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A Randomized Controlled Trial of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis (Tennis Elbow)

MARGARET P. STAPLES, ANDREW FORBES, RONNIE PTASZNIK, JEANINE GORDON, and RACHELLE BUCHBINDER

ABSTRACT.

Objective. The aims of this double-blind, randomized, placebo-controlled trial were to determine whether ultrasound-guided extracorporeal shock wave therapy (ESWT) reduced pain and improved function in patients with lateral epicondylitis (tennis elbow) in the short term and intermediate term.

Methods. Sixty-eight patients from community-based referring doctors were randomized to receive 3 ESWT treatments or 3 treatments at a subtherapeutic dose given at weekly intervals. Seven outcome measures relating to pain and function were collected at followup evaluations at 6 weeks, 3 months, and 6 months after completion of the treatment. The mean changes in outcome variables from baseline to 6 weeks, 3 months, and 6 months were compared for the 2 groups.

Results. The groups did not differ on demographic or clinical characteristics at baseline and there were significant improvements in almost all outcome measures for both groups over the 6-month followup period, but there were no differences between the groups even after adjusting for duration of symptoms.

Conclusion. Our study found little evidence to support the use of ESWT for the treatment of lateral epicondylitis and is in keeping with recent systematic reviews of ESWT for lateral epicondylitis that have drawn similar conclusions. (First Release Sept 15 2008; J Rheumatol 2008;35:2038-46)

Key Indexing Terms:

TENNIS ELBOW
RANDOMIZED CONTROLLED TRIAL
EXTRACORPOREAL SHOCK WAVE THERAPY

From the Department of Clinical Epidemiology, Cabrini Hospital, Malvern; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne; Monash Medical Centre and Southern Health; Faculty of Medicine, Department of Medical Imaging and Radiation Sciences, Monash University, Monash Medical Centre, Clayton; and Symbion Imaging, Northern Hospital, Epping, Victoria, Australia.

Supported by Melbourne Diagnostic Imaging Group. Prof. Buchbinder is supported by an Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship.

M.P. Staples, PhD, Biostatistician, Department of Clinical Epidemiology, Cabrini Hospital, and Department of Epidemiology and Preventive Medicine, Monash University, Cabrini Institute; A. Forbes, PhD, Head, Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University; R. Ptasznik, MBBS, FRANZCR, Director of Diagnostic Ultrasound, Monash Medical Centre and Southern Health, and Honorary Senior Lecturer, Faculty of Medicine, Department of Medical Imaging and Radiation Sciences, Monash University, Monash Medical Centre; J. Gordon, BAppSc, Radiation Therapist, Symbion Imaging, Northern Hospital; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Department of Clinical Epidemiology, Cabrini Hospital, Professor, Department of Epidemiology and Preventive Medicine, Monash University.

Address reprint requests to Prof. R. Buchbinder, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, Victoria, 3144, Australia.

Accepted for publication May 9, 2008.