Dose-related Effect of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis - Prospective Randomized Double Blind Comparative Study -

Abstract

Purpose: The aim of this study was to examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for lateral epicondylitis. Materials and methods: Thirty patients with refractory lateral epicondylitis despite conservative treatment for 6 months were enrolled in this study. The patients were divided randomly into a low-and highenergy group. All patients were treated 3 times with ESWT with an interval of 1 week in a double blinded manner. The mean energy level in the low-and high-energy group was 0.12 mJ/mm 2 and 0.24 mJ/mm 2 , respectively. The upper extremity functional scales and Mayo elbow scores were measured prospectively at the baseline, 1, 3 and 6 months after ESWT. Results: Significant clinical improvement was observed in both groups after ESWT. The high-energy group showed better pain improvement at 6 months after ESWT (p=0.019). The effect of ESWT was dominant between 1 and 6 months after ESWT than within 1 month. Conclusion: ESWT for lateral epicondylitis demonstrated showed good results regardless of the energy dose. However, a high-energy level was more effective in pain improvement after 6 months of treatment.

Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis

“…Looking into existing research supporting these results, a number of studies reported that the effects of extracorporeal shock wave therapy lasted up to 6 months along with excellent short-term effects 10,20,21. The effects of the therapy lasted until 8 weeks in this study.…”

“…Looking into existing research supporting these results, a number of studies reported that the effects of extracorporeal shock wave therapy lasted up to 6 months along with excellent short-term effects. 10 , 20 , 21 The effects of the therapy lasted until 8 weeks in this study. In contrast, Speed et al 27 reported that extracorporeal shock wave therapy was not effective while patients with lateral epicondylitis were treated.…”

“…Rompe et al17 reported that histological responses of tendon were dependent on energy dose, hence, high energy shock wave therapy would be more effective in treating pain. In addition, Oh et al,20 who compared effectiveness of the treatment according to actual energy dose, also reported that 0.24 mJ/mm 2 of high energy shock wave was more effective than low energy shock wave while treating lateral epicondylitis. On the other hand, local anesthesia might be required when a high energy shock wave was delivered due to severe pain and a high energy shock wave greater than 0.60 mJ/mm 2 could cause necrosis of a tendon or semi-permanent damage, from an animal experiment 17.…”

Clinical and functional outcomes of extracorporeal shock wave therapy in isolated medial epicondylitis

“…We used low energy shock wave in this study according to the definition of energy dose established by Speed [7] in 2004; here, 0.12 mJ/mm 2 is a cut of value and above doses was defined as high energy shock wave and below doses was as low energy shock wave. Rompe et al [18] and Oh et al [19] reported that responses of tendon to shockwaves are dependent on energy dose and high energy shock wave therapy is more effective in treatment. However local anesthesia might be required when a high energy delivered because of severe pain and also higher energy doses above 0.60 mJ/mm 2 could cause necrosis of tendon [18].…”

Effects of extracorporeal shock wave treatment on the muscle tone and static stability of gastrocnemius muscle according to the energy level in children with cerebral palsy

“…In previous studies, applying extracorporeal shock wave treatment of low energy also had an effect on the improvement of muscle tone 12,14) , but the findings of the present study suggest that the effect of the treatment continued longer after the intervention in the high energy group than in the low energy group. Although the appropriate energy amount for reduction of muscle tone by extracorporeal shock wave treatment has not been clearly defined, 25,26) there was a study that found that high energy was more effective for treatment in the clinical application for musculoskeletal disorders. Most studies used intervention with a low energy in pediatric patients in consideration of adverse reactions such as psychological anxiety, redness, and pain.…”