Published: 2016-12-18

Role of extracorporeal shockwave therapy and injectable corticosteroids in the treatment of lateral epicondylitis: a comparative study of 100 patients

Yogesh Sharma, Vivek Mathew Philip, Gururaj R. Joshi, Naveen BM. BM.


Background: Even though considered to be self-limiting, lateral epicondylitis (tennis elbow) can cause significant impediment in professional and activities of daily living. A safe and minimally invasive procedure that will enable patients to return to their daily activities as soon as possible should be advocated in the management of this condition. The aim of the present study was to investigate the role of extracorporeal shock wave therapy (ESWT) and injectable corticosteroids in the treatment of lateral epicondylitis with the secondary objective of comparing the difference in pain relief and functional improvement in patients treated with both modalities.

Methods: A cross sectional analytical study was conducted over an 18 month period.100 patients were randomized into two groups, A (51 patients) who received three sessions of ESWT on weekly intervals and B (49 patients) who received two intra-lesional injections of 1ml of methylprednisolone and 2% lignocaine on weekly intervals. The patients were followed up at 3 weeks, 6 weeks and 6 months after the interventions. Subjective and objective improvements were measured using visual analogue score (VAS) and Patient Rated Tennis Elbow Evaluation Score (PRTEE).

Results: The mean VAS in both groups reduced from 8.47 and 8.53 to 2.51 and 1.67 respectively at the end of the follow up (p <0.001) .The mean PRTEE score in Group A reduced from 80.59 to 26.53 (p<0.001) and Group B from 82.76 to 13.59 (p<0.05). In Group A (ESWT), the average reduction In PRTEE Score at the end of follow up was 54.06 and Group B (steroids) was 69.16. The difference was found to be statistically significant (p<0.001) favouring steroid injections.

Conclusions: Both ESWT and steroid injections were found to be effective in producing symptomatic pain relief and improving the functional disability in the management of lateral epicondylitis. The comparison of both modalities showed a statistically significant improvement in pain and functional disability in favour of steroids at a short duration of follow up i.e., 03 weeks, 06 weeks and 06 months.



ESWT, Epicondylitis, Steroids, Tennis elbow, VAS, PRTEE

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S Terry Canale JHB. Campbell Operative Orthopaedics 12th ed. S Terry Canale JHB, editor: Elsevier. 2013:4614.

Rompe JD, Decking J, Schoellner C, Theis C. Repetitive Low-Energy ShockWave Treatment for Chronic Lateral Epicondylitis in Tennis Players. The American Journal of Sports Medicine. 2004;32(3):734-43.

Rompe J, Eysel P, Hopf C, Krischek O, Vogel J, Bürger R. Extracorporeal shockwave therapy in orthopedics. Positive results in tennis elbow and tendinosis calcarea of the shoulder. Fortschritte der Medizin. 1997;115(18)26:9-33.

Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Europa Medicophysica. 2005;41(1):17-25.

Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Annals of the rheumatic diseases. 2009;68(12):1843-96.

Sanders TL, Kremers HM, Bryan AJ, Ransom JE, Smith J, Morrey BF. The Epidemiology and Health Care Burden of Tennis Elbow A Population-Based Study. The American journal of sports medicine. 2015:0363546514568087

Crowther M, Bannister G, Huma H, Rooker G. A prospective, randomised study to compare extracorporeal shock-wave therapy and injection of steroid for the treatment of tennis elbow. Journal of Bone & Joint Surgery, British Volume. 2002;84(5):678-9.

Walter GM. Netter's Orthopaedics. In: rheumatism N, editor. Netter images: Elsevier; 200610. Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Europa Medicophysica. 2005;41(1):17-25.

Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association. 2003;4(1):9-15.12. Salidin K. Anatomy and Physiology: The Unity of Form and Function: McGraw-Hill. 2011:1248.

Overend TJ, Wuori-Fearn JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. Journal of Hand Therapy. 1999;12(1):31-7.

Tajika T, Kobayashi T, Yamamoto A, Kaneko T, Takagishi K. Prevalence and risk factors of lateral epicondylitis in a mountain village in Japan. Journal of Orthopaedic Surgery. 2014;22(2).

Wang CJ, Chen HS. Shock Wave Therapy for Patients with Lateral Epicondylitis of the Elbow A One-to Two-Year Follow-up Study. The American journal of sports medicine. 2002;30(3):422-5.

Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. The Journal of Bone & Joint Surgery. 2005;87(6):1297-304.

Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. The Lancet. 2002;359(9307):657-62.

Tonks J, Pai S, Murali S. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomised controlled trial. International journal of clinical practice. 2007;61(2):240-618.

Belhan O, Karakurt L. To compare clinically the application of lateral epicondylitis bandage with local steroid injection and its effectiveness on treatment of humerus lateral epicondylitis. Fırat Tıp Derg. 2008;13:24-7.

Karşı EKŞDT. Treatment of Lateral Epicondylitis: Steroid Injection versus Extra-Corporeal Shock Wave Therapy. 2014.

Sharma R, Sharma R, Singh R, Boparai R, Sathyadharan P. Management of lateral epicondylitis− local steroid injection versus extra corporeal shock wave therapy. Pb J Orthop. 2009:11.

Gündüz R, Malas FÜ, Borman P, Kocaoğlu S, Özçakar L. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical rheumatology. 2012;31(5):807-12.23.