# Comparing the Functional Outcomes of Hyaluronic Acid Injection and Dry Needling in Lateral Epicondylitis: A Retrospective Study

## TL;DR

This study compares hyaluronic acid injections and dry needling for treating tennis elbow, finding that hyaluronic acid provides better long-term pain relief and functional improvement.

## Contribution

The study provides direct comparative evidence on the long-term efficacy and safety of hyaluronic acid injections versus dry needling for lateral epicondylitis.

## Key findings

- Hyaluronic acid injections showed significantly greater pain reduction and functional improvement at six months compared to dry needling.
- Hyaluronic acid had lower complication rates, with less local tenderness than dry needling.
- Both treatments improved pain and function, but hyaluronic acid was more effective long-term.

## Abstract

Background

Lateral epicondylitis (LE), commonly referred to as tennis elbow, is a widespread condition characterized by elbow pain and functional impairment. Conservative treatment options include physiotherapy, pharmacotherapy, and interventional procedures such as dry needling (DN) and hyaluronic acid (HA) injections. HA, an emerging treatment, has shown anti-inflammatory and lubricating properties, which may enhance tendon healing. However, direct comparative evidence between HA and DN injections for the management of LE remains limited. The main objective of this research was to compare the functional outcomes of HA injections versus DN in patients with LE, specifically focusing on pain relief, and overall functional improvement over a six-month period.

Materials and methods

A retrospective comparative study was conducted at a tertiary care institution between June and November 2024, involving 64 patients diagnosed with LE. The patients were divided into two equal groups: Group A (hyaluronic acid injection, n=32) received a single-dose hyaluronic acid injection under ultrasound guidance, followed by rehabilitation, while Group B (dry needling, n=32) underwent peritendinous dry needling using a 25G needle. Pain reduction was assessed using the Visual Analog Scale (VAS) and functional improvement was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Oxford Elbow Score, Mayo Elbow Score, and Patient-Rated Tennis Elbow Evaluation (PRTEE) at baseline, post-procedure, first month, third months and sixth months. Statistical analyses were performed using SPSS version 22 (IBM Corp, Armonk, NY).

Results

At six months, HA injections demonstrated a significantly greater reduction in pain, as measured by the VAS (2.41±0.50 vs. 3.44±0.56, p < 0.001), and superior functional outcomes in the QuickDASH (19.03±2.93 vs. 23.44±3.64, p<0.001), the Oxford Elbow Score (91.87±5.89 vs. 82.13±1.52, p<0.001), and the Mayo Elbow Score (91.75±6.34 vs. 82.41±2.00, p <0.001). The complication rates were lower in the HA group, with significantly less local tenderness (3.1% vs. 25.0%).

Conclusion

Both HA injection and DN effectively improved pain and function in LE patients, but HA demonstrated superior long-term efficacy and safety. Future studies with larger sample sizes and extended follow-up periods are recommended.