title: Ultrasound-guided dry needling with percutaneous paratenon decompression for chronic Achilles tendinopathy.
abstract: OBJECTIVE
  Chronic Achilles tendinopathy is a common overuse injury. There are several modalities of treatment, reflecting difficulties in management. In particular, due to the well-recognised surgical morbidity, treatment has steered towards less invasive routes. Previous studies have targeted pathology either inside or outside the tendon in isolation with varying results. This study aimed to target both pathological sites by combining dry needling with percutaneous hydrostatic decompression as a novel treatment.
  
  
  METHODS
  Twenty-one patients with 26 chronic, non-insertional Achilles tendinopathy were prospectively enrolled. Ultrasound-guided dry needling of neovascular areas and small-volume hydrostatic paratenon decompression was performed 6-weekly. Sonographic assessment of tendon thickness and neovascularity was undertaken. Following treatment, a standardised physiotherapy regime was adopted. Visual analogue scores (VAS) were used as the primary outcome measure. Telephonic interviews were carried out 12 and 24 months post-treatment.
  
  
  RESULTS
  Twenty-four tendons (in 19 patients) were successfully treated. The mean treatment session was 2. There was no significant change in neovascularity or tendon thickness. Therapeutic intervention led to a significant improvement in VAS at rest (42.4 ± 24.4 vs. 18.4 ± 26.0, p = 0.0005) and during activity (72.8 ± 16.0 vs. 33.7 ± 23.2, p < 0.0001). At 12 and 24 months, >75 % of patients were highly satisfied with their outcome with nearly half reporting complete resolution of their symptoms. >85 % were also able to return to their sporting interests.
  
  
  CONCLUSIONS
  Combined therapy of dry needling with percutaneous hydrostatic paratenon decompression under ultrasound guidance is a well-tolerated procedure with good short- and long-term pain and functional outcomes.
  
  
  METHODS
  Prospective case series, Level IV.
authors.affiliation: St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK. andreayeo@doctors.org.uk.
authors.forename: Andrea
authors.initials: A
authors.lastname: Yeo
authors.affiliation: St Richard's Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE, UK.
authors.forename: Namita
authors.initials: N
authors.lastname: Kendall
authors.affiliation: St Richard's Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE, UK.
authors.forename: Sunderarajan
authors.initials: S
authors.lastname: Jayaraman
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Dry needling; Hydrostatic decompression; Non-insertional Achilles tendinopathy; Non-surgical treatment; Percutaneous decompression