Managing Refractory Tendinopathy: What is UltraSound Guided Galvanic Electrolysis?

Previously, we have discussed the use of topical nitroglycerin, needle tenotomy, dextrose prolotherapy, extracorporeal shock wave therapy, and acupuncture for refractory tendinopathies. In this post, we will review the rationale and literature behind UltraSound Guided Galvanic Electrolysis Technique.

UltraSound Guided Galvanic Electrolysis Technique (USGET), sometimes referred to as intratissue percutaneous electrolysis (EPI) or percutaneous needle electrolysis (PNE), is a novel, minimally invasive therapeutic technique which consists in an ultrasound-guided needle insertion and application of a galvanic electrolytic current that causes a controlled local inflammatory process in the target tissue [1]. This produces a non-thermal electrochemical reaction on degenerated tissue, leading to an inflammatory process, increasing oxidative stress and cell death in the first days after treatment [3]. This allows for phagocytosis and subsequent healing and regeneration of pathologic tissue.

USGET may help with some upper extremity pathology. In patients with subacromial pain syndrome, USGET combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises [5]. It is not clear whether the authors were referring to cuff tendinopathy, impingement and/or subacromial bursitis. In a single arm study of patients with lateral epicondylitis, weekly USGET combined with eccentric exercises and home stretching resulted in 83% of patients rating overall outcome as successful at 6 weeks. US findings in these patients showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly [4].

In a study of patients with patellar tendinopathy, USGET combined with eccentric exercises was superior to conventional electro physiotherapy (consisting of ultrasound, laser and interferential current techniques) for pain and function [1]. There is currently a trial registered with clinicaltrials.gov evaluating USGET for achilles tendinopathy [2]. In patients with proximal hamstring tendinopathy-related sciatic nerve entrapment, the procedure has been described but not studied. In a case series of patients treated for plantar fasciitis, the authors found that 10/17 patients improved within one month, from which 4 had no symptoms and the other 7 had no relief [3].

Conclusions

UltraSound Guided Galvanic Electrolysis Technique (USGET) represents a novel, promising technique for management of tendinopathies. Due to it’s relatively recent presence on the scene as a therapeutic tool, there is minimal research to support its use. Thus far, the most promising locations including lateral epicondylitis, patellar tendonitis and plantar fasciitis. Ultimately, larger, more robust studies are needed to better identify the best applications for this new modality.

References

[1] Abat, Ferran, et al. "Randomized controlled trial comparing the effectiveness of the ultrasound-guided galvanic electrolysis technique (USGET) versus conventional electro-physiotherapeutic treatment on patellar tendinopathy." Journal of experimental orthopaedics 3.1 (2016): 34.

[2] https://clinicaltrials.gov/ct2/show/NCT03167554

[3] Freire, Gonçalo, et al. "Ultrasound guided Intratissue Percutaneous Electrolysis (EPI) technique–a new approach to plantar fasciitis?." European Congress of Radiology 2018, 2018.

[4] Valera-Garrido, Fermín, Francisco Minaya-Muñoz, and Francesc Medina-Mirapeix. "Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results." Acupuncture in Medicine 32.6 (2014): 446-454.

[5] Arias-Buría, José L., et al. "Ultrasound-guided percutaneous electrolysis and eccentric exercises for subacromial pain syndrome: a randomized clinical trial." Evidence-Based Complementary and Alternative Medicine 2015 (2015).

[6] Mattiussi, Gabriele, and Carlos Moreno. "Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application." Muscles, ligaments and tendons journal 6.2 (2016): 248.