07 January 2010
Shock wave therapy may be effective for both short-term and long-term treatment of tennis elbow, researchers report.
In a study of 43 patients (44 elbows) with the condition, 90.9% were found to be either free of complaints or significantly better 1 to 2 years after shock wave treatment. Lateral epicondylitis of the elbow, or tennis elbow as it is commonly known, is a fairly common disorder that can be caused by a number of factors, including local injury, mechanical imbalance, aging, and chemical, vascular, hormonal, and hereditary factors.
Symptoms include pain in gripping and in moving heavy objects and a decreased range of motion and flexibility in the wrist. Nonoperative treatment, such as nonsteroidal anti-inflammatory drugs, ultrasound therapy, steroid injection, functional bracing, physical therapy, and laser therapy has shown inconsistent results, as has surgical treatment of the condition.
Shock wave therapy, in which varying impulses of shock waves are administered to the affected area, is a relatively new approach that has been used primarily in Europe (particularly Germany). Although the reason shock waves help is still uncertain, it has been suggested that they can provoke a degree of stimulation that leads to pain relief through increased blood flow.
In recent years, shock wave therapy has been shown to be an effective short-term treatment. In a study published in the May-June 2002 issue of The American Journal of Sports Medicine (AJSM), 57 patients (58 elbows) with tennis elbow were recruited to undergo shock wave treatment at Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; an additional six (six elbows) were treated as a control group. Participants had to have an established diagnosis of tennis elbow that had failed to improve over at least 6 months of nonoperative treatment.
Each patient was treated with 1,000 impulses of shock wave therapy. Patients' vital signs and local pain or discomfort at the treatment site were carefully monitored throughout the course of treatment. Immediately after shock wave treatment, the elbow was examined for swelling, redness, ecchymosis, or hematoma. A dummy electrode was used for the control patients so that the machine did not generate an acoustic shock wave. A 100-point scoring system was used to evaluate pain, function, strength, and range of elbow motion.
Of the 44 cases (elbows) available for follow-up, 27 (61.4%) were free of complaints, 13 (29.5%) were significantly better, 3 (6.8%) were slightly better, and 1 (2.3%) was unchanged. In the control group, the results were unchanged in all six patients, according to Dr. Ching-Jen Wang of Chang Gung Memorial Hospital, Taiwan, one of the researchers in the study.
Shock wave therapy is a relatively new modality of treatment for patients with tennis elbow. Based on our experience, the success rate was high and the recurrence rate was low; complications were negligible. It is noninvasive, cost effective, and can be done on an outpatient basis. Furthermore, patients with unsuccessful shock wave therapy are not precluded from pursuing conventional treatments, including surgery. Therefore, we feel that shock wave therapy is a good alternative method of treatment in patients with tennis elbow and should be considered prior to surgery.
