Letter to the Editor: Myofascial Perspective and Dry Needling Treatment of Muscles Associated with Lateral Epicondylitis

Dear Editor:

Myofascial pain syndrome (MPS) is a common musculoskeletal pathology that causes pain in the elbow region. ¹ MPS of the brachioradialis; extensor carpi ulnaris; extensor carpi radialis brevis and longus; extensor digitorum; anconeus; and lateral part of the triceps muscles, which are adjacent to the lateral epicondyle, may be areas of pain spread similar to the pain that occurs in lateral epicondylitis. Considering myofascial pain syndrome in individuals with pain in the lateral epicondyle region, application of such treatments as dry needling or local-anesthetic injection may yield effective results.^2–4

This letter describes the blinding technique, dry-needling treatment, that we apply with the 3P rule of position, palpation, and perpendicular needling for treating myofascial pain syndrome of the muscles associated with the lateral epicondyle region. ⁵ The diagrams in Figure 1, parts A–F, show the pain patterns and the photographs in Figure 1, parts G–L show the parts of the body where the needling is performed.

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FIG. 1.

Dry needling of lateral epicondyle–associated muscles. (A and G) Supinator-muscle trigger-point localization, referred pain pattern, and needling technique. (B and H). Brachioradialis–muscle pain radiation and needling. (C and I) Extensor carpi radialis brevis–muscle pain radiation and needling. (D and J) Anconeus–muscle pain radiation and needling. (E and K) Lateral part of triceps-muscle pain radiation and needling. (F and L) Extensor digitorum–muscle pain radiation and needling.

For the supinator, the patient should be in a supine position. The shoulder should be close to the body, the elbow should be slightly flexed, and the forearm should be pronated. Needling is performed with the flat palpation technique. The needle should enter the skin perpendicularly, laterally-to-medially (Fig. 1G).

For the brachioradialis, the patient should be in a supine position, the shoulder should be positioned close to the body, the elbow should be slightly flexed, and the forearm should be pronated. Needling is performed with the pincer palpation technique. The needle should penetrate the skin laterally-to-medially (Fig, 1H).

For the extensor carpi radialis brevis, the patient should be in the supine position. The elbow is brought to flexion and the wrist to pronation. Needling is performed with the flat palpation technique. The needle should enter the skin perpendicularly dorsally-to-ventrally (Fig. 1I).

For the anconeus, the patient should be in a supine position. The patient's elbow should be slightly flexed and the forearm should be pronated. Needling is done with the flat palpation technique. The needle should pierce the skin, laterally-to-medially, targeting the ulna bone (Fig. 1J).

For the lateral part of the triceps, the patient should be in a prone position. The shoulder should be at 90° abduction, the elbow 90° flexed, and the forearm pronated. Needling is performed with the flat palpation technique. The needle should penetrate the skin vertically, from back-to-front (Fig. 1K).

For the extensor digitorum, the patient should be in a supine position. The elbow should be slightly flexed and the forearm should be pronated. Needling is performed with the flat palpation technique. The needle should penetrate the skin, aiming at a perpendicular radius (Fig. 1L).