SHORT- AND LONG-TERM OUTCOMES OF ELECTROLYSIS PERCUTANEOUS INTRATISSUE (EPI) IN CHRONIC LATERAL ELBOW EPICONDYLITIS
- 1MVClinic-Madrid, Spain. University San Pablo CEU (Madrid)
- 2CEREDE-Barcelona, Spain
- 3Department of Physical Therapy; University of Murcia, Spain
Introduction Chronic lateral elbow epicondylitis is a tendinosis with angiofibroblastic degeneration of the wrist extensors' origin. Electrolysis Percutaneous Intratissue (EPI) is a minimally invasive technique that involves the application of a galvanic current with an acupuncture needle in the soft tissue to initiate a local inflammatory process allowing phagocytosis and repair of the affected tissue. The aim of the study was evaluate the effectiveness of the EPI in chronic epicondylitis lateral.
Methods Design: Cases series.
Setting. MVClinic Physiotherapy.
Subjects: Inclusion criteria were clinically diagnosed lateral epicondylitis (based on symptoms, site of tenderness, and pain elicited with resisted active extension of the wrist in pronation and elbow extension), onset of symptoms (equal to or more than 3 months), no previous local injections (eg. cortisone), no cervicoarthrosis C5–C6, no rheumatic disorder, no history of trauma, and no signs of posterior interosseous nerve entrapment.
Outcome measures. Sonographic assessment, pain was evaluated using a visual analogue scale (VAS), algometry, and functional status was evaluated by completion of the DASH and Cozen´s test and Thomson´s test which were recorded at base line and at the end of treatment, at 6w and 6m post-treatment.
Intervention. All patients received Electrolysis Percutaneous Intratissue (EPI)-one treatment session per week. At home, a simple programme of stretching and eccentric loading exercises to be performed on an individual basis twice every day.
No cortisone or non-steroidal anti-inflammatories were prescribed during follow-up. For pain relief only, oral paracetamol and ice therapy were used.
Results 36 subjects were included in the study, 52.8% men (47.2% women) with a mean age of 38 years. 80.5% of subjects reached a complete response after four sessions of EPI with a VAS<2, 86.2% negative Cozen´s test and Thomson´s test, and algometry values changed very significantly from 7.9 kg of pressure on the lateral epicondyle to 29.3 kg. DASH questionnaire showed significant changes, the mean score in the total of 36 subjects was 37.4 points, which means that there was an improvement of over 40% in functional capacity. Sonographic assessment showed change in the structure of the tendon, or hypoechoic region (long term outcomes, no short outcomes) and neovascularization (short outcomes).
Discussion The combined programme of EPI, more eccentric exercise and stretching is an effective treatment for chronic elbow lateral epicondylitis.
Limitations of the study. The main limitation is the absence of a control group to compare the results obtained with a placebo or another intervention. In scientific literature, there are no similar studies as the technique has been recently developed. The next step is to launch a pilot study to validate the results.