Nettoyage epicondylalgie percutaan en fysiotherapie bij patiënten met laterale epicondylalgie

Rationale: Lateral epicondylalgia of the elbow is a common cause for chronic pain in the elbow, where the pain is present for longer than 6 months. Multiple treatment methods for lateral epicondylalgia are described in the literature. In 90% of the cases conservative treatment is successful. But it is unclear what the best treatment modality is in the 10% where a lateral epicondylalgia persists and the previous treatment was without result. There is no current consensus on the treatment that should be considered as standard in these cases. Previous studies have shown that percutaneaous needle tenotomy (PNT) may be an effective minimal invasive method for the treatment of lateral epicondylalgia. To date, studies on PNT have only been performed in cohort design or with low numbers. In the Sint Maartenskliniek PNT is used on indication, but thus without proper scientific support.

Objective: To study the effect of PNT and structured physiotherapy on function and pain of patients with lateral epicondylalgia.

Study design: A single blind randomized controlled trial with two study groups: 1. PNT and structured physio-therapy, and 2. structured physiotherapy only.

Study population: Subjects with lateral epicondylalgia will be selected at the orthopaedic outpatient clinic in our hospital by the orthopaedic surgeon. The patient information will be provided to the patients who are referred to the radiologist for possible percutaneous needle tenotomy.

Intervention: Percutaneaous needle tenotomy (PNT) is a method where multiple micro trauma are administered in the effected tissue using a needle.

Main study parameters/endpoints: The Patient-Rated Tennis Elbow Evaluation (PRTEE) is a patient reported outcome measure (PROM) specifically developed for lateral epicondalgia. The endpoint of the PRTEE is set at one year post treatment.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: PNT is already a treatment option for these patients in our hospital. The patients included in the study will be seen at several moments: pre-intervention and at 3 months and 1 year post-intervention. The visit at 1 year is not coinciding with standard care. The extra time investment for the patients is 0.5 x 3 = 1.5 hours. Patients participating in this study will not being barred by any additional benefits or risks other than the regular risks for the treatment with PNT. The questionnaires and physical examinations of the upper extremity do not bring any extra burden.

We expect that percutaneous needle tenotomy added to structured physiotherapy will have positive effect on function and pain of patients with lateral epicondylalgia

The patients included in the study will be seen at several moments: pre-intervention and at 3 months and 1 year post-intervention

Percutaneous Needle Tenotomy