Publications
Comparative effectiveness of percutaneous needle electrolysis and shockwave therapy in subscapularis tendinopathy: a randomized clinical trial
Authors: Adrian Kuzdzal 1, Malgorzta Smoter 2, Gracjan Olaniszyn 3, 4, Bartlomiej Bogdanski 5, Tomasz Halski 6, Robert Trybulski 7, 8
Affiliations:
- Institute of Physiotherapy, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszow, Rzeszow, Poland
- Department of Basic Physiotherapy, Gdansk University of Physical Education and Sport, Gdansk, Poland
- Medical Department Wojciech Korfanty, Upper Silesian Academy in Katowice, Katowice, Poland
- Olaniszyn Physiotherapy Centre, Raciborz, Poland
- Doctoral School of Gdansk University of Physical Education and Sport, Gdansk, Poland
- Faculty of Health Sciences, University of Opole, Opole, Poland
- Faculty of Medicine, Katowice Business University, Katowice, Poland
- Provita Zory Medical Center, Zory, Poland
Journal: Pain Management - May 2026 (DOI: 10.1080/17581869.2026.2669520)
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Field & Applications:
- Medical
- Treatment evaluation
- Physiotherapy
- Musculoskeletal disorder
- Musculoskeletal rehabilitation
Objectives: To evaluate whether adding ultrasound-guided percutaneous needle electrolysis (PNE) to extracorporeal shockwave therapy (ESWT) and therapeutic exercise improves short-term outcomes in adults with imaging-confirmed subscapularis tendinopathy.
Methods: This assessor-blinded, randomized, parallel-group clinical trial included 30 participants randomly allocated (1:1) to PNE+ESWT+exercise (n = 15) or ESWT+exercise (n = 15) for 8 weeks. Primary outcomes were pain (VAS), upper-limb disability (DASH), and tendon stiffness; secondary outcomes were pressure pain threshold, internal rotation range of motion and strength, cross-sectional area, tissue perfusion, Tenascin-C, and ultrasound tendon integrity findings.
Results: Compared with ESWT+exercise, PNE+ESWT+exercise produced significant improvements in tendon stiffness (between-group difference in change, −31.29 N/m [95% CI, −36.65 to −25.93]; interaction p < .001), DASH disability (−3.91 points [95% CI, −5.84 to −1.97]; p < .001), pressure pain threshold (10.01 kPa [95% CI, 9.07 to 10.94]; p < .001), internal rotation range of motion (5.29° [95% CI, 4.18 to 6.39]; p < .001), internal rotation strength (1.53 kgF [95% CI, 1.15 to 1.92]; p < .001), cross-sectional area (−0.99 mm2 [95% CI, −1.20 to −0.79]; p < .001), and Tenascin-C (19.90 pg/mL [95% CI, 7.63 to 32.17]; p = .002).
Conclusions: Adding PNE to ESWT, manual therapy, and exercise was associated with greater short-term improvements in upper-limb disability, tendon properties, and shoulder mechanical performance. Pain improved in both groups, without a between-group difference.
Keywords: tendinopathy, electrolysis, shockwave therapy, physical therapy modalities, randomized controlled trial
In this randomized clinical trial, adding ultrasound-guided PNE to ESWT, manual therapy, and exercise was associated with greater short-term improvements in upper-limb disability, tendon stiffness, pressure pain threshold, internal rotation range of motion, internal rotation strength, cross-sectional area, and Tenascin-C than ESWT, manual therapy, and exercise alone. Pain improved in both groups, without a between-group difference. These findings support PNE as a potentially useful adjunct within a multimodal physiotherapy program for subscapularis tendinopathy, but the results should be interpreted cautiously given the small sample, short-term follow-up, and absence of a sham control. Larger trials with longer follow-up are needed to confirm these findings and determine their durability.