Study on the effect of extensor muscles dry needling of the wrist with Mulligan mobilization technique on the thickness of extensor carpi radialis brevis tendon, pain and upper extremity function in patients with lateral elbow epicondylitis

The effect of Mulligan mobilization as an adjuvant therapy to extensor muscle dry needling of the wrist on the thickness of extensor carpi radialis brevis tendon, pain and upper extremity function in patients with lateral epicondylitis of the elbow

The clinical trial with control and parallel-group, simple randomized,with 34 participants

Patients with tennis elbow affiliated to Semnan University of Medical Sciences will randomly be assigned to two groups: dry needling, dry needling with Mulligan. Upper extremity functional index by DASH questionnaire, grip strength with a Pneumatic squeeze bulb dynamometer, pain with VAS, and tendon thickness of extensor Carpi Radialis Brevis with ultra-sonography will be assessed. All evaluations will be done, before, after three treatment sessions and 10 days after

Inclusion Criteria؛ 1. Age between18 to 35 years 2. Confirmation of Tennis elbow Involvement by performing specialized tests 3. VAS greater than 4 Exclusion criteria ؛ 1- past epicondyle surgery 2-Cervical radiculopathy 3-Past injections (such as corticosteroid, self-blood, PRP, mesotherapy) 4- Acute complication

First intervention group؛mulligan+ dry needling that, In addition to dry needling, the Mulligan technique will be done in the extension of elbow and pronation of forearm with 5-10 sec gentle glide in 3 sets of 10 repetitions. simultaneously taping of the extensor muscle group will be done to maintain normal radius alignment. The control group؛dry needling that the patient in supine or sitting, forearm in mid-position, the sterile needle at 0.25 * 0.25 mm inserted in lateral epicondyle trigger points of the elbow with 3 to 4 times rotation for 10 minutes.

Upper extremity function؛ The power of grip؛ pain ؛The thickness of extensor Carpi Radialis Brevis tendon

simple and single randomization, The random numbers table such that each person is given a code. The numbers will written in a table, and we select one place from the table in a blinded manner, then we select 17 numbers smaller than the selected number in the same row. The same would be true for the control group