Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis

Abstract

Background. Lateral epicondylitis (LE) is a common elbow problem. Extracorporeal shock wave therapy (ESWT) was widely used in the treatment of LE and has been shown to relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow. However, the evidence with regard to whether ESWT has better clinical efficacy over other method is not clear. The aim of the study was to compare the effectiveness of ESWT with other techniques in the treatment of LE. Methods. Literature searches of PubMed, OVID, Embase, Cochrane Library, and Web of Science were searched up to 30 th June, 2019. Only RCTs comparing ESWT with other methods for LE were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results. A total of 13 articles with 1035 patients were included. Of which, 501 underwent ESWT and 534 underwent other methods. The result of meta-analysis showed that pooled VAS (P = 0:0004) and grip strength (P < 0:00001) were better in the ESWT group. Conclusion. Based on the existing clinical evidence, extracorporeal shock wave therapy can effectively relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow, with better overall safety than several other methods. However, owing to the limited quality and quantity of the included studies, more high-quality RCTs are needed to support the trend towards better functional outcomes with ESWT.

Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis

“…Although a clinical superiority of the method was suggested, these recommendations should be treated with caution as minimal clinically important differences were not used for the interpretation of their study results. 12,13 There was an overestimation of the effectiveness of shockwave therapy compared to our findings which can be explained due to several methodological differences. Firstly, a substantial clinical heterogeneity of the types of interventions including sham treatment, wrist splint, laser, multimodal physiotherapy and corticosteroid injections was found in their quantitative synthesis.…”

“…Previous meta-analyses 12,13 reported significantly better results for extracorporeal shockwave therapy compared with other treatments in pain reduction and grip strength. Although a clinical superiority of the method was suggested, these recommendations should be treated with caution as minimal clinically important differences were not used for the interpretation of their study results.…”

“…9,10 Although previous systematic reviews advocated that little or no evidence exists for the use of extracorporeal shockwave therapy in patients with lateral elbow tendinopathy, 10,11 recently published meta-analyses reported superior outcomes of the method compared with sham or other passive treatments in pain reduction and grip strength. 12,13 However, several methodological issues were identified in their quantitative synthesis. For example, substantial heterogeneity was found in the interventions provided (shockwave therapy compared with sham, control, laser, ultrasound, injection(s), kinesiotaping and physiotherapy) and the retrieved results as well (including cases from 6 to 24 weeks follow-up after treatment).…”

“…For example, substantial heterogeneity was found in the interventions provided (shockwave therapy compared with sham, control, laser, ultrasound, injection(s), kinesiotaping and physiotherapy) and the retrieved results as well (including cases from 6 to 24 weeks follow-up after treatment). 12,13 Similarly, previously reported study outcomes 13,14 included variable methods of measurement in pain intensity or grip strength that were inappropriately summarized in the mean differences rather than in the standardized mean differences suggested by the literature. 14 It seems that systematic reviews on the use of extracorporeal shockwave therapy in lateral elbow tendinopathy vary widely in quality and clarity of reporting which may threaten the credibility of their proposed clinical inferences.…”

Extracorporeal Shockwave Therapy for the Treatment of Tendinopathies: Current Evidence on Effectiveness, Mechanisms, Limitations and Future Directions

“…Despite methodological heterogeneity, the authors concluded there was effectiveness of ESWT for lateral elbow tendinopathy when well-defined restrictive study parameters are appropriately implemented. A recent systematic review and metaanalysis included 13 studies and 1035 patients comparing ESWT with other treatments for lateral elbow tendinopathy [113]. Meta-analysis showed that ESWT was superior for pain and function (loss of grip strength) compared to other treatment methods.…”