Radial Shock Wave Therapy in Patients with Lateral Epicondylitis

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Introduction: Lateral epicondylitis, or “tennis elbow”, is a relatively common disorder. Various therapeutic modalities have been tried in an attempt to manage the disorder but neither the conservative methods nor the surgical options have proved to be benefi cial so far. During the past decade in the USA and European countries and the past several years in Bulgaria, the shock wave therapy (focused and radial) has been introduced as a method of choice in the treatment of chronic tendynopathies.

The AIM of the present study was to make quantitative assessment of the effect of radial shockwave therapy in patients with lateral epicondylitis.

PATIENTS AND METHODS: The study included 16 patients with lateral epicondylitis (9 males, 7 females, mean age 47.2 ± 2.3 yrs) of mean duration of 15.06 ± 4.06 months. We used the BTL-5000 radial shockwave therapy equipment and performed 5 procedures (one per week). The total number of shocks was 2500, the pressure was 2 Bars: 1500 shocks of 5 Hz frequency followed by 500 shocks of 10 Hz frequency were applied locally on the lateral epicondyle and 500 shocks of 2 Bar pressure and 5 Hz frequency were applied along the muscles near the insertion. The patients were evaluated 5 times: before treatment, immediately after the end of treatment and at 3, 6 and 12 months of follow-up. Pain was assessed at rest, on palpation and by the Thomsen test using a visual analogue scale (VAS). The patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to assess the patients‘ pain, functional condition and limitations in performing specifi c activities, as well as for the overall self evaluation.

RESULTS: We found signifi cant difference (p < 0.05) between the mean pain scores (at rest, on palpation and by Thomsen test) before treatment and these scores obtained immediately after treatment, the decrease sustained at 3, 6 and 12 months. VAS showed decrease from 3.75 ± 0.49 before therapy to 2.44 ± 0.39 after treatment, to 1.94 ± 0.46 at 3 months and to 0.69 ± 0.38 at one year at rest, from 7.44 ± 0.38 before therapy to 4.69 ± 0.51 after treatment, to 3.56 ± 0.40 at 3 months and 1.46 ± 0.56 at one year at palpation, and from 5.87 ± 0.46 before therapy to 3.5 ± 0.29 after it, to 2.5 ± 0.40 at 3 months and 1 ± 0.38 at one year in the Thomsen test.

The pain, function and the total score as assessed on the patient-rated scale (PRTEE) also showed statistically signifi cant improvement (p < 0.05) after completion of therapy and over the whole follow-up. Total score decreased from 56.75 ± 2.34 before therapy to 39.38 ± 3.96 after treatment, to 27.53 ± 3.7 at 3 months and to 13.69 ± 4.48 at one year.

CONCLUSION: Based on the results of this preliminary study we could recommend the radial shock wave therapy in the treatment of lateral epicondylitis of more than 6 months‘ duration if the condition is recalcitrant to other conservative methods of treatment.

1. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 2004;51:642-51.

2. Struijs PA, Korthals-de Bos IB, van Tulder MW, van Dijk CN, Bouter LM, Assendelft WJ. Cost effectiveness of brace, physiotherapy or both for treatment of tennis elbow. Br J Sports Med 2006;40:637-43.

3. Assendelft W, Green S, Buchbinder R, Struijs P, Smidt N. Tennis elbow. BMJ 2003;327(8):329-30.

4. Vicenzino B, Wright A. Lateral epicondylalgia I: epidemiology, pathophysiology, aetiology and natural history. Phys Ther Rev 1996;1:23-34.

5. Regan W, Wold LE, Conrad R, Morrey BE. Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 1992;20:746-9.

6. Staples M, Forbes A, Ptasznik R, Gordon J, Buchbinder R. A randomized control trial of extracorporeal shock wave therapy for lateral epicondylitis. J Rheumatol 2008;35:2038-46.

7. Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician 2007;76:843-53.

8. Seil R, Wilmes P, Nuhrenborger C. Extracorporeal shock wave therapy for tendinopathies. Expert Rev Med Devices 2006:3(4);463-70.

9. Onose G, Chendreanu CD, Haras M, Spinu A, Andone I. Extracorporeal shock wave therapy - a new «wave» also in Physiatry. Practica Medicala 2011;1(21):35-42.

10. Rompe JD, Kirpatrick CJ, Kulmer k, Swittale M, Krischek O. Dose related effect of shock waves on rabit tendo Achilles. J Bone J Surg (Br) 1998;80: 546-52.

11. MacDermit JC. The patient related tennis elbow evaluation (PRTEE) User Manual. Ontario, 2007

12. Haake M, Konig IR, Decker T, Riedel C, Buch M, Muller H. ESWT in the treatment of lateral epicondylitis. A randomized multicentre trial. J Bone and Joint Surg 2002;84:1982-90.

13. Speed CA, Nichols D, Richards C, et al. Extracorporeal shock wave therapy for lateral epicondylitis - a double blind randomised controlled trial. J Orthop Res 2002;20(5):895-8.

14. Lebrun CM. Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis. Clin J Sport Med 2005;15(5):401-2.

15. Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial. Am J Sports Med 2004;32(7):1660-7.

16. Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am 2005;87(6):1297-304.

17. Rompe JD, Decking J, Schoellner C, Theis C. Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players. Am J Sports Med 2004;32(3):734-43.

18. Rompe JD, Hope C, Kullmer K, Heine J, Burger R. Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow. J Bone Joint Surg Br 1996;78(2):233-7.

19. Spacca G, Nocozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis. A prospective randomized control single-blind study. Eur Med Phys 2005;41:17-25.

20. Wang CJ, Hung HY, Pai CH. Shock-wave enhanced neovascularization at the tendon-bone junction: an experiment in dogs. J Foot Ankle Surg 2002;41: 16-22.

21. Wang CJ, Wang FS, Yang KD, Huang CS, Hsu CC. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in Rabbits J Orthop Res 2003;21:984-9.

22. Chen YJ, Wang CJ, Yang KD, et al. Extracorporeal shock waves promote healing of colagenase induced Achilles tendinitis and increase TGF-β1 and IGF-I expression. J Orthop Res 2004;22(4):854-61.

23. Mariotto S, Cavalieri E, Amelio E, Campa AR, Carcereri de Prati A, et al. Extracorporeal shock waves: from lithotripsy to anti-infl ammatory action by NO production. Nitrix Oxide 2005;12:89-96.

24. Ko JY, Chen HS, Chen CM. Treatment of lateral epicondylitis of the elbow with shock waves. Clin Orthop 2001;387:60-7.

25. Takahashi N, Ohtori S, Saisu T, Takahashi K, Wada Y, Moria H. Application of shock waves to rat skin decreases calcitonin gene related peptide immunoreactivity in dorsal root ganglion neurons. 5th International Congress of the ISMST; 2003, February; Orlando.

26. Maler M, Miltz S, Writz DC, Rompe JD, Schmitz C. Basic research of applying extracorporeal shockwaves on the musculoskeletal system. An assessment of current status. Orthopade 2002;31(7):667-77.

Folia Medica

The Journal of Medical University-Plovdiv

Journal Information

CiteScore 2017: 0.54

SCImago Journal Rank (SJR) 2017: 0.206

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