Effects of Radial Shockwave therapy in the treatment of chronic lateral elbow tendinopathy: a non-randomised controlled trial

Abstract

Introduction: Lateral elbow tendinopathy (LET), more commonly known as tennis elbow, is the most common chronic musculoskeletal pain condition affecting the elbow. It affects from 1-3% of active working people. It is an overuse injury mostly affecting the extensor carpi radialis brevis tendon. There are many treatment approaches for this condition, including medical treatment (conservative treatment as well as surgery), physiotherapy, bracing, rest, or a ‘wait and see’ approach. No single intervention has been proven to be more efficient than another. Radial shockwave is a non-invasive modality, and may be an alternative treatment option. There is conflicting evidence regarding the effectiveness of radial shockwave treatment for lateral elbow tendinopathy. Although it has been reported to be effective in some trials, in others it was no more effective than the placebo. Good quality evidence of effective physiotherapy-based treatment (such as radial shockwave) for chronic lateral elbow tendinopathy is lacking. The primary aim of this study was to determine the effects of radial shockwave therapy in the treatment of chronic lateral elbow tendinopathy. A non-randomised controlled trial was conducted for this purpose, consisting of an intervention and a control group, comparing radial shockwave treatment to placebo treatment. Patients were selected that had persistent (three months and longer) symptoms of chronic lateral elbow tendinopathy not responding to conservative treatment, and complying to the inclusion criteria. Methods: Forty-one participants were included in the study; they were systematically assigned to either an intervention or control group. They received one treatment per week for three weeks of either radial shockwave or placebo treatment, as well as an eccentric exercise program. Their pain levels, grip strength and upper limb function were assessed at baseline, one week and three months’ post treatment. The data were collected and statistical analysis done using the Mann-Whitney U test as well as the Fisher Exact test. Results: There was no statistical significance found for pain, grip strength and upper limb function in patients with chronic lateral elbow tendinopathy treated with radial shockwave therapy, compared to patients receiving placebo treatment. v Conclusion: The intervention group presented similarly to the control group. The null hypothesis was thus accepted in this study. There are notable limitations to this study such as the small sample size, as well as the many treatment variables (type of shockwave and application methods used), and protocols (dosage-intensity, specifications of apparatus, focal energy, treatment frequency, localisation methods and combination of therapies) available when using radial shockwave treatment. Therefore, further research is required with larger sample sizes and specific treatment parameters to find an effective treatment strategy for chronic lateral elbow tendinopathy.