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![Perineural fibrosis procedure and application of percutaneous needle electrolysis (PNE). (a) Sciatic nerve exposed before treatment to generate perineural fibrosis. (b) Electrophysiological recording procedure diagram. (c) Application of PNE in the area with perineural fibrosis [1] with a solid needle [2]. (d) Atrophy of the posterior muscles, comparing the normal size of the mouse paw [1] with the treated paw [2].](publication/347896801/figure/fig4/AS:1083885479829545@1635429844833/Perineural-fibrosis-procedure-and-application-of-percutaneous-needle-electrolysis-PNE.jpg)
Perineural fibrosis procedure and application of percutaneous needle electrolysis (PNE). (a) Sciatic nerve exposed before treatment to generate perineural fibrosis. (b) Electrophysiological recording procedure diagram. (c) Application of PNE in the area with perineural fibrosis [1] with a solid needle [2]. (d) Atrophy of the posterior muscles, comparing the normal size of the mouse paw [1] with the treated paw [2].
Source publication
Nerve entrapments such as carpal tunnel syndrome are the most common mononeuropathies. The lesional mechanism includes a scarring reaction that causes a vascular compromise. The most effective treatment is surgery, which consists of removing the scarred area, thus reverting the vascular impairment. In the present study, a more conservative therapeu...
Citations
... Moderate quality evidence supports a positive effect of percutaneous needle electrolysis for reducing pain and related-disability in chronic pain conditions of musculoskeletal origin [12]. In fact, percutaneous needle electrolysis can be applied to different tissues such as tendons [13], muscles [14], or nerves [15]. Further, this intervention has been advocated for managing scars or connective tissue at different interphases, e.g., hamstring tendon-sciatic nerve [14]. ...
... In fact, percutaneous needle electrolysis can be applied to different tissues such as tendons [13], muscles [14], or nerves [15]. Further, this intervention has been advocated for managing scars or connective tissue at different interphases, e.g., hamstring tendon-sciatic nerve [14]. Accordingly, accurate and safe needle procedures targeting specific tissue-to-tissue interphases are needed. ...
Background: Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface. Objective: We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle. Methods: A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted
(safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed. Results: The ultrasound-guided technique was associated with a significantly higher accuracy (p < 0.001) but without differences in safety (p = 0.249) as compared to the palpation-guided procedure. Conclusion: Our results suggest that ultrasound-guided insertion
exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis.
... Moderate quality evidence supports a positive effect of percutaneous needle electrolysis for reducing pain and related-disability in chronic pain conditions of musculoskeletal origin [12]. In fact, percutaneous needle electrolysis can be applied to different tissues such as tendons [13], muscles [14], or nerves [15]. Further, this intervention has been advocated for managing scars or connective tissue at different interphases, e.g., hamstring tendon-sciatic nerve [14]. ...
... In fact, percutaneous needle electrolysis can be applied to different tissues such as tendons [13], muscles [14], or nerves [15]. Further, this intervention has been advocated for managing scars or connective tissue at different interphases, e.g., hamstring tendon-sciatic nerve [14]. Accordingly, accurate and safe needle procedures targeting specific tissue-to-tissue interphases are needed. ...
Background:
Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface.
Objective:
We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle.
Methods:
A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted (safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed.
Results:
The ultrasound-guided technique was associated with a significantly higher accuracy (p < 0.001) but without differences in safety (p = 0.249) as compared to the palpation-guided procedure.
Conclusion:
Our results suggest that ultrasound-guided insertion exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis.
... Hence, percutaneous electrolysis is used as an electrochemical procedure that can induce a regulated inflammatory response in the targeted tissue, facilitating phagocytosis of the degenerated tissue and enabling a subsequent site-specific repair process. [19]. An animal study found that the application of percutaneous electrolysis in an experimentally induced Achilles tendinopathy model is able to increase the expression of the different genes associated with collagen regeneration and remodeling of extracellular matrix [20]. ...
For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa's fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended.
... Percutaneous needle electrolysis (PNE) consists of the ultrasound-guided application of a galvanic electrical current through a solid filament needle [1]. It has been found that PNE produces an inflammatory reaction in the treated tissue [2] and a marked increase in pH [basic] at the tip of the needle, which could hydrolyze scar tissue [3,4]. edle electrolysis (PNE) consists of the ultrasound-guided application of a through a solid filament needle. ...
... eedle electrolysis; temperature; EPI; cadaver le electrolysis (PNE) consists of the ultrasound-guided applicacal current through a solid filament needle [1]. It has been found nflammatory reaction in the treated tissue [2] and a marked inthe tip of the needle, which could hydrolyze scar tissue [3,4]. ...
... Percutaneous needle electrolysis (PNE) consists of the ultrasound-guided application of a galvanic electrical current through a solid filament needle [1]. It has been found that PNE produces an inflammatory reaction in the treated tissue [2] and a marked increase in pH [basic] at the tip of the needle, which could hydrolyze scar tissue [3,4]. were observed between both applications in the tendon (3:3:3 vs. 1:24:1) and fat/muscle (1.5:3:3 vs. 1:24:1) tissues. ...
Percutaneous needle electrolysis (PNE) consists of the ultrasound-guided application of a galvanic electrical current through a solid filament needle. One proposed therapeutic mechanism for this intervention is a potential thermal effect. The aim of this study was to investigate if the application of PNE induces changes in temperature in different cadaveric musculoskeletal tissues. A repeated measure experimental cadaveric study was designed with 10 cryopreserved knees (5 men, 5 women). Sterile stainless-steel needles of 40 mm length and 0.30 mm caliber were used in this study. An ultrasound-guided needling puncture was performed in the targeted tissue (patellar tendon, infra-patellar fat, and vastus medialis muscle). Additionally, the tip of the needle was placed next to the thermometer sensor at the minimum possible distance without direct contact with it. The temperature differences before and after different applications were measured. The applications were: three applications for 3 s of 3 mA of intensity (3:3:3) when the tendon was the targeted tissue, three applications for 3 s of 1.5 mA of intensity (1.5:3:3) when the fat or muscle was the targeted tissue, and 24 s of 1 mA of intensity (1:24:1) in all tissues. No statistically significant Group*Time interactions were found in any tissue (tendon: F = 0.571, p = 0.459, ŋ2 = 0.03; fat pad: F = 0.093; p = 0.764, ŋ2 = 0.01; muscle: F = 0.681; p = 0.420, ŋ2 = 0.04). Overall, no changes in temperature were observed between both applications in the tendon (3:3:3 vs. 1:24:1) and fat/muscle (1.5:3:3 vs. 1:24:1) tissues. The application of two different percutaneous needle electrolysis protocols did not produce appreciable thermal changes in the tendon, fat, and muscle tissues of human cadavers. The results from the current cadaver study support that a thermal effect should not be considered as a mechanism of clinical action regardless of the targeted human tissue when applying percutaneous needle electrolysis since no changes in temperature after its application were observed.
... Moderate evidence suggests a positive effect of US-guided percutaneous electrolysis treatment for tendon-related pain [20]. In addition, an animal study has found that the application of percutaneous electrolysis can help to release the nerve tissue from a fibrous entrapment [29]. The authors proposed that percutaneous electrolysis combines the mechanical effect of the needle and the galvanic current as a mechanism of connective tissue breakdown [29]. ...
... In addition, an animal study has found that the application of percutaneous electrolysis can help to release the nerve tissue from a fibrous entrapment [29]. The authors proposed that percutaneous electrolysis combines the mechanical effect of the needle and the galvanic current as a mechanism of connective tissue breakdown [29]. ...
Achilles tendon tendinopathy (AT) is a musculoskeletal condition characterized by pain in the Achilles tendon and impaired physical performance or sport activities. AT is difficult to treat, and the results are variable. Preliminary evidence suggests a positive effect for pain of percutaneous electrolysis in patients with tendinopathy. Our aim was to determine the validity and safety of a percutaneous electrolysis approach targeting the interphase between the Achilles tendon and the Kager’s fat with ultrasound imaging in both healthy individuals and on a fresh cadaver model (not ultrasound guiding). A needle was inserted from the medial to the lateral side under the body of the Achilles tendon, just between the tendon and the Kager’s triangle, about 5 cm from the insertion of tendon in the calcaneus in 10 healthy volunteers (ultrasound study) and 10 fresh cadaver legs. An accurate needle penetration of the interphase was observed in 100% of the approaches, in both human and cadaveric models. No neurovascular bundle of the sural nerve was pierced in any insertion. The distance from the tip of the needle to the sural nerve was 5.28 ± 0.7 mms in the cadavers and 4.95 ± 0.68 mms in the volunteer subjects, measured in both cases at a distance of 5 cm from the insertion of the Achilles tendon. The results of the current study support that percutaneous electrolysis can be safely performed at the Kager’s fat–Achilles tendon interphase if it is US guided. In fact, penetration of the sural nerve was not observed in any needle approach when percutaneous needling electrolysis was performed by an experienced clinician. Future studies investigating the clinical effectiveness of the proposed intervention are needed.
... A recent meta-analysis found moderate evidence suggesting a positive effect of US-guided percutaneous electrolysis for pain and related disability in patients with musculoskeletal pain [13]. Further, an animal study has observed that the application of percutaneous electrolysis can release nerve tissue, i.e., the sciatic nerve, from a fibrous entrapment [14]. These authors proposed that percutaneous electrolysis would combine the mechanical effect of the needle and the galvanic current as a disruptive mechanism for the connective muscle tissue, thus freeing the nerve from the pressure of the surrounding tissue and improving the patient's symptoms [14]. ...
... Further, an animal study has observed that the application of percutaneous electrolysis can release nerve tissue, i.e., the sciatic nerve, from a fibrous entrapment [14]. These authors proposed that percutaneous electrolysis would combine the mechanical effect of the needle and the galvanic current as a disruptive mechanism for the connective muscle tissue, thus freeing the nerve from the pressure of the surrounding tissue and improving the patient's symptoms [14]. The aim of this study was to determine the validity of applying percutaneous electrolysis, targeting the supinator muscle at the arcade of Frohse with US imaging and also in a Thiel-embalmed cadaver model (not US-guiding). ...
Entrapment of the radial nerve at the arcade of Frohse could contribute to symptoms in patients with lateral epicondylalgia or radial tunnel syndrome. Our aim was to determine the validity of applying percutaneous electrolysis, targeting the supinator muscle at the Frohse’s arcade with ultrasound imaging and in a Thiel-embalmed cadaver model (not ultrasound-guiding). Percutaneous electrolysis targeting the supinator muscle was conducted in five healthy volunteers (ultrasound study) and three Thiel-embalmed cadaver forearms. Two approaches, one with the forearm supinated and other with the forearm pronated were conducted. The needle was inserted until the tip reached the interphase of both bellies of the supinator muscle. Accurate needle penetration of the supinator muscle was observed in 100% in both US-imaging and cadaveric studies. No neurovascular bundle of the radial-nerve deep branch was pierced in any insertion. The distance from the tip of the needle to the neurovascular bundle was 15.3 ± 0.6 mm with the forearm supinated, and 11.2± 0.6 mm with the forearm pronated. The results of the current study support that percutaneous electrolysis can properly target the supinator muscle with either the forearm in supination or in pronation. In fact, penetration of the neurovascular bundle was not observed in any approach when percutaneous needling electrolysis was performed by an experienced clinician.
The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
