Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: A Randomized Clinical Trial

This randomized clinical trial compared the effects of adding ultrasound (US)-guided percutaneous electrolysis into a program consisting of manual therapy and exercise on pain, shoulder-related disability, function, and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, 1 session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included pain, function (Shoulder Pain and Disability Index [SPADI]) pressure pain thresholds (PPTs) and Global Rating of Change (GROC). They were assessed at baseline, post-treatment, and 3 and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all followups (P = .051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantly greater changes in shoulder pain (P < .001) and SPADI (P < .001) than did those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (standardized mean difference > .91) for shoulder pain and function at 3 and 6 months in favor of the percutaneous electrolysis group. No between-group differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related disability (DASH) compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether these effects are reliable should be addressed in future studies. Perspective: This study found that the inclusion of US-guided percutaneous electrolysis into a manual therapy and exercise program resulted in no significant differences for disability and pressure pain sensitivity compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. (C) 2018 by the American Pain Society