Percutaneous electrolysis in the treatment of tennis elbow.

INTERVENTION: The aim of the study is to evaluate changes in ultrasound and clinical parameters in patients with enthesopathy of the lateral epicondyle of the humerus after the use of percutaneous electrolysis. Patients diagnosed with enthesopathy of the lateral epicondyle of the humerus will be randomly allocated to one of two experimental groups: Group A or Group B. Group A – Percutaneous electrolysis + isometric training Percutaneous electrolysis treatments will be performed using the PHYSIO INVASIVA 2.0 device from EASYTECH. During each treatment, the patient will be in a sitting position. A needle connected to the negative pole of the power source will be inserted under ultrasound guidance into the common extensor tendon of the wrist and fingers, near the lateral epicondyle of the humerus, at the site of the lesion. A self‐adhesive plate electrode made of conductive carbon rubber, completing the circuit, will be attached to the lateral aspect of the forearm, 15 cm above the lateral epicondyle of the humerus. Each treatment will last 90 seconds, with a current intensity of 400 microamperes. Treatments will be performed once a week for a total of five sessions. All procedures will be delivered by the same experienced physiotherapist, trained and licensed to perform percutaneous electrolysis. Fidelity monitoring for percutaneous electrolysis: To ensure fidelity to the intervention, all treatment parameters (current intensity, treatment duration, needle placement, patient positioning) will be documented in the medical notes after each session. Medical records will be reviewed weekly by the study coordinator to confirm adherence to the protocol. Isometric training: Throughout the therapy period, all patients in Group A will also perform isometric training. During CONDITION: Enthesopathy of the lateral epicondyle of the humerus; ; Enthesopathy of the lateral epicondyle of the humerus Musculoskeletal ‐ Other muscular and skeletal disorders Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Grip strength, both in the affected and healthy limbs.[Dynamometer Assessments will be conducted before starting treatment, and at 1, 6 (primary timepoint) and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Pain occurring during activity,[Numerical Rating Scale 0‐10. Assessments will be conducted before starting treatment, and at 1, 6 (primary timepoint) and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Pressure sensitivity level .[Algometer Assessments will be conducted before starting treatment, and at 1, 6 (primary timepoint) and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] INCLUSION CRITERIA: • pain at the attachment of the common extensor tendon of the wrist and fingers to the lateral epicondyle of the humerus, lasting for at least 3 months, • pain on palpation at the attachment of the common extensor tendon of the wrist and fingers to the lateral epicondyle of the humerus, • positive Thomson's test, • positive Mill's test, • positive Moudsley's test. SECONDARY OUTCOME: Function[Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Function[Patient‐Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Pain at night.[Numerical Rating Scale 0‐10. Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Pain at rest.[Numerical Rating Scale 0‐10. Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Pincer grip strength[Dynamometer Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Strength of the wrist extensors, both in the affected and healthy limbs.[Dynamometer Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.] Strength of the wrist flexors, both in the affected and healthy limbs.[Dynamometer Assessments will be conducted before starting treatment, and at 1, 6 and 12 weeks post‐treatment commencement, as well as at 6 and 12 months after treatment completion.]