Extracorporeal shock wave therapy for lateral epicondylitis—a double blind randomized controlled trial

Abstract

Extracorporeal shock wave therapy for lateral epicondylitis-a double blind randomised controlled trialWe thank Drs Day and Rompe for their comments on our paper Extracorporeal shock wave therapy for lrterul rpicondylitis-a double blind randomised rontrolled trial [l].There continues to be a considerable debate relating to the use of shock wave therapy in soft tissue musculoskeletal complaints, and much of this is due to the plentiful anecdotal reports and uncontrolled trials of shock wave therapy in the literature. Randomised controlled trials are more limited in number.It is clear that RCTs vary in their findings relating to efficacy of this treatment. This may be due to heterogeneous study populations, differences in treatment regimes and/or variations in outcome measures. We agree that our study involved a small sample size and relatively short ( 3 month) follow-up. However we noted similar findings to those made by Haake et al. in an RCT of 270 subjects with 12 months follow-up [2]. We note the findings of an FDA study of shock wave therapy that is quoted by Dr Day and look forward to its publication in the formal literature.Accurate focussing of the shock wave therapy is increasingly recognised as an important aspect of shock wave administration [3] and manufacturers have worked to ensure that accurate focussing is possible. Most well designed studies of shock wave therapy have ensured that the treatment is focussed using fluoroscopy or ultrasound.We fully agree with Dr Rompe that ESWT should be reserved for recalcitrant cases where the diagnosis is clear. We also support the view that optimal shock wave treatment regimes and dosing intervals have not yet been defined, but well designed RCTS will help to provide insight into this issue. References

Effect of Shock Wave in Treatment of Sciatic Neuralgia

“…ESWT seems to be a useful conservative alternative in the treatment of both conditions. The results of the present study are in contradiction with the finding of Speed CA et al, 2002 (12) . They studied the effect of extra corporeal shock wave therapy (ESWT) for patients with lateral epicondylitis.…”

A Comparison of Laser and Extracorporeal Shock Wave Therapies in Treatment of Lateral Epicondylitis

“…Likewise, in clinical trials, optimal treatment intensity was not established (2). This can explain the ineffective results in certain studies (29,30). In the study by Rompe et al (31) in tennis elbow, patients were divided into two groups.…”

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

“…하지만, 아직까지 체외 충격파 시술의 기전과 효과가 아직 정확하지 않으며, 무엇보다도 아직 정립된 치료 지침(protocol)이 없어, 특히 병소 부위에 가해 지는 적절한 에너지의 양에 대해서는 논란이 많은 실정 이다 3,6,16) . 이에 저자들은 비수술적 치료에 반응하지 않 는 주관절 외상과염에서 체외 충격파의 에너지 양을 달 리하여 그 치료 효과가 어떻게 다른 지를 알아보고자 하였다.…”