Repetitive Low-Energy Shock Wave Treatment for Chronic Lateral Epicondylitis in Tennis Players

Abstract

Background There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow. Hypothesis Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extracorporeal shock wave treatment. Methods Seventy-eight patients enrolled in a placebo-controlled trial. All patients were tennis players with recalcitrant MRIconfirmed tennis elbow of at least 12 months’ duration. Patients were randomly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks (treatment group 1) or an identical placebo extracorporeal shock wave treatment (sham group 2). Main outcome measure was pain during resisted wrist extension at 3 months; secondary measures were >50% reduction of pain andthe Upper Extremity Function Scale. Results At 3 months, there was a significantly higher improvement in pain during resisted wrist extension in group 1 than in group 2 (mean [SD] improvement, 3.5 [2.0] and 2.0 [1.9]; P= .001 for between-group difference of improvement) and in the Upper Extremity Function Scale (mean [SD] improvement, 23.4 [14.8] and 10.9 [14.9]; P< .001 for between-group difference of improvement). In the treatment group, 65% of patients achieved at least a 50% reduction of pain, compared with 28% of patients in the sham group (P= .001 for between-group difference). Conclusion Low-energy extracorporeal shock wave treatment as applied is superior to sham treatment for tennis elbow.