Tennis/Golfers Elbow
Otherwise known as extensor tendinopathy of the elbow and is usually an overuse injury causing pain on the bony prominence on the outer aspect of the elbow. It is usually caused by repetition of movements of the wrist or by gripping activities, pulling on the tendon attachment at the elbow, which may eventually result in pain.
Treatment may involve rest, avoidance of aggravating factors, NSAIDs, manual therapy, eccentric loading (lengthening under load) to the tendon/muscle group, orthotic devices or injection therapy.
Current evidence from NICE suggests the efficacy for the use of shockwave therapy for the treatment of tennis elbow is inconsistent as the evidence is limited and contradictory.
In a randomised controlled trial (RCT) comparing 272 patients treated by ESWT or sham ESWT, success was reported in 26% and 25% of patients, respectively, at 3-month follow-up. An RCT of 93 patients treated by ESWT or steroid injection reported treatment success (at least 50% improvement in Visual Analogue Scale [VAS] score) in 60% and 84% of patients, respectively, at 3-month follow-up.
An RCT of 75 patients treated by ESWT or sham ESWT reported that at 3 months, 35% and 37% of patients, respectively, had at least a 50% improvement in VAS score for pain during the day and 30% and 43% of patients, respectively, had at least a 50% improvement in VAS score for pain at night.
A systematic review performed in 2014 also found there was mixed evidence for the use of shockwave therapy for the treatment of tennis elbow.
A more recent review of the RCTs (2015) performed for tennis elbow concluded that shockwave therapy is a good treatment modality for chronic tennis elbow. (greater than 3 months) However further research is still required.
Although the current evidence is limited and contradictory, shockwave therapy may provide some benefits for chronic tennis elbow especially if other treatment modalities have failed. However, more research is required.
For further information check out the link to the leaflet produced by NICE about the procedure for the treatment of tennis elbow using shockwave therapy.
References
- Speed C. A systematic review of shockwave therapies in soft-tissue conditions: focussing on the evidence. Brit Jour Sports Med. 2014;48(21)
- Haake M, Konig MA, Decker T et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis. Journal of Bone and Joint Surgery. 2002;84A:1982-1991.
- Speed CA, Nichols D, Richards C et al. Extracorporeal shock wave therapy for lateral epicondylitis – a double blind randomised controlled trial. Journal of Orthopaedic Research. 2002;20:895-898.
- Thiele S, Thiele R, Gerdesmeyer L. Lateral epicondylitis: this is still a main indication for extracorporeal shockwave therapy. Int J of Surg. 2015;24:165-170.