Short-term efficacy of physical interventions for lateral epicondylitis: a network meta-analysis based on...

Lateral epicondylitis (LE) is a prevalent chronic tendinopathy that significantly impairs upper limb function and quality of life. This network meta-analysis (NMA) aims to evaluate and compare the short-term (≤3 months) efficacy of various micro-invasive and physical interventions for pain relief and functional restoration, providing an evidence-based framework for tailored clinical decision-making.

A comprehensive search was performed in PubMed, Embase, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) investigating physical interventions for LE. Primary outcomes included the Visual Analogue Scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Patient-Rated Tennis Elbow Evaluation (PRTEE). Data synthesis, consistency testing, and Surface Under the Cumulative Ranking curve (SUCRA) calculations were performed using Stata 18.0. Two-dimensional cluster analysis was employed to concurrently assess the analgesic and functional benefits of the interventions.

Analysis of 38 RCTs revealed that percutaneous electrolysis (PE) was the most effective intervention for pain reduction (SUCRA = 98.5%), yielding a clinically pronounced effect size against baseline care (MD = -6.00, 95% CI: -9.75 to -2.25) and outperforming most other physical therapies. Dry needling (DN) demonstrated the highest ranking probability in functional improvement (DASH SUCRA = 79.7%; PRTEE SUCRA = 85.2%), and was the sole active treatment significantly superior to conservative care on the PRTEE scale (MD = -25.04, 95% CI: -48.29 to -1.79). In the cluster analysis, PE was localized to the "strong analgesia" quadrant, while DN was situated in the "strong functional recovery" quadrant. Other interventions, such as platelet-rich plasma and corticosteroid injections, exhibited only moderate effectiveness.

The investigated interventions yield distinct therapeutic profiles for LE within an early temporal window. Percutaneous electrolysis shows the highest probability for rapid pain mitigation, whereas dry needling presents a favorable probability profile for restoring localized elbow function. However, given the high underlying network heterogeneity, the lack of statistical significance in DASH-related pairwise comparisons, and overlapping prediction intervals, these SUCRA-based rankings should be interpreted cautiously. We do not recommend formulating definitive long-term clinical recommendations based on these early temporal profiles; instead, clinical decisions should be tailored to the patient's predominant short-term symptoms-balancing immediate pain relief with early targeted functional recovery.

https://www.crd.york.ac.uk/prospero, PROSPERO CRD420251234552.