Ultra-sonographic study of the effect of dry needling of extensor muscles combined with Mulligan mobilization technique on extensor muscle tendon thickness, pain and upper limb function in patients with lateral epicondylitis: A double-blinded randomi

Introduction: Lateral epicondylitis (LE) is one of the most common causes of pain in the elbow. The aim of this study was to evaluate the effect of dry needling (DN) of wrist extensor muscles along with Mulligan mobilization (MM) technique on extensor muscle tendon thickness, pain and upper limb function in patients with LE. Materials and Methods: 39 patients with LE participated in this double-blinded clinical trial study and were randomly divided into one of three groups: first intervention (DN), second intervention (DN with MM) and control. In first intervention group, DN was inserted in the trigger point(s) of the target muscles during 3 sessions of treatment, every other day. In second intervention group, in addition to DN, MM technique was performed. Control group didn’t receive any intervention. Pain intensity, function level, grip strength, and tendon thickness of extensor muscles were assessed in three stages before treatment, 24 hours after last session, and ten days after the end of sessions. Results: The results showed that all variables in the DN group and DN with MM had a significant improvement compared to the control group. Function and VAS scores in the DN with MM group showed a more significant difference than in the DN alone, but the differences in tendon thickness between the two groups were not significant. Conclusion: Dry needling with Mulligan mobilization can produce further improvement in grip strength, function and pain level in patients with LE. DN is sufficient to improve the thickness of the extensor muscle tendon