Ultrasound-Guided Pharmacopuncture Targeting the Myotendinous Junction for Refractory Common Extensor Tendinopathy: A Case Series.

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 1.5-3 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→13, -79.7%; Case 2: 73→38, -47.9%; Case 3: 55→11.5, -79.1%), exceeding the MCID threshold of 37% reduction. Qualitative sonographic changes were observed at follow-up assessments conducted 103-270 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.