tendons.

Able to give informed consent.

Able to perform the exercises according to the detailed exercise scheme.

Surgery related to the lateral elbow tendinopathy, including needle aspiration of calcific deposits or prior percutaneous needle tenotomy.

Systemic joint disease such as rheumatoid arthritis, etc.

Rupture of extensor tendons. Detachment of extensor tendons or tears in collateral ligament. Clefts >1 cm in extensor tendons.

Contraindication for lidocaine in accordance with the summary of product characteristics (second- or third-degree AV block without pacemaker, known hypersensitivity to other anesthetics of the amide type).

Pregnancy.

Use of anti-inflammatory drugs, such as NSAIDs, steroids, methotrexate, anti-TNF, azathioprine in the period two weeks before and after the intervention.

Use of anticoagulant drugs which will be bridged with acetylsalicylate acid around the procedure.

Physical, emotional or neurological conditions that would compromise the patient’s compliance with post intervention rehabilitation protocol follow-up.

Difference in median scores of QuickDASH and secondary endpoints. If available, compared to MCII**

Primary and secondary endpoints PNT* (n = 11) Drop-out = 4 Hydrodissection (n = 9) Drop-out = 1 Physiotherapy (n = 10) Drop-out = 1
QuickDASH: Δmedian (min–max) −18.2 (−45.5 – 29.3) 1.14 (−70.5 – 25.0) −13.6 (−54.5 – 38.6)
ΔQuickDASH ≥MCII 4/7 3/8 4/9
NRS pain at rest: Δmedian (min–max) −2 (−7 – 0) −3 (−7 – −1) 1 (−3 – 4)
ΔNRS pain at rest ≥MCII 5/7 7/8 2/9
NRS pain during activity: Δmedian (min–max) −2 (−7 – 0) −3 (−9 – −0.5) −1 (−6 – 2)
ΔNRS pain during activity ≥MCII 4/7 7/8 4/9
EQ-5D-5L: Δmedian (min–max) 0.11 (−0.03 – 0.35) 0.11 (−0.13 – 0.65) 0.06 (−0.19 – 0.67)

Demographics and clinical characteristics

PNT* (n = 11) Hydrodissection (n = 9) Physiotherapy (n = 10)
Mean age, years (95% CI**) 50.8 (44.4–57.2) 56.3 (53.9–58.7) 56.7 (52.3–61.1)
Gender (male / female) 9 / 2 6/3 7/3
Affected side = dominant hand 8 6 8
Mean duration of symptoms, weeks 73 103 80
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Sprache:
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