Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis

Novel Ultrasound-Guided Radiofrequency Ablation of the Epicondylar Branch of the Posterior Cutaneous Nerve of the Forearm for Recalcitrant Lateral Epicondylosis

This report describes a novel technique for the treatment of recalcitrant lateral epicondylosis (LE) by radiofrequency ablation (RFA) of the epicondylar branch of the posterior cutaneous nerve of the forearm (PCNF-BrEpi). Here, we describe two patients suffering from recalcitrant LE who were treated with ultrasound-guided RFA of the PCNF-BrEpi in the outpatient pain clinic setting. Patient follow-up was made at eight weeks, five months, and seven months. Numerical pain rating (NPR) for pain and Upper Extremity Functional Index-15 (UEFI-15) were obtained at baseline and at each of the follow-ups. Both patients reported significant improvement in their pain and function quickly. RFA may be a viable treatment option for recalcitrant LE. Larger comparative trials and further investigation are needed to establish results in comparison to conventional treatments and to validate RFA as a treatment option in recalcitrant LE.

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial

OBJECTIVE

The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE).

METHODS

Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength-duration curve were evaluated.

RESULTS

Both groups showed no differences in the baseline measurements (all p = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment (p = 0.001). However, chronaxie values always reported similar values with no differences between groups (p >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population.

Comparison of the effects of using non-steroidal anti-inflammatory drugs with or without kinesio taping on the radial nerve in lateral epicondylitis: A randomized-single blind study

BACKGROUND

There is no knowledge about the effects of kinesio taping (KT) on the radial nerve in lateral epicondylitis.

OBJECTIVE

This study aimed to determine the effects of non-steroidal-anti-inflammatory drugs (NSAIDs) combined with KT on lateral epicondylitis using ultrasonographic findings.

METHODS

NSAID therapy was administered to the control group for 10 days, and the KT group additionally received KT three times a week for two weeks. Clinical and ultrasonographic evaluations were performed before treatment and at post-treatment at second, sixth and fourteenth weeks. The radial nerve cross sectional area and common extensor tendon thicknesses were measured using ultrasonography.

RESULTS

The study was completed with 40 patients in each group. Improvements in clinical parameters, common extensor tendon thickness, and cross sectional area values were significant in the KT group (p<0.01).

CONCLUSIONS

NSAID plus kinesio taping decrease pain intensity while improving functionality and ultrasonographic parameters, including common extensor tendon thickness and radial nerve cross sectional area; therefore, it may be an option treatment in lateral epicondylitis.