Ultrasound-guided percutaneous needle tenotomy using Tenex system for refractory lateral epicondylitis; short and long-term effectiveness and contributing factors.
Elbow
Lateral epicondylitis
Needle tenotomy
Physical therapy
Tenex
Ultrasound
Journal
Skeletal radiology
ISSN: 1432-2161
Titre abrégé: Skeletal Radiol
Pays: Germany
ID NLM: 7701953
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
23
11
2020
accepted:
31
03
2021
revised:
02
03
2021
pubmed:
11
4
2021
medline:
18
8
2021
entrez:
10
4
2021
Statut:
ppublish
Résumé
Ultrasound-guided percutaneous needle tenotomy (USPNT) has been proposed as an alternative treatment to surgical intervention for lateral epicondylitis (LE). The Tenex system (Tenex Health Inc., Lake Forest, CA, USA) for USPNT is an ultrasonic device involving a needle which oscillates at high frequency to debride and aspirate diseased tendon under ultrasound image guidance. This investigation evaluates the efficacy of USPNT using the Tenex system for LE refractory to conservative management. We also seek to evaluate patient-specific factors which may correlate with treatment response. PRTEE (Patient-Rated Tennis Elbow Evaluation) and DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaires were completed before performing the Tenex USPNT for all consecutive patients over a course of 38 months (Feb 2015-Mar 2018). Patients were contacted for follow-up evaluations. Paired t test was used to evaluate significant changes in treatment response (p < 0.05). The univariate Tobit regression model was applied followed by multivariate Tobit model with forward selection algorithm. All models were adjusted by preoperative score and follow-up duration. A total of 37 patients (average age 51± 9 years, M/F:15/22) with refractory LE were included (mean follow-up, 531 days; range, 65-1148 days). Tenex USPNT significantly improved PRTEE and DASH scores (p < 0.001). In some patients, this decrease persisted for up to 3 years after intervention. A significant association between treatment response and post-procedure physical therapy (PT) was present. Post-procedure PT contributes to 60, 68, 59, and 50% of reduction in PRTEE pain, function, total scores, and DASH score, respectively (p < 0.001). No tendon ruptures, post-procedural infections, or other complications were noted. USPNT with Tenex significantly improves symptoms and function in individuals with LE even with long-term follow-up for 3 years. Post-procedure PT is associated with improved treatment response and should be considered after USPNT.
Sections du résumé
BACKGROUND
BACKGROUND
Ultrasound-guided percutaneous needle tenotomy (USPNT) has been proposed as an alternative treatment to surgical intervention for lateral epicondylitis (LE). The Tenex system (Tenex Health Inc., Lake Forest, CA, USA) for USPNT is an ultrasonic device involving a needle which oscillates at high frequency to debride and aspirate diseased tendon under ultrasound image guidance. This investigation evaluates the efficacy of USPNT using the Tenex system for LE refractory to conservative management. We also seek to evaluate patient-specific factors which may correlate with treatment response.
MATERIALS AND METHODS
METHODS
PRTEE (Patient-Rated Tennis Elbow Evaluation) and DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaires were completed before performing the Tenex USPNT for all consecutive patients over a course of 38 months (Feb 2015-Mar 2018). Patients were contacted for follow-up evaluations. Paired t test was used to evaluate significant changes in treatment response (p < 0.05). The univariate Tobit regression model was applied followed by multivariate Tobit model with forward selection algorithm. All models were adjusted by preoperative score and follow-up duration.
RESULTS
RESULTS
A total of 37 patients (average age 51± 9 years, M/F:15/22) with refractory LE were included (mean follow-up, 531 days; range, 65-1148 days). Tenex USPNT significantly improved PRTEE and DASH scores (p < 0.001). In some patients, this decrease persisted for up to 3 years after intervention. A significant association between treatment response and post-procedure physical therapy (PT) was present. Post-procedure PT contributes to 60, 68, 59, and 50% of reduction in PRTEE pain, function, total scores, and DASH score, respectively (p < 0.001). No tendon ruptures, post-procedural infections, or other complications were noted.
CONCLUSION
CONCLUSIONS
USPNT with Tenex significantly improves symptoms and function in individuals with LE even with long-term follow-up for 3 years. Post-procedure PT is associated with improved treatment response and should be considered after USPNT.
Identifiants
pubmed: 33837827
doi: 10.1007/s00256-021-03778-9
pii: 10.1007/s00256-021-03778-9
doi:
Substances chimiques
Guanfacine
30OMY4G3MK
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2049-2057Informations de copyright
© 2021. ISS.
Références
Tosti R, Jennings J, Milo SJ. Lateral epicondylitis of the elbow. Am J Med. 2013;126:357.e1–6. https://doi.org/10.1016/j.amjmed.2012.09.018 .
doi: 10.1016/j.amjmed.2012.09.018
Cyriax J. The pathology and treatment of tennis elbow. J Bone Joint Surg Am. 1936;18:921–40.
Goldie I. Epicondylitis lateralis humeri. Acta Chir Scand Cupple. 1964;57(Suppl 339):1.
Nirschl R, Pettrone F. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61A:832–41.
doi: 10.2106/00004623-197961060-00005
Kamien M. A rational management of tennis elbow. J Sports Med. 1990;9:173–91.
doi: 10.2165/00007256-199009030-00005
Nirschl RP, Ashman AS. Elbow tendinopathy: tennis elbow. Clic Sports Med. 2003;22:813–36.
doi: 10.1016/S0278-5919(03)00051-6
Thurston AJ. Conservative and surgical treatment of tennis elbow: a study of outcome. Aust N Z J Surg. 1998;68:568–72.
doi: 10.1111/j.1445-2197.1998.tb02102.x
Calfee RP, Patel A, DaSilva MR, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008:16–29.
McShane JM, Nazarian LN, Hardwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006;25:1281–9. https://doi.org/10.7863/jum.2006.25.10.1281 .
doi: 10.7863/jum.2006.25.10.1281
pubmed: 16998100
Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Should Elbow Surg. 2015;24:67–73. https://doi.org/10.1016/j.jse.2014.07.017 .
doi: 10.1016/j.jse.2014.07.017
Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K. Percutaneous needle tenotomy for the treatment of lateral epicondylitis: a systematic review of the literature. PM R. 2017;9(6):603–11. https://doi.org/10.1016/j.pmrj.2016.10.012 .
doi: 10.1016/j.pmrj.2016.10.012
pubmed: 27780771
Szabo SJ, Savoi FH 3rd, Field LD, Ramsey JR, Hosemann CD. Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elb Surg. 2006;15(6):721–7. https://doi.org/10.1016/j.jse.2006.01.017 .
doi: 10.1016/j.jse.2006.01.017
Su B, O’Connor JP. NSAID therapy effects on healing of bone, tendon, and the enthesis. J Appl Physiol. 2013;115(6):892–9. https://doi.org/10.1152/japplphysiol.00053.2013 .
doi: 10.1152/japplphysiol.00053.2013
pubmed: 23869068
pmcid: 3764618
Shergill R, Choudur HN. Ultrasound-guided interventions in lateral epicondylitis. J Clin Rheumatol. 2019;25:e27–34. https://doi.org/10.1097/RHU.0000000000000879 .
doi: 10.1097/RHU.0000000000000879
pubmed: 30074911
Amemiya T. Tobit models: a survey. J Econ. 1984;24:3–61.
doi: 10.1016/0304-4076(84)90074-5
Koh JS, Mohan PC, Howe TS, Lee BP, Chia SL, Yang Z, et al. Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy. Am J Sports Med. 2012;41-3:636–44. https://doi.org/10.1177/0363546512470625 .
doi: 10.1177/0363546512470625
Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clin Orthop. 2002;398:127–30.
doi: 10.1097/00003086-200205000-00018
Nagraba L, Tuchalska J, Mitek T, Stolarczyk A, Desczczynski J. Dry needling as a method of tendinopathy treatment. Ortop Traumatol Rehabil. 2013;15(2):109–16. https://doi.org/10.5604/15093492.1045947 .
doi: 10.5604/15093492.1045947
pubmed: 23652530
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am. 2003;28:272–8. https://doi.org/10.1053/jhsu.2003.50041 .
doi: 10.1053/jhsu.2003.50041
pubmed: 12671860
Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis. Am J Sports Med. 2011;39-10:2130–4. https://doi.org/10.1177/0363546511417113 .
doi: 10.1177/0363546511417113