This randomized single-blind controlled trial aims to compare the effectiveness of ultrasound-guided dry needling and extracorporeal shock wave therapy in patients with lateral epicondylitis. Sixty participants aged 18-65 years will be randomized into two groups. The dry needling group will receive ultrasound-guided tendon fenestration once weekly for five sessions, while the ESWT group will receive radial extracorporeal shock wave therapy once weekly for five sessions. All participants will be given a standardized home exercise program. Pain, function, grip strength, pressure pain threshold, quality of life, and ultrasonographic findings will be evaluated at baseline, post-treatment, and at 3- and 6-month follow-up. The primary outcome is change in pain severity measured by Visual Analog Scale.
Adults aged 18 to 65 years
Clinical diagnosis of lateral epicondylitis
Symptoms persisting for at least 6 weeks
Pain over the lateral epicondyle aggravated by wrist extension or gripping activities
Previous surgery for lateral epicondylitis in the affected elbow
Corticosteroid injection, PRP injection, prolotherapy, mesotherapy, or ESWT to the affected elbow within the previous 6 months
Bilateral lateral epicondylitis requiring simultaneous treatment
Cervical radiculopathy or other neurologic disorders affecting the upper extremity
Parallel
Ultrasound-guided dry needling
Procedure/SurgeryDry needling will be performed under ultrasound guidance targeting the tendinosis area of the common extensor tendon. The procedure will be applied once weekly for five sessions.
Extracorporeal Shock Wave Therapy
DeviceRadial extracorporeal shock wave therapy will be applied using standard parameters (10-15 Hz, 1.5-2.5 bar, 2000 pulses) once weekly for five sessions.
Change in pain intensity measured by Visual Analog Scale (VAS)
Pain intensity will be assessed using a 10-cm visual analog scale. Change from baseline to immediate post-treatment, upto 3 months, and upto 6 months will be analyzed.
Change in Patient-Rated Tennis Elbow Evaluation (PRTEE) score
PRTEE questionnaire will be used to evaluate pain and functional disability in lateral epicondylitis.
Change in grip strength
Grip strength will be measured using a hand dynamometer in kilograms.
Change in pressure pain threshold
Pressure pain threshold will be measured using a handheld algometer over the lateral epicondyle.
Change in quality of life measured by SF-12
Quality of life will be assessed using the Short Form-12 questionnaire.
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