Dry needling (peppering, fenestration)

Cause, clinical and ultrasound findings

• Inflammatory arthritis, chronic injury or overuse may cause inflammation/microtearing of the tendon.

• Pain and swelling are present at the affected area.

• Hypoechoic areas and clefts with or without neovascularity and calcifications in the tendon.

• Irregularity of the cortex of the bone is in keeping with enthesopathy at the site of tendon insertion.