{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:24:37Z","timestamp":1787923477813,"version":"build-2784847793"},"reference-count":21,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Lateral epicondylalgia (LE) is a prevalent musculoskeletal condition, and a substantial proportion of patients fail to respond to conservative treatment. The myotendinous junction (MTJ) of the common extensor tendon (CET) harbors dense nociceptive nerve endings yet remains an underexplored target in pharmacopuncture practice. Case Presentation: In this retrospective case series, three patients with refractory LE (duration 1.5\u20133 years, with prior treatments including corticosteroid injection, NSAIDs, physical therapy, and prolotherapy) received a structured multicomponent ultrasound-guided pharmacopuncture protocol, of which MTJ-targeted hydrodissection with placenta pharmacopuncture constituted the primary component, administered over ten sessions. A structured three-stage protocol was applied, incorporating placenta pharmacopuncture at the MTJ, Eohyeol pharmacopuncture at LI11, and dry needling at the CET enthesis. Results: All three patients achieved clinically meaningful improvements in PRTEE scores (Case 1: 64\u219213, \u221279.7%; Case 2: 73\u219238, \u221247.9%; Case 3: 55\u219211.5, \u221279.1%), exceeding the MCID threshold of 37% reduction. Qualitative sonographic changes were observed at follow-up assessments conducted 103\u2013270 days after treatment completion. No adverse events were observed. Conclusions: A structured multicomponent ultrasound-guided pharmacopuncture protocol may represent a feasible non-surgical approach for patients with refractory LE. Controlled prospective studies are warranted.<\/jats:p>","DOI":"10.3390\/diagnostics16172755","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:27:46Z","timestamp":1787920066000},"page":"2755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-Guided Pharmacopuncture Targeting the Myotendinous Junction for Refractory Common Extensor Tendinopathy: A Case Series"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6941-5011","authenticated-orcid":false,"given":"Taeseok","family":"Ahn","sequence":"first","affiliation":[{"name":"VARO Korean Medicine Clinic, Seoul 07714, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1535-6117","authenticated-orcid":false,"given":"Jihyun","family":"Moon","sequence":"additional","affiliation":[{"name":"VARO Korean Medicine Clinic, Seoul 07714, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2604-1818","authenticated-orcid":false,"given":"Myungjin","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyoung","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Yun","family":"Ahn","sequence":"additional","affiliation":[{"name":"Dasram Cancer Care Hospital, Goyang 10250, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4628-9230","authenticated-orcid":false,"given":"Daeook","family":"Lee","sequence":"additional","affiliation":[{"name":"SAMSUNG Korean Medicine Clinic, Pohang 37788, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jongha","family":"Lee","sequence":"additional","affiliation":[{"name":"BAREUNBUBU Korean Medicine Clinic, Naju 58325, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyoung","family":"Park","sequence":"additional","affiliation":[{"name":"Samsong Myeongmun Korean Medicine Clinic, Goyang 10571, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3179-9439","authenticated-orcid":false,"given":"Dong-Woo","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Diagnostics, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.3928\/01477447-20230329-05","article-title":"A clinical overview of the natural course and management of lateral epicondylitis","volume":"46","author":"Konarski","year":"2023","journal-title":"Orthopedics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.jse.2020.10.008","article-title":"Increased expression of macrophages and inflammatory cytokines at tendon origin in patients with chronic lateral epicondylitis","volume":"30","author":"Joo","year":"2021","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"354","DOI":"10.5312\/wjo.v13.i4.354","article-title":"Lateral epicondylitis: New trends and challenges in treatment","volume":"13","author":"Karabinov","year":"2022","journal-title":"World J. Orthop."},{"key":"ref_4","first-page":"80","article-title":"Inflammatory mechanisms linking obesity and tendinopathy","volume":"31","author":"Lui","year":"2021","journal-title":"J. Orthop. Transl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jor.2018.01.040","article-title":"Current advances in the treatment of medial and lateral epicondylitis","volume":"15","author":"Tarpada","year":"2018","journal-title":"J. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bachta, A., Rowicki, K., Kisiel, B., \u017babicka, M., Elert-Kope\u0107, S., P\u0142omi\u0144ski, J., T\u0142ustochowicz, W., and Maliborski, A. (2017). Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0181828"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40634-018-0142-8","article-title":"The spread of injectate after ultrasound-guided lateral elbow injection\u2013a cadaveric study","volume":"5","author":"Evans","year":"2018","journal-title":"J. Exp. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103195","DOI":"10.1016\/j.eats.2024.103195","article-title":"Myotendinous Junction anesthesia: An alternative Infiltration Site for Ultrasound-Guided Injections","volume":"14","author":"Rosales","year":"2025","journal-title":"Arthrosc. Tech."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/mus.880160503","article-title":"Mechanoreceptors in human myotendinous junction","volume":"16","author":"Jozsa","year":"1993","journal-title":"Muscle Nerve"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ricci, V., Mezian, K., Cocco, G., Tamborrini, G., Fari, G., Zunica, F., Chang, K.-V., Kara, M., and \u00d6z\u00e7akar, L. (2023). Ultrasonography for injecting (around) the lateral epicondyle: EURO-MUSCULUS\/USPRM perspective. Diagnostics, 13.","DOI":"10.3390\/diagnostics13040717"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lee, S.-h., Youn, Y.S., Kim, M.C., Sun, J., Ha, D., and Kim, T.-H. (2025). Ultrasound-guided acupuncture therapy in Korea: Advancing traditional practices with new technology. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1544618"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.56986\/pim.2024.10.004","article-title":"Trends in clinical research on ultrasound-guided acupuncture: A scoping review","volume":"3","author":"Lee","year":"2024","journal-title":"Perspect. Integr. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.2147\/JPR.S247208","article-title":"Ultrasound-guided nerve hydrodissection for pain management: Rationale, methods, current literature, and theoretical mechanisms","volume":"13","author":"Lam","year":"2020","journal-title":"J. Pain Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2217\/pmt-2019-0056","article-title":"Ultrasound imaging and guidance in peripheral nerve entrapment: Hydrodissection highlighted","volume":"10","author":"Chang","year":"2020","journal-title":"Pain Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"25","DOI":"10.13066\/kspm.2014.9.1.25","article-title":"Reliability and validity of the Korean version of patient-rated tennis elbow evaluation","volume":"9","author":"Lee","year":"2014","journal-title":"J. Korean Soc. Phys. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1258\/ht.2011.011013","article-title":"Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation","volume":"16","author":"Poltawski","year":"2011","journal-title":"Hand Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1016\/j.arthro.2013.06.018","article-title":"Cytotoxicity of local anesthetics on human mesenchymal stem cells in vitro","volume":"29","author":"Breu","year":"2013","journal-title":"Arthroscopy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e3635","DOI":"10.1097\/MD.0000000000003635","article-title":"Safety of acupuncture and pharmacopuncture in 80,523 musculoskeletal disorder patients: A retrospective review of internal safety inspection and electronic medical records","volume":"95","author":"Kim","year":"2016","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.18325\/jkmr.2017.27.4.75","article-title":"A review of clinical study on Jungsongouhyul pharmacopuncture treatment published in Korea","volume":"27","author":"Yoon","year":"2017","journal-title":"J. Korean Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"137","DOI":"10.13048\/jkm.24030","article-title":"A case report of ultrasound-guided hominis placenta pharmacopuncture on lateral epicondylitis","volume":"45","author":"Oh","year":"2024","journal-title":"J. Korean Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"200","DOI":"10.13048\/jkm.25061","article-title":"A Pathophysiology-Based Four-Stage Ultrasound-Guided Acupuncture Strategy for Chronic Achilles Tendinopathy: A Case Report (CARE Compliant)","volume":"46","author":"Kim","year":"2025","journal-title":"J. Korean Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2755\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:38:36Z","timestamp":1787920716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":21,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16172755"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16172755","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}