Objective:

To evaluate and compare the short-term efficacy of various micro-invasive and physical interventions for pain relief and functional restoration in patients with lateral epicondylitis using network meta-analysis.

Approach:

• Search Strategy: A comprehensive search was performed in major databases for randomized controlled trials investigating physical interventions for lateral epicondylitis, focusing on primary outcomes such as VAS, DASH score, and PRTEE.
• Data Analysis: Data synthesis, consistency testing, and SUCRA calculations were conducted using Stata 18.0, along with two-dimensional cluster analysis to assess analgesic and functional benefits.

Key Findings:

• Percutaneous electrolysis (PE) was the most effective intervention for pain reduction (SUCRA = 98.5%, MD = −6.00, 95% CI: −9.75 to −2.25).
• Dry needling (DN) showed the highest ranking for functional improvement (DASH SUCRA = 79.7%; PRTEE SUCRA = 85.2%, MD = −25.04, 95% CI: −48.29 to −1.79).
• PE was categorized in the 'strong analgesia' quadrant, while DN was in the 'strong functional recovery' quadrant.
• Other interventions like platelet-rich plasma and corticosteroid injections showed only moderate effectiveness.

Interpretation:

The interventions exhibit distinct therapeutic profiles for lateral epicondylitis in the short term, with PE being optimal for pain relief and DN for functional recovery. Caution is advised in interpreting SUCRA rankings due to high network heterogeneity and lack of statistical significance in some comparisons.

Limitations:

• High underlying network heterogeneity.
• Lack of statistical significance in DASH-related pairwise comparisons.
• Overlapping prediction intervals in the analysis.

Conclusion:

The findings indicate that clinical decisions should be tailored to the patient's predominant short-term symptoms, balancing immediate pain relief with targeted functional recovery.

Sources:

• Systematic Review Registration