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Comparative effectiveness of percutaneous needle electrolysis and shockwave therapy in subscapularis tendinopathy: a
Adrian Kużdżał1, Małgorzta Smoter2, Gracjan Olaniszyn3,4
1Institute of Physiotherapy, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszów, Rzeszów, Poland.
Objectives:
To evaluate whether adding ultrasound-guided percutaneous needle electrolysis (PNE) to extracorporeal shockwave therapy (ESWT) and therapeutic exercise improves short-term outcomes in adults with imaging-confirmed subscapularis tendinopathy.
Methods:
This assessor-blinded, randomized, parallel-group clinical trial included 30 participants randomly allocated (1:1) to PNE+ESWT+exercise (n = 15) or ESWT+exercise (n = 15) for 8 weeks. Primary outcomes were pain (VAS), upper-limb disability (DASH), and tendon stiffness; secondary outcomes were pressure pain threshold, internal rotation range of motion and strength, cross-sectional area, tissue perfusion, Tenascin-C, and ultrasound tendon integrity findings.
Results:
Compared with ESWT+exercise, PNE+ESWT+exercise produced significant improvements in tendon stiffness (between-group difference in change, -31.29 N/m [95% CI, -36.65 to -25.93]; interaction p < .001), DASH disability (-3.91 points [95% CI, -5.84 to -1.97]; p < .001), pressure pain threshold (10.01 kPa [95% CI, 9.07 to 10.94]; p < .001), internal rotation range of motion (5.29° [95% CI, 4.18 to 6.39]; p < .001), internal rotation strength (1.53 kgF [95% CI, 1.15 to 1.92]; p < .001), cross-sectional area (-0.99 mm2 [95% CI, -1.20 to -0.79]; p < .001), and Tenascin-C (19.90 pg/mL [95% CI, 7.63 to 32.17]; p = .002).
Conclusions:
Adding PNE to ESWT, manual therapy, and exercise was associated with greater short-term improvements in upper-limb disability, tendon properties, and shoulder mechanical performance. Pain improved in both groups, without a between-group difference.
Clinical Trial Registration:
The www.isrctn.com identifier is ISRCTN66866842.
