Journal de la douleur et du soulagement

Abstrait

Treatment Of Lateral Epicondylitis With Pulsed Radiofrequency: Comparative Study Of Two Procedures

Bovaira M, Calvo A, Jiménez A, Jovaní M, Desçe J and March R

Objectives: Lateral epicondylitis (tennis elbow) is a tendinosis of the forearm extensor muscles; it has a clear occupational profile. Epicondylitis usually improves with conservative treatment but some 10% of cases require more invasive therapies, such as shock waves, infiltration with steroids or growth factors. Although its mechanism of action is unknown, pulsed radiofrequency appears to improve the patient’s perception of pain. In recent years, this has been used in peripheral pathologies with promising results. This study evaluates the efficacy of two different patterns of radiofrequency for treating epicondylitis.

Materials and methods: This was a comparative study of 34 patients, divided randomly intotwo groups: Group A received pulsed radiofrequency (PRF) at the lateral epicondyle trigger point with two needles (45 volts, for four minutes), creating a dual field; whenever a trigger point was located at the exit of the posterior interosseous, PRF was applied for two minutes; Group B received PRF at the lateral cutaneous branch of the radial nerve for 4 minutes; whenever a trigger point was located at the exit of the posterior interosseous, PRF was applied for two minutes. All patients were monitored during a six-month follow-up.

Results: In general, there was a tendency for pain to decrease, but the visual analogical scale(VAS) identified significantly higher decreases in Group B than Group A. Group Atreatment was effective (VAS decreased more than 50%) for 23% of patients after one month, for 47% of patients after three months and 58.8% of patients after six months. Group B results were better, with decreases in pain experienced by 65% of patients after one month, and 82.3% of patients after three and six months. The recovery of strength was also greater in Group B (8 out of 10) than Group A (6 out of 12). The average time passed before Group A patients could return to work following treatment was 3.058 ± 2.4, and 1.176 ± 1.24 months for Group B patients.

Conclusions: When epicondylitis fails to respond to conservative treatment, pulsedradiofrequency is a safe, partially effective technique. Its effect is greater when it is applied to peripheral nerves than to trigger points.