Ultrasound-Guided Pharmacopuncture for Lateral Epicondylitis Initially Misdiagnosed Due to Incomplete Common Extensor Tendon Evaluation: a case report

Lateral epicondylitis is a common musculoskeletal condition caused by repetitive strain, most frequently affecting the extensor carpi radialis brevis (ECRB) muscle. Although musculoskeletal ultrasonography is a valuable diagnostic tool, limited scanning of the common extensor tendon (CET) might result in missed diagnoses. Therefore, accurate evaluation requires a comprehensive assessment of both superficial and deep tendon fibers. A 45-year-old woman presented with persistent right lateral elbow pain that has worsened over eight weeks. Initial ultrasonography performed at an orthopedic clinic reportedly showed no abnormalities. Corticosteroid injections were administered for symptomatic relief; however, the pain persisted and interfered with the patient's daily activities. Upon visiting a Korean medicine clinic, ultrasonographic re-evaluation revealed pathological changes in the deep fibers of the ECRB, including thickening and fibrillar disruption. Ultrasound-guided pharmacopuncture was performed three times over five days using a mixture of polydeoxyribonucleotide and 5% dextrose water. Pain intensity rapidly improved, with the Numerical rating scale decreasing from 7 to 0 and the Patient-rated tennis elbow evaluation score decreasing from 82 to 11. No recurrence was reported during follow-up. This case report underscores the diagnostic limitations of partial CET evaluation, and highlights the need for multilayered ultrasonographic assessment in cases of lateral epicondylitis. Additionally, ultrasound-guided pharmacopuncture could offer an effective nonsurgical treatment option by targeting peritendinous inflammation. Comprehensive diagnostic evaluation and integrative therapeutic approaches could lead to improved clinical outcomes in patients with lateral epicondylitis.