Is dry needling an effective treatment for tennis elbow? A literature review

This literature review examines the efficacy of dry needling in treating lateral epicondylitis, known as tennis elbow, a condition that affects 1% to 3% of the population, especially between ages 35 and 55. Lateral epicondylitis, initially described by Runge in 1873, is characterized by pain and functional limitations of the elbow, traditionally attributed to inflammation of the common extensor tendon at the lateral epicondyle. However, recent research reveals it is more a degenerative tendinopathy than inflammatory, characterized by fibroblast proliferation, abnormal vascularization, granulation tissue formation, microruptures, and collagen disorganization. The pathophysiology of lateral epicondylitis remains incompletely understood, but it is believed to result from repetitive microtrauma causing histological alterations in the tendon.

Risk factors include smoking, obesity, vigorous repetitive activities, intensive manual work, and occupational factors. Differential diagnosis must consider other structures such as the radial collateral ligament, annular ligament, radiocapitellar joint, radial nerve, and cervical spine. Traditional treatment of lateral epicondylitis involves multiple approaches, with rest from activities that exacerbate the condition being the main recommendation. For pain relief, ice application, oral or topical nonsteroidal anti-inflammatory drugs, and corticosteroid therapy are used.

Local corticosteroid injections mixed with local anesthetics represent a primary approach, showing significant short-term efficacy. Physical therapy includes various techniques such as manual therapy, the Cyriax method, Mill's manipulation, and myofascial release techniques. Other modalities include extracorporeal shock wave therapy, laser therapy, and ultrasound. Dry needling has emerged as a promising therapeutic option for cases that do not respond to conventional treatments.

This technique uses fine needles to reach specific areas of muscle or connective tissue, aiming to deactivate myofascial trigger points, provoke a muscle twitch response, or trigger a localized inflammatory reaction that aids healing. Although the physiological mechanisms are not completely understood, dry needling is believed to cause biochemical changes that break the cycle of pain and degeneration. Reviewed studies demonstrate that dry needling is as effective as corticosteroids in treating lateral epicondylitis, with significant advantages. Nagarajan et al.

showed that dry needling therapy not only presents gradually improved functional outcomes compared with corticosteroids, but also offers notable benefits in terms of cost-effectiveness and lower invasiveness. Uygur et al., in a prospective randomized controlled study with 92 patients, demonstrated notable reduction in pain levels in the long term. In another randomized controlled study with 101 patients, the same authors found that percutaneous dry needling provided superior long-term results compared with corticosteroid injections. Suzuki et al., in a retrospective study, examined the use of dry needling in patients who did not respond to conventional conservative treatments, showing significant clinical and functional improvement.

A systematic review by Sousa Filho et al. confirmed that dry needling offered greater benefits compared with corticosteroid injections, particularly in pain reduction and improvement in functional outcomes. Advantages of dry needling include being a safe, cost-effective, minimally invasive technique with fewer complications than corticosteroids, that can be performed by professionals trained in upper extremity anatomy and rehabilitation. Although multiple sessions are necessary, in contrast to corticosteroids that generally require a single dose, the long-term benefits justify this approach.

Limitations of this review include the need for further extensive research with larger samples, adequate randomization, and control groups to better evaluate the efficacy of dry needling in the treatment of tendinopathies. Despite this, current evidence supports the use of dry needling as an effective therapeutic option for chronic lateral epicondylitis refractory to conventional treatments.