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Kamonseki DH, da Rocha GM, Ferreira VMLM, Ocarino JM, Pogetti LS. Extracorporeal Shockwave Therapy for the Treatment of Noncalcific Rotator Cuff Tendinopathy: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:471-479. [PMID: 37903597 DOI: 10.1097/phm.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE The aim of the systematically review the short-, intermediate-, and long-term effects of extracorporeal shockwave therapy on pain intensity and shoulder function in individuals with noncalcific rotator cuff tendinopathy. DESIGN The MEDLINE, CINAHL, SPORTDiscus, and Embase were searched from inception up to June 2023. We included randomized controlled trials that investigated the effects of extracorporeal shockwave therapy on pain intensity and shoulder function. RESULTS Nine studies were included with a total sample of 543 individuals. Extracorporeal shockwave therapy was superior to sham extracorporeal shockwave therapy in improving pain intensity at short-term follow-up (standardized mean difference = -0.28; 95% confidence interval, -0.55 to -0.01). Extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy in improving pain intensity at intermediate- and long-term follow-ups ( P > 0.05). Extracorporeal shockwave therapy was not superior to other treatments in improving pain intensity at short- and intermediate-term follow-ups ( P > 0.05). Extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy and other treatments in improving shoulder function at short-, intermediate-, and long-term follow-ups ( P > 0.05). CONCLUSIONS Moderate-certainty evidence indicated that extracorporeal shockwave therapy showed small improvement in shoulder pain over sham extracorporeal shockwave therapy at short-term follow-up. In addition, extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy in improving function, and it was not superior to other treatments in improving shoulder pain and function.
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Affiliation(s)
- Danilo Harudy Kamonseki
- From the Department of Physical Therapy, Universidade Federal da Paraíba, João Pessoa, Brazil (DHK); Graduate Program in Rehabilitation Science, Physical Therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (GMdR, VMLMF, JMO, LSP); and Univesidade Federal de Uberlândia, Uberlândia, Brazil (LSP)
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Majidi L, Khateri S, Nikbakht N, Moradi Y, Nikoo MR. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials. BMC Sports Sci Med Rehabil 2024; 16:93. [PMID: 38659004 PMCID: PMC11041007 DOI: 10.1186/s13102-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Tendinopathy is a common condition that affects the body's tendon structures, causing discomfort, restricted movement, and reduced functionality. In this study, we looked at how extracorporeal shock wave therapy (ESWT) affected pain levels in individuals with various forms of tendinopathy around the world. DESIGN This study is a comprehensive review and meta-analysis of previously published randomized controlled trials. To gather relevant data, the researchers performed keyword searches in international databases, including PubMed (Medline), Scopus, Web of Sciences, Cochrane Central Register of Controlled Trials (CENTRAL), Research Registers of ongoing trials (ClinicalTrials.gov), as well as Embase. The search was conducted up until March 2023. The quality of the selected articles was assessed using the Cochrane risk-of-bias method for randomized trials (RoB2). RESULTS Based on the results of the meta-analysis, which included 45 clinical studies, the use of ESWT was found to have a significant impact on reducing pain in various conditions. The standardized mean difference (SMD) in patients with plantar fasciitis (PF) was reduced by 1.63 (SMD: -1.63, 95% CI: -3.04, -0.21; I2: 77.36%; P heterogeneity: 0.0001). For lateral epicondylitis (LE), the SMD was 0.63 (SMD: -0.63, 95% CI: -1.11, -0.16; I2: 67.50%; P heterogeneity: 0.003). In the case of chronic Achilles tendinopathy, the SMD was 1.38 (SMD: -1.38, 95% CI: -1.66, -1.10; I2: 96.44%; P heterogeneity: 0.0001). Additionally, in individuals with rotator cuff tendinopathy, the SMD for pain reduction was 2.37 units (SMD: -2.37, 95% CI: -3.58, -1.15; I2: 98.46%; P heterogeneity: 0.0001). CONCLUSION This study suggests that ESWT can be a highly effective therapy option for relieving pain in people with tendinopathy. Nonetheless, it is encouraged to make additional recommendations based on high-quality clinical research and more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.
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Affiliation(s)
- Lobat Majidi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Sorour Khateri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran.
| | - Nikta Nikbakht
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Reza Nikoo
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamedan, Iran.
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Sen SB, Kosehasanogullari M, Yilmaz NO, Kocyigit BF. Comparative analysis of the therapeutic effects of extracorporeal shock wave therapy and high-intensity laser therapy in lateral epicondylitis: a randomised clinical trial. Rheumatol Int 2024; 44:593-602. [PMID: 38280938 DOI: 10.1007/s00296-023-05525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/20/2023] [Indexed: 01/29/2024]
Abstract
Lateral epicondylitis (LE) presents a substantial obstacle due to the pain and functional decline, frequently requiring non-surgical treatments. This study contrasts the efficacy of high-ıntensity laser therapy (HILT) and extracorporeal shock wave therapy (ESWT) in managing LE. A prospective, randomized comparative trial was conducted with 50 participants assigned to either HILT or ESWT groups. Both groups received standard physiotherapy (exercise program and LE bandages), and outcomes, including tenderness, Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand scale (Q-DASH), and grip strength, were assessed at baseline, 3rd weeks, and 12th weeks. The baseline features of the groups exhibited similarities (p > 0.05). In intra-group comparisons, both HILT and ESWT groups exhibited significant enhancements in tenderness, VAS, Q-DASH, and grip strength (p < 0.05). In inter-group comparisons, the HILT group exhibited superior outcomes in tenderness reduction, pain alleviation, and disability improvement compared to the ESWT group (p < 0.05). Grip strength did not differ significantly across the groups (p > 0.05). Both HILT and ESWT, when combined with standard physiotherapy, showed effectiveness in treating LE. However, HILT demonstrated greater efficacy in terms of tenderness reduction, pain relief, and disability improvement. This study suggests that non-invasive techniques, particularly HILT, can be preferable for managing LE.
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Affiliation(s)
- Sidika Buyukvural Sen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Turkey
| | - Meryem Kosehasanogullari
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Turkey
| | - Nurhan Okur Yilmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Turkey
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Turkey.
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Starosta M, Marek K, Redlicka J, Miller E. Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb-A Narrative Review. J Clin Med 2024; 13:2017. [PMID: 38610782 PMCID: PMC11012993 DOI: 10.3390/jcm13072017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Stroke is a severe injury of the central nervous system (CNS) and one of the leading causes of long-term disability and mortality. One of the main symptoms of neurological diseases is spasticity. This is defined as a motor condition characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks and resulting in the hyperexcitability of the stretch reflex. Rehabilitation after a stroke is focused on relearning lost skills and regaining independence. Many new methods in neurorehabilitation have been introduced. This review concentrates on the current evidence for extracorporeal shockwave therapy (ESWT) as a noninvasive alternative to treat spasticity. We present the effect of EWST and radial EWST interventions to post-stroke patients with spasticity in the upper limb. Our collected data suggest that different parameters of shockwaves can be used to achieve functional improvementsin the upper limb after a stroke. Our accumulated data imply that ESWT is safe and can be used for pain relief, reduced muscle tension, and an increased range of motion. According to many studies, complications after shockwave treatment are infrequent. Transient complications after shockwave therapy (ESWT) include redness, tingling, pain, and bruising. We reviewed clinical trials that present the possible benefits in upper-limb function after shockwave therapy for post-stroke patients. In this article, we used many database search engines, including PEDro. In the stroke rehabilitation literature, a key methodological problem is the design of double-blind studies, which very often are not feasible.
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Affiliation(s)
- Michał Starosta
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland; (K.M.); (J.R.); (E.M.)
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Campos MGM, Maia LB, Mascarenhas RO, Lourenço BM, Henschke N, Oliveira VC. Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis. Braz J Phys Ther 2024; 28:100596. [PMID: 38402668 PMCID: PMC10904251 DOI: 10.1016/j.bjpt.2024.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear. OBJECTIVE To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy. METHODS Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence. RESULTS Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use. CONCLUSIONS Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.
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Affiliation(s)
- Mariana G M Campos
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Laísa B Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Rodrigo O Mascarenhas
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Bianca M Lourenço
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Vinicius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
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Koru H, Yilmaz H, Yilmaz R, Karpuz S. Comparison of the efficiency of peloidotherapy and extracorporeal shock wave therapies in patients diagnosed with lateral epicondylitis: a prospective, randomized, controlled study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:101-108. [PMID: 37934301 DOI: 10.1007/s00484-023-02574-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Various treatment methods are used in the management of lateral epicondylitis (LE); however, there is no universally accepted standard treatment approach. The aim of this study is to compare the effects of peloidotherapy and extracorporeal shock wave therapy (ESWT) on pain, functional status, and quality of life in the treatment of LE. The study was designed as a hospital-based, prospective randomized controlled trial. Ninety patients, with a mean age of 47.30±7.95 (range, 18 to 65 years), diagnosed with chronic (3 months) unilateral LE were included in the study. The patients were randomly divided into two groups. The peloidotherapy group received 15 sessions of peloid therapy for 3 weeks, 5 days a week, while the ESWT group received three sessions of ESWT (1.8 bar, 10.0 Hz, 2000 impulses) for 3 weeks, once a week. The patients were evaluated before treatment, at the end of the treatment, and one month after the treatment. The groups were compared in terms of pain, quality of life, functional status, and handgrip strength. At the end of the treatment and one-month follow-up, statistically significant improvements were observed in all parameters. This study is the first randomized trial comparing peloidotherapy to ESWT as an adjunct to exercise therapy in LE. Both ESWT and peloidotherapy, when added to exercise therapy, showed positive short-term effects on pain, quality of life, functional status, and handgrip strength in primary conservative treatment of chronic LE (p<0.001), and no superiority was found between them in terms of efficacy. Peloidotherapy or ESWT may be preferred in the treatment of lateral epicondylitis, depending on the patient's condition. Peloidotherapy appears to be more advantageous due to its lower side effects and painless nature. ClinicalTrials.gov ID: NCT04748406.
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Affiliation(s)
- Hasan Koru
- Department of Physical Medicine and Rehabilitation, Konya Beyhekim Training and Research Hospital, University of Health Sciences, Devlethane Street No:2/A, 42060, Selcuklu, Konya, Turkey.
| | - Halim Yilmaz
- Department of Physical Medicine and Rehabilitation, Konya Beyhekim Training and Research Hospital, University of Health Sciences, Devlethane Street No:2/A, 42060, Selcuklu, Konya, Turkey
| | - Ramazan Yilmaz
- Department of Physical Medicine and Rehabilitation, Konya Beyhekim Training and Research Hospital, University of Health Sciences, Devlethane Street No:2/A, 42060, Selcuklu, Konya, Turkey
| | - Savaş Karpuz
- Department of Physical Medicine and Rehabilitation, Konya Beyhekim Training and Research Hospital, University of Health Sciences, Devlethane Street No:2/A, 42060, Selcuklu, Konya, Turkey
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Marigi EM, Dancy M, Alexander A, Marigi IM, Clark J, Krych AJ, Camp CL, Okoroha KR. Lateral Epicondylitis: Critical Analysis Review of Current Nonoperative Treatments. JBJS Rev 2023; 11:01874474-202302000-00007. [PMID: 36800442 DOI: 10.2106/jbjs.rvw.22.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
» Lateral epicondylitis (LE) or tennis elbow is a common cause of elbow pain in the general population, especially women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm. » The pathogenesis of this overuse injury is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis that is subsequently prone to additional injury and structural weakness over time. » Treatment of LE often begins with a wide variety of nonoperative modalities including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies are implemented; however, there remains a lack of comparative efficacy between these adjunct treatments. » In this article, we examine the available literature regarding nonoperative management of LE and provide supplementary insight into the effectiveness of current modalities.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Malik Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew Alexander
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Ian M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Julian Clark
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Kapusta J, Domżalski M. Long Term Effectiveness of ESWT in Plantar Fasciitis in Amateur Runners. J Clin Med 2022; 11:jcm11236926. [PMID: 36498501 PMCID: PMC9737564 DOI: 10.3390/jcm11236926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis-a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners. MATERIALS AND METHODS The study includes a group of 39 men and women, aged 34-64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later. RESULTS The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group. CONCLUSIONS Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.
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Affiliation(s)
- Joanna Kapusta
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Medical University of Łódź, 70-445 Lodz, Poland
- Correspondence:
| | - Marcin Domżalski
- Department of Orthopaedics and Trauma, Veteran’s Memorial Hospital, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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Liu WC, Chen CT, Lu CC, Tsai YC, Liu YC, Hsu CW, Shih CL, Chen PC, Fu YC. Extracorporeal Shock Wave Therapy Shows Superiority Over Injections for Pain Relief and Grip Strength Recovery in Lateral Epicondylitis: A Systematic Review and Network Meta-analysis. Arthroscopy 2022; 38:2018-2034.e12. [PMID: 35093494 DOI: 10.1016/j.arthro.2022.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the efficacy of extracorporeal shock wave therapy (ESWT) and injection therapies by synthesizing direct and indirect evidence for all pairs of competing therapies for lateral epicondylitis. METHODS PubMed, EMBASE, and Web of Science databases were searched for all appropriate randomized controlled trials (RCTs), assessing the effect of ESWT or injection therapies. The primary outcome was short-term (≤3 months) and medium-term (>3 months but ≤12 months) pain, while the secondary outcomes were grip strength and patient-reported outcome measures. All outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs) and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to determine a hierarchy of treatments. Sensitivity analysis was performed to eliminate potential therapeutic effects of normal saline (NS) and exclude trials that included patients with acute lateral epicondylitis (LE). RESULTS 40 RCTs were included to evaluate ESWT and five different injection therapies, including corticosteroids (CSs), autologous whole blood, platelet-rich plasma (PRP), botulinum toxin A (BoNT-A), and dextrose prolotherapy (DPT). DPT (-.78 [-1.34 to -.21]), ESWT (.57 [-.89 to -.25]), PRP (-.48 [-.85 to -.11]), and BoNT-A (-.43 [-.84 to -.02]) outperformed placebo for short-term pain relief; ESWT (-.44 [-.85 to -.04]) outperformed placebo for medium-term pain relief. DPT was ranked as the most optimal short-term and medium-term pain reliever (SUCRA, 87.3% and 98.6%, respectively). ESWT was ranked as the most optimal short-term and medium-term grip strength recovery (SUCRA; 79.4% and 86.4%, respectively). CONCLUSIONS DPT and ESWT were the best two treatment options for pain control and ESWT was the best treatment option for grip strength recovery. CSs were not recommended for the treatment of LE. More evidence is required to confirm the superiority in pain control of DPT among all these treatment options on LE. LEVEL OF EVIDENCE Level I, meta-analysis of Level I randomized controlled trials.
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Affiliation(s)
- Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Ting Chen
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Che Tsai
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Chun Liu
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chia-Lung Shih
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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Amako M, Arai T, Iba K, Ikeda M, Ikegami H, Imada H, Kanamori A, Namba J, Nishiura Y, Okazaki M, Soejima O, Tanaka T, Tatebe M, Yoshikawa Y, Suzuki K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication. J Orthop Sci 2022; 27:514-532. [PMID: 34922804 DOI: 10.1016/j.jos.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The guidelines presented herein provide recommendations for the management of patients with lateral epicondylitis of the humerus. These recommendations are endorsed by the Japanese Orthopaedic Association (JOA) and Japan Elbow Society. METHODS The JOA lateral epicondylitis guideline committee revised the previous guidelines on the basis of the "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which emphasized the importance of the balance between benefit and harm, and proposed a desirable method for preparing clinical guidelines in Japan. These guidelines consist of 11 clinical questions (CQs), 9 background questions (BQs), and 3 future research questions (FRQs). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS The committee proposed recommendations for each CQ by determining the level of evidence and assessing the consensus rate. Physical therapy was the best recommendation with the best evidence. The BQs and FRQs were answered by collecting evidence based on the literature. CONCLUSIONS The guidelines presented herein were reviewed systematically, and recommendations were proposed for each CQ. These guidelines are expected to be widely used not only by surgeons or physicians but also by other healthcare providers, such as nurses, therapists, and athletic trainers.
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Affiliation(s)
- Masatoshi Amako
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Rehabilitation Medicine, National Defense Medical College Hospital, Japan.
| | - Takeshi Arai
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Japan
| | - Kousuke Iba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Masayoshi Ikeda
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Shonan Central Hospital, Japan
| | - Hiroyasu Ikegami
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Toho University, Japan
| | - Hideaki Imada
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Higashihiroshima Medical Center, Japan
| | - Akihiro Kanamori
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Tsukuba University Hospital, Japan
| | - Jiro Namba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Japan
| | - Yasumasa Nishiura
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Tsuchiura Clinical Education and Training Center, Tsukuba University Hospital, Japan
| | - Masato Okazaki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopedic Surgery, Ogikubo Hospital, Japan
| | - Osamu Soejima
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Japan
| | - Toshikazu Tanaka
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Kikkoman General Hospital, Japan
| | - Masahiro Tatebe
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Hand Surgery, Nagoya University, Japan
| | - Yasuhiro Yoshikawa
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Komazawa Hospital, Japan
| | - Katsuji Suzuki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Okazaki Medical Center, Fujita Medical University, Japan
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Evidenced-Based Management of Tennis Elbow. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Extracorporeal Shockwave Therapy for the Treatment of Tendinopathies: Current Evidence on Effectiveness, Mechanisms, Limitations and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karanasios S, Tsamasiotis GK, Michopoulos K, Sakellari V, Gioftsos G. Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil 2021; 35:1383-1398. [PMID: 33813913 DOI: 10.1177/02692155211006860] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. DATA SOURCES MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. REVIEW METHODS We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. RESULTS Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: -1.21, 95% confidence interval:-1.53, -0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: -1.54, 95% confidence interval: -2.60, -0.48, P = 0.005). CONCLUSION Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively.Level of Evidence: Therapy, level 1a.
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Shannon N, Cable B, Wood T, Kelly J. Common and Less Well-known Upper-limb Injuries in Elite Tennis Players. Curr Sports Med Rep 2021; 19:414-421. [PMID: 33031207 DOI: 10.1249/jsr.0000000000000760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
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Affiliation(s)
| | - Brian Cable
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Timothy Wood
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kelly
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Defoort S, De Smet L, Brys P, Peers K, Degreef I. Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy. HAND SURGERY & REHABILITATION 2021; 40:263-267. [PMID: 33636381 DOI: 10.1016/j.hansur.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.
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Affiliation(s)
- S Defoort
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - L De Smet
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - P Brys
- Department of Radiology, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - K Peers
- Department of Physical Medicine and Rehabilitation, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - I Degreef
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2020; 478:2324-2339. [PMID: 32332245 PMCID: PMC7491893 DOI: 10.1097/corr.0000000000001246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. QUESTIONS/PURPOSES (1) Does ESWT reduce pain and improve grip strength in patients with lateral epicondylitis? (2) Which type of ESWT, radial or focused, is more effective? (3) Is the duration of symptoms associated with the efficacy of ESWT for lateral epicondylitis? (4) Do improvements in pain scores remain in patients with longer follow-up? METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to July 2019 for articles published in English or Korean. Studies were included if patient allocation was randomized, the sample was composed of patients with lateral epicondylitis, interventions were ESWT (focused or radial), comparison group only received sham stimulation or no additional treatment, and the study outcome was pain intensity or grip strength. The quality of the evidence was assessed using the Cochrane risk of bias tool. Twelve studies including 1104 participants fulfilled the inclusion criteria and were included in the meta-analysis. The mean difference for pain reduction and improvement in grip strength was calculated. RESULTS The meta-analysis showed no clinically important difference in the VAS score (2.48 ± 7.55 versus 3.17 ± 9.78, mean difference -0.68 [95% confidence interval -1.17 to -0.19]; p = 0.006) and grip strength (38.02 ± 70.56 versus 34.85 ± 108.26, mean difference 3.33 [95% CI 0.93 to 5.73]; p = 0.007) after ESWT relative to the comparison group's score. Even though radial ESWT showed more improvement than focused, the mean difference for VAS did not exceed the minimal clinically important differences threshold. There were no clinically important effects on the VAS scores of patients with lateral epicondylitis (2.78 ± 5.57 versus 3.92 ± 6.29, mean difference -1.13 [95% CI -1.84 to -0.42]; p = 0.002) and focused ESWT did not improve pain in patients with lateral epicondylitis. In the subgroup analysis, ESWT was effective in patients with a symptom duration of more than 6 months (2.28 ± 8.48 versus 3.31 ± 11.81, mean difference -0.95 [95% CI -1.75 to -0.15]; p = 0.02) but not for those with shorter symptom duration. The effects did not last beyond 24 weeks (2.52 ± 9.19 versus 3.34 ± 5.93, mean difference -0.82 [95% CI -2.57 to 0.93]; p = 0.36). CONCLUSIONS ESWT did not show clinically important improvement in pain reduction and grip strength. Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. Further studies are needed to determine the appropriate protocol and elucidate the effects according to the intervention type and specific disease condition. LEVEL OF EVIDENCE Level I, therapeutic study.
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Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized controlled trial. Foot (Edinb) 2020; 44:101679. [PMID: 32674009 DOI: 10.1016/j.foot.2020.101679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed at estimating the extent to which a combination therapy of extracorporeal shockwave therapy (ESWT) with usual care (exercise and orthotic support) improve functional ability in the patient with plantar fasciitis when compared to usual care alone. METHODS Participants with plantar fasciitis were randomly allocated into two groups: ESWT (n=23), and control (n=21). All participants received home exercise program with orthotic support. In addition, ESWT group received 2000 shock waves with 0.02 mJ/mm2 for three sessions. Functional outcomes were measured by function subscale of American orthopedic foot and ankle society (AOFAS-F) score and 12 minutes walking test including walking speed, cadence. The scores were recorded at baseline, third week and third month after the treatment. Analysis was performed using repeated measures ANOVA, and an intention to treat approach using multiple imputations. RESULTS Results showed that there was a significant improvement in AOFAS-F total score and walking speed over three months in both groups (p<0.001, p=0.04 respectively); improvements in AOFAS-F were particularly in activity limitation (p=0.001), walking distance (p=0.02) and walking surface (p=0.02). Groups were comparable with each other for both walking speed and AOFAS-F in any assessment time (p>0.05). However, groups performed differently in cadence where there was an increase in cadence in ESWT group whereas a decline in control at the third month (p=0.07). CONCLUSION The results revealed that ESWT did not have an additive benefit over usual care to improve foot function and walking performance in patient with plantar fasciitis over three months post-treatment.
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Zheng C, Zeng D, Chen J, Liu S, Li J, Ruan Z, Liang W. Effectiveness of extracorporeal shock wave therapy in patients with tennis elbow: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21189. [PMID: 32791694 PMCID: PMC7387053 DOI: 10.1097/md.0000000000021189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the effectiveness of Extracorporeal Shock Wave (ECSW) in the treatment of lateral epicondylitis (LE) of humerus. HYPOTHESIS ECSW therapy in people with LE effectively reduces the pain and gains functional rehabilitation. MATERIALS/METHODS Databases of PubMed, EMBASE, Web of Science and the Cochrane Library from inception to April 2020 was searched to identify all relevant RCTs comparing ECSW therapy with any other conservative treatment, including injection and local anesthetic versus placebo or control in patients aged 18 with LE. The primary outcome is the mean overall pain score at 12 weeks after treatment. Another secondary outcome mainly included Thomsen test, 50% pain reduction, grip strength and adverse effect at 12 weeks after treatment. RESULTS Nine studies were included in the meta-analysis. Compared with the placebo group, ECSW cannot significantly reduce the pain score (mean deviation [MD] = -4.23, 95% confidence interval [CI]: -8.78 to 0.32, P = .07), but make more people acquire 50% pain reduction (MD = 1.38, 95% CI: 1.09 to 1.75, P = .008). There was no significant difference between ECSW and control in decreasing the pain score of Thomsen test (MD = -3.22, 95% CI: -14.06 to 7.62, P = .56). ECSW was more effective in Grip strength as compared with control at 12 weeks-3 months (MD = 3.52, 95% CI: 2.43 to 4.60, P < .00001) CONCLUSIONS:: Results suggested that ECSW cannot effectively reduce the mean overall pain, but it showed more people acquire 50% pain reduction and might be a better option for the treatment of LE. Because of study limitations, additional high level of evidence, more rigorously designed large-samples and high-quality randomized controlled trials are needed to guide clinical practice.
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Affiliation(s)
- Chenxiao Zheng
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Dongjie Zeng
- Graduate School of Guangzhou University of Traditional Chinese Medicine, Guangzhou
| | - Jiayi Chen
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Sijing Liu
- Department of Orthopaedics and Traumatology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jianyi Li
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Zhaohai Ruan
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Wusheng Liang
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
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Vahdatpour B, Taheri P, Abasi F. Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior? Galen Med J 2020; 9:e1791. [PMID: 34466592 PMCID: PMC8343590 DOI: 10.31661/gmj.v9i0.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/24/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. Materials and Methods In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. Results Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value<0.001 for all), while the comparison of the two interventions, ESWT, merely versus in combination with topical clobetasol, revealed insignificant difference (P-value>0.05). Conclusion The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences.
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Affiliation(s)
- Babak Vahdatpour
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Taheri
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Abasi
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
- Correspondence to: Fatemeh Abasi, Department Physical therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran Telephone Number: +989376445992 Email Address:
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Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2064781. [PMID: 32309425 PMCID: PMC7106907 DOI: 10.1155/2020/2064781] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 11/17/2022]
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 30th 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.
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21
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Testa G, Vescio A, Perez S, Petrantoni V, Mazzarella G, Costarella L, Pavone V. Functional Outcome at Short and Middle Term of the Extracorporeal Shockwave Therapy Treatment in Lateral Epicondylitis: A Case-Series Study. J Clin Med 2020; 9:E633. [PMID: 32120893 PMCID: PMC7141112 DOI: 10.3390/jcm9030633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022] Open
Abstract
Lateral epicondylitis (LE) of the humerus is a chronic degeneration of wrist extensor tendons at their attachments to the lateral epicondyle of the humerus. There is not a common consensus on a specific therapeutic algorithm, but Extracorporeal Shockwave Therapy (ESWT) is widely used. The purpose of this study is to evaluate the clinical benefits of low dose ESWT in LE-affected patients in short and medium follow-up. Between January 2015 and December 2017, 60 patients (38 male, mean age 52.2 ± 10.1 years, the duration of the disease was 3.6 ± 1.3 months) were clinically evaluated using visual analog scale (VAS) and Patient Rated Tennis Elbow Evaluation Test (PRTEE-I) scores before treatment, at one, three, six and 12 months after treatment. According to the VAS and PRTEE-I scoring systems, all patients achieved an improvement of pain and functional outcome comparing the baseline results with one, six and 12 months values. Low dose ESWT is a safe and effective treatment of LE in the short and middle term. In elderly subjects, patients with a long disease history, or those with occupational and sportive risk factors, a longer persistence of the symptomatology could be observed.
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Affiliation(s)
| | | | | | | | | | | | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (G.T.); (A.V.); (S.P.); (V.P.); (G.M.); (L.C.)
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Testa G, Vescio A, Perez S, Consoli A, Costarella L, Sessa G, Pavone V. Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review. J Clin Med 2020; 9:E453. [PMID: 32041301 PMCID: PMC7074316 DOI: 10.3390/jcm9020453] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. METHODS A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. RESULTS A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. CONCLUSIONS ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.
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Affiliation(s)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (S.P.); (A.C.); (L.C.); (G.S.); (V.P.)
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Lee CH, Oh MK, Yoo JI. Ultrasonographic evaluation of the effect of extracorporeal shock wave therapy on calcific tendinopathy of the rectus femoris tendon: A case report. World J Clin Cases 2019; 7:3772-3777. [PMID: 31799303 PMCID: PMC6887597 DOI: 10.12998/wjcc.v7.i22.3772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Calcific tendinopathy denotes calcific deposits in a specific tendon. It is also known as calcifying tendinitis, calcifying periarticulitis, or periarticular apatite deposition disease. Recently, extracorporeal shock wave therapy (ESWT) has been reported to be effective in relieving and treating pain in calcific tendinopathy.
CASE SUMMARY A 36-year-old female patient suffered from left hip joint pain for six months. The pain was increased during abduction of the hip, waking, and jumping. B-mode ultrasonography was performed by a physiatrist with an L12-5 linear transducer. A single session of ESWT was given in the marking area under ultrasound guidance at 4 Hz, 2500 shots with intensity of stimulation using energy of 0.1 mJ/mm2. The hip pain of the patient slowly decreased within 4 wk after starting the ESWT. After six weeks of ESWT, her hip pain was completely resolved. However, the size of calcification showed almost no reduction in simple radiography at the final follow-up.
CONCLUSION Ultrasonography is a very good modality not only for diagnosing calcified tendinitis by classical appearance, but also for evaluating the effect of ESWT during the follow-up period.
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Affiliation(s)
- Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, School of Medicine, Gyeongsang National University, 90 Chilamdong, Gyeongsangnam-do, Jinju 52727, South Korea
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Lian J, Mohamadi A, Chan JJ, Hanna P, Hemmati D, Lechtig A, Nazarian A. Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. Am J Sports Med 2019; 47:3019-3029. [PMID: 30380334 DOI: 10.1177/0363546518801914] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB). PURPOSE To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo. STUDY DESIGN Systematic review and meta-analysis. METHODS Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009). RESULTS Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up. CONCLUSION Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.
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Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jimmy J Chan
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Phillip Hanna
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Hemmati
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA
| | - Aron Lechtig
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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25
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Ahadi T, Esmaeili Jamkarani M, Raissi GR, Mansoori K, Emami Razavi SZ, Sajadi S. Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial. PAIN MEDICINE 2019; 20:1745-1749. [PMID: 30698771 DOI: 10.1093/pm/pny303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of prolotherapy with hypertonic dextrose and radial shock wave therapy in chronic lateral epicondilosis. DESIGN Prospective single-blind randomized clinical trial. SETTING Physical medicine and rehabilitation clinic. SUBJECTS Thirty-three patients with at least three months of signs and symptoms of lateral epicondilosis, as well as failure of at least one of the conservative treatments, randomly allocated into two groups. METHODS Sixteen patients received three sessions of shock wave therapy, and 17 received one session prolotherapy. Severity of pain via visual analog scale (VAS), grip strength via Baseline Pneumatic Dynamometer, pressure pain threshold (PPT) by algometer and Disabilities of Arm, Shoulder, and Hand quick questionnaire (Quick DASH) were assessed at baseline, four weeks, and eight weeks after the intervention. RESULTS Within-group analysis showed that in both groups, differences between all of the outcome measures were significant after four and also eight weeks. Between-group analysis after four and eight weeks showed that the VAS and Quick DASH had significantly more improvement in the shock wave group. However, the two groups were similar regarding grip strength and PPT. No complication was observed in the two groups. CONCLUSIONS Based on the results of this study, a regiment of three sessions (weekly) of radial extracorporeal shock wave therapy is significantly more effective than one session of prolotherapy with 20% dextrose regarding pain and function in the management of chronic lateral epicondylosis in short-term follow-up.
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Affiliation(s)
- Tannaz Ahadi
- Neuromusculoskeletal Research Centre, Firoozgar Hospital
| | | | | | - Korosh Mansoori
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami Razavi
- Physical medicine and rehabilitation department, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Centre, Iran University of Medical Sciences, Tehran, Iran
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26
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Efficacy of extracorporeal shockwave therapy in patients with lateral epicondylitis: A randomized, placebo-controlled, double-blind clinical trial. North Clin Istanb 2019; 5:314-318. [PMID: 30859161 PMCID: PMC6371991 DOI: 10.14744/nci.2017.82435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/09/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Lateral epicondylitis is a common elbow problem. Although extracorporeal shockwave therapy (ESWT) is widely used in the treatment of lateral epicondylitis, its efficacy is still controversial. Moreover, the number of prospective, randomized, controlled studies in the literature is not sufficient. Here, we intend to investigate the efficacy of ESWT. METHODS: The study was randomized, placebo-controlled, double-blind, and prospectively planned. Forty patients who met the inclusion criteria were divided into two groups, real ESWT (Group 1, n=20) and placebo ESWT (Group 2, n=20), in a 1: 1 randomized closed envelope manner. Patients were evaluated for Patient-Rated Tennis Elbow Evaluation-Turkish Version (PRTEE-T), visual analog scale (VAS) pain scores, and grip and pinching strengths. The evaluation were performed thrice before, at the end of treatment and 1 month after treatment. Both groups were treated with wrist splinting, ice treatment, and rest. RESULTS: There was no statistical difference between sex and dominant hand in both groups. There was no significant difference in the grasp and pinching strength between the measurements of the groups themselves (p>0.05). When examined in terms of VAS scores, only significant changes were found in the actual ESWT group (p<0.05). According to the PRTEE-T scores, both groups showed significant changes (p<0.05). No significant difference was found between post-treatment and control measures in the grip and pinching power between groups, VAS and PRTEE-T scores before treatment (p>0.05). CONCLUSION: Although pain and functional improvement were more prominent in our patients treated with ESWT than placebo, no statistically significant results were found.
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27
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Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open Access J Sports Med 2018; 9:243-251. [PMID: 30464656 PMCID: PMC6214594 DOI: 10.2147/oajsm.s160974] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work.
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Affiliation(s)
- Wilson C Lai
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - Dean Wang
- Department of Orthopaedic Surgery, UC Irvine Health, Orange, CA, USA,
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28
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Aydın A, Atiç R. Comparison of extracorporeal shock-wave therapy and wrist-extensor splint application in the treatment of lateral epicondylitis: a prospective randomized controlled study. J Pain Res 2018; 11:1459-1467. [PMID: 30122976 PMCID: PMC6080668 DOI: 10.2147/jpr.s166679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Extracorporeal shock-wave therapy (ESWT) and wrist-extensor splints (WESs) are two commonly used methods in the treatment of lateral epicondylitis. In this study, the efficacy of these two methods was compared. Methods The study was planned as a prospective randomized controlled study. A total of 67 patients were enrolled. The patients were divided into two groups: group 1 received ESWT (32 patients) and group 2 received WES (35 patients). Patients in group 1 underwent four sessions of ESWT once every week. In each session, an ESWT device at 10–12 Hz, 2,000 pulses, and 1.6–1.8 bar pressure was used. Patients in group 2 used a wrist splint, holding the wrist at 30°–45° extension for 4 weeks. Patients were assessed for handgrip strength, pain at rest, pain while working, and quality of life. Data were collected before and after treatment (at weeks 4, 12, and 24). A visual analog scale was used to evaluate pain at rest and while working, a hand dynamometer for handgrip strength, subscales of the SF36 Health Survey to evaluate quality of life, and the Turkish version of the patient-rated tennis-elbow evaluation was used to evaluate functioning of the affected arm during various daily life activities. Results In both ESWT and WES groups, although there were considerably significant improvements (P<0.001) in the parameters evaluated (pain at rest and while working, handgrip strength, Patient-Rated Tennis Elbow Evaluation, Nirschl score, and SF36 subscales) were observed at 4, 12, and 24 weeks compared to pretreatment values, there was no statistically significant difference between the two groups in terms of our evaluation parameters at the three time points (P>0.05). Conclusion Both ESWT and WES applications were found to yield significantly superior results when compared to pretreatment values. In comparison of the two groups, on the other hand, there was no statistically significant difference.
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Affiliation(s)
- Abdulkadir Aydın
- Prosthetics and Orthotics Department, Dicle University Medical School, Diyarbakir, Turkey,
| | - Ramazan Atiç
- Orthopedics and Traumatology Department, Dicle University Medical School, Diyarbakır, Turkey
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29
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Reilly JM, Bluman E, Tenforde AS. Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review. PM R 2018; 10:1385-1403. [PMID: 29775801 DOI: 10.1016/j.pmrj.2018.05.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/22/2018] [Accepted: 05/06/2018] [Indexed: 02/08/2023]
Abstract
Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urologic conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of nonunion fractures, and joint disease including avascular necrosis. The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels. Complications from ESWT are rare but include 2 reported cases of injury to bone and Achilles tendon rupture in older adults using focused shockwave. Collectively, studies suggest ESWT is generally well-tolerated treatment strategy for multiple musculoskeletal conditions commonly seen in clinical practice. LEVEL OF EVIDENCE: III.
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Affiliation(s)
| | | | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, 300 First Street, Charlestown, MA 02129(‡).
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30
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Mattyasovszky SG, Langendorf EK, Ritz U, Schmitz C, Schmidtmann I, Nowak TE, Wagner D, Hofmann A, Rommens PM, Drees P. Exposure to radial extracorporeal shock waves modulates viability and gene expression of human skeletal muscle cells: a controlled in vitro study. J Orthop Surg Res 2018; 13:75. [PMID: 29625618 PMCID: PMC5889540 DOI: 10.1186/s13018-018-0779-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent clinical and animal studies have shown that extracorporeal shock wave therapy has a promoting influence on the healing process of musculoskeletal disorders. However, the underlying biological effects of extracorporeal shock wave therapy on human skeletal muscle cells have not yet been investigated. METHODS In this study, we investigated human skeletal muscle cells after exposure to radial extracorporeal shock waves in a standardized in vitro setup. Cells were isolated from muscle specimens taken from adult patients undergoing spine surgery. Primary muscle cells were exposed once or twice to radial extracorporeal shock waves in vitro with different energy flux densities. Cell viability and gene expression of the paired box protein 7 (Pax7), neural cell adhesion molecule (NCAM), and myogenic factor 5 (Myf5) and MyoD as muscle cell markers were compared to non-treated muscle cells that served as controls. RESULTS Isolated muscle cells were positive for the hallmark protein of satellite cells, Pax7, as well as for the muscle cell markers NCAM, MyoD, and Myf5. Exposure to radial extracorporeal shock waves at low energy flux densities enhanced cell viability, whereas higher energy flux densities had no further significant impact. Gene expression analyses of muscle specific genes (Pax7, NCAM, Myf5, and MyoD) demonstrated a significant increase after single exposure to the highest EFD (4 bar, 0.19 mJ/mm2) and after double exposure with the medium EFDs (2 and 3 bar; 0.09 and 0.14 mJ/mm2, respectively). Double exposure of the highest EFD, however, results in a significant down-regulation when compared to single exposure with this EFD. CONCLUSIONS This is the first study demonstrating that radial extracorporal shock wave therapy has the potential to modulate the biological function of human skeletal muscle cells. Based on our experimental findings, we hypothesize that radial extracorporal shock wave therapy could be a promising therapeutic modality to improve the healing process of sports-related structural muscle injuries.
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Affiliation(s)
- Stefan G Mattyasovszky
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Eva K Langendorf
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ulrike Ritz
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Irene Schmidtmann
- Institue for Medical Biometry, Epidemiology and Computer Science, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tobias E Nowak
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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31
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Altun RD, Incel NA, Cimen OB, Sahin G. EFFICACY OF ESWT FOR LATERAL EPICONDYLITIS TREATMENT: COMPARISON WITH PHYSICAL THERAPY MODALITIES. ACTA ACUST UNITED AC 2018. [DOI: 10.1142/s021895771850001x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lateral epicondylitis (LE) is a common condition characterized by pain in the lateral side of the elbow with tenderness on lateral epicondyle, caused by repetetive overuse of extensor muscles of the wrist. Extracorporeal shockwave therapy (ESWT) is used in musculoskeletal problems with the possible mechanism of action including hyperstimulation analgesia, neovascularization and induction of healing process. LE generally responds well to conservative treatment. One of the widely used and accepted terms of treatment for LE is physical therapy (PT). In this study, we aimed to compare the efficacy of ESWT for LE treatment with conventional therapy modalities. This is a prospective randomized study with 73 patients with elbow pain and otherwise healthy, diagnosed as LE. Patients were randomized to two groups to receive either ESWT weekly for 3 weeks or PT for 10 days. Our analysis revealed similar treatment success rates for both groups in many of the evaluation parameters. As a result of our study we were unable to display a major difference between the short-term outcome for two options. However, ESWT still has the advantage of being less time consuming for both the patient and the doctor, an important parameter we believe.
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Affiliation(s)
- Resa D Altun
- Department of Physical Medicine and Rehabilitation, Mersin Toros State Hospital, Mersin, Turkey
| | - Nurgül Arinci Incel
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
| | - Ozlem Bölgen Cimen
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
| | - Gunsah Sahin
- Department of Physical Medicine and Rehabilitation, Mersin University School of Medicine, Mersin, Turkey
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32
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Liu Y, Chen X, Guo A, Liu S, Hu G. Quantitative Assessments of Mechanical Responses upon Radial Extracorporeal Shock Wave Therapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1700797. [PMID: 29593978 PMCID: PMC5867036 DOI: 10.1002/advs.201700797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 05/03/2023]
Abstract
Although radial extracorporeal shock wave therapy (rESWT) has been widely used to treat orthopedic disorders with promising clinical results, rESWT largely relies on clinicians' personal experiences and arbitrary judgments, without knowing relationships between administration doses and effective doses at target sites. In fact, practitioners lack a general and reliable way to assess propagation and distribution of pressure waves inside biological tissues quantitatively. This study develops a methodology to combine experimental measurements and computational simulations to obtain pressure fields from rESWT through calibrating and validating computational models with experimental measurements. Wave pressures at the bottom of a petri dish and inside biological tissues are measured, respectively, by attaching and implanting flexible membrane sensors. Detailed wave dynamics are simulated through explicit finite element analyses. The data decipher that waves from rESWT radiate directionally and can be modeled as acoustic waves generated from a vibrating circular piston. Models are thus established to correlate pressure amplitudes at the bottom of petri dishes and in the axial direction of biological tissues. Additionally, a pilot simulation upon rESWT for human lumbar reveals a detailed and realistic pressure field mapping. This study will open a new avenue of personalized treatment planning and mechanism research for rESWT.
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Affiliation(s)
- Yajun Liu
- Orthopedic Shock Wave Treatment CenterSpine Surgery DepartmentBeijing Jishuitan HospitalBeijing100035China
| | - Xiaodong Chen
- The State Key Laboratory of Nonlinear MechanicsBeijing Key Laboratory of Engineered Construction and MechanobiologyInstitute of MechanicsChinese Academy of SciencesBeijing100190China
- School of Engineering ScienceUniversity of Chinese Academy of SciencesBeijing100049China
| | - Anyi Guo
- Orthopedic Shock Wave Treatment CenterSpine Surgery DepartmentBeijing Jishuitan HospitalBeijing100035China
| | - Sijin Liu
- The State Key Laboratory of Environmental Chemistry and EcotoxicologyResearch Center for Eco‐Environmental SciencesChinese Academy of SciencesBeijing100085China
| | - Guoqing Hu
- The State Key Laboratory of Nonlinear MechanicsBeijing Key Laboratory of Engineered Construction and MechanobiologyInstitute of MechanicsChinese Academy of SciencesBeijing100190China
- School of Engineering ScienceUniversity of Chinese Academy of SciencesBeijing100049China
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Comparative outcomes of extracorporeal shockwave therapy for shoulder tendinitis or partial tears of the rotator cuff in athletes and non-athletes: Retrospective study. Int J Surg 2018; 51:184-190. [PMID: 29408642 DOI: 10.1016/j.ijsu.2018.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/20/2017] [Accepted: 01/25/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Refractory shoulder tendinitis or partial thickness rotator cuff tears (PTRCTs) are common findings in overhead athletes. Previous studies have examined the effectiveness of extracorporeal shockwave therapy (ESWT) for shoulder tendinitis. MATERIALS AND METHODS In the current study, we recruited 36 shoulders and performed a comparison between the professional athletes (13 shoulders, athletic group; AG) and the non-athletic population (23 shoulders, non-athletic group, NAG) with PTRCTs or shoulder tendinitis of the shoulder after ESWT. Patients with symptomatic tendinitis of the shoulder with or without a partial tear of the rotator cuff tendon and failed oral medication and physical therapy for more than 3 months were treated with electrohydraulic mode of ESWT. All patients that met the inclusion criteria were categorized into two groups according to their pre-treatment activity level. RESULTS We found that NAG exhibited significant aging and degenerative change around the glenohumeral joint and subacromial space. After ESWT treatment, the patients in AG were with 53.8% high satisfaction rating and patients in NAG were 52.1% by one-year followed up. CONCLUSION The results showed ESWT was equally effective treatment in both AG and NAG. In light of its efficacy and less-invasive nature, we suggest ESWT can be used to treat athletes with refractory tendinitis or PTRCTs before proceeding to arthroscopic intervention.
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Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am 2018; 100:251-263. [PMID: 29406349 DOI: 10.2106/jbjs.17.00661] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Daniel Moya
- Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Silvia Ramón
- Hospital Quirón, Barcelona, Fundación García Cugat, Spain
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Razavipour M, Azar MS, Kariminasab MH, Gaffari S, Fazli M. The Short Term Effects of Shock-Wave Therapy for Tennis Elbow: a Clinical Trial Study. Acta Inform Med 2018; 26:54-56. [PMID: 29719315 PMCID: PMC5869227 DOI: 10.5455/aim.2018.26.54-56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/02/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Tennis elbow is one of the most often diagnosed pathology of the upper extremity and different treatments have been suggested for this disease, so this study was to investigate the effects of extracorporeal shock wave therapy in Tennis elbow treatment. MATERIALS AND METHODS We design a before and after clinical trial study (registry number: IRCT2012072610405N1) and investigated 40 patients with tennis elbow disease. All patients received 2000 pulses extracorporeal shock wave by piezoelectric device (WOLF Company) daily for one-week. The severity of pain was the primary outcome and measured with visual analogue scale (VAS). Secondary outcome was the ability to perform daily activities using questionnaire's quick DASH (Disabilities of the Arm, Shoulder and Hand). Primary and secondary outcomes at baseline, 30 and 60 days after intervention were measured. RESULTS The mean age of patients was 43.80±8.97 years and 28 patients (70%) were female. The mean duration of disease was 6.5 ± 7.9 month. The mean score of VAS pain score reduced from 7.25±1.54cm (median=7cm) before treatment to 2.76±2.08cm (median=2cm) at 60 days after the end of treatment (P<0.001). The Quick Dash score reduced significantly from 25.20±5.31 (median=25) before treatment to 8.69±8.32 (median=6) at 60 days after the treatment (P<0.001). CONCLUSION For newly diagnosed patients with tennis elbow, extracorporeal shock wave therapy can reduce the severity of pain and improve daily activity.
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Affiliation(s)
- Mehran Razavipour
- Orthopaedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | | | | | - Salman Gaffari
- Orthopaedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | - Mehran Fazli
- Mazandaran University of Medical Science, Sari, Iran
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Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Clin J Pain 2017; 33:71-86. [PMID: 27022675 DOI: 10.1097/ajp.0000000000000368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. DISCUSSION Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.
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Chou WY, Wang CJ, Wu KT, Yang YJ, Ko JY, Siu KK. Prognostic factors for the outcome of extracorporeal shockwave therapy for calcific tendinitis of the shoulder. Bone Joint J 2017; 99-B:1643-1650. [PMID: 29212688 DOI: 10.1302/0301-620x.99b12.bjj-2016-1178.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
AIMS We conducted a study to identify factors that are prognostic of the outcome of extracorporeal shockwave therapy (ESWT) for calcific tendinitis of the shoulder. PATIENTS AND METHODS Since 1998, patients with symptomatic calcific tendinitis of the rotator cuff have been treated with ESWT using an electrohydraulic mode shockwave device. One year after ESWT, patients were grouped according to the level of resorption of calcification. RESULTS Of 241 symptomatic shoulders, complete resorption (CR) of calcification occurred in 134 (CR group). The remaining 107 shoulders had incomplete resorption (ICR) (ICR group). Gartner type I calcification was most common (64.5%) in the ICR group. The mean duration of symptoms before ESWT was significantly longer in the ICR group. Overall, 81% of the CR group and 23.4% of the ICR group were symptom free. There was a strong relationship between subsidence of symptoms and remission of calcification. Poor prognosis was significantly related to Gartner type I calcification, calcification extent > 15 mm and duration of symptoms > 11 months. CONCLUSION Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. Cite this article: Bone Joint J 2017;99-B:1643-50.
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Affiliation(s)
- W-Y Chou
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-J Wang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - K-T Wu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Y-J Yang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - J-Y Ko
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - K-K Siu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Taheri P, Emadi M, Poorghasemian J. Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis. Adv Biomed Res 2017; 6:61. [PMID: 28603702 PMCID: PMC5458403 DOI: 10.4103/2277-9175.207148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. Materials and Methods: This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm2, 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm2, 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs) and the visual analog scale (VAS) was reassessed 1 week after the last session and 12 weeks after finishing the treatment. Results: The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups (P = 0.001). Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. Conclusion: Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Emadi
- Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Poorghasemian
- Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Smith WB, Melton W, Davies J. Midsubstance Tendinopathy, Percutaneous Techniques (Platelet-Rich Plasma, Extracorporeal Shock Wave Therapy, Prolotherapy, Radiofrequency Ablation). Clin Podiatr Med Surg 2017; 34:161-174. [PMID: 28257672 DOI: 10.1016/j.cpm.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this article is to present the current options available for noninvasive and percutaneous treatment options for noninsertional Achilles tendinopathy. An attempt is made to offer recommendations for both the treatment techniques as well as postprocedure protocols to be considered. Additionally, because there are numerous treatment options in this category, the different techniques are summarized in a chart format with a short list of pros and cons as well as the levels of evidence in the literature to support the different modalities.
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Affiliation(s)
- William Bret Smith
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA.
| | - Will Melton
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
| | - James Davies
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
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Abstract
Tendinopathies of the elbow and in particular of the common extensor origin are a common cause of elbow pain. Part one of this two part review of tendinopathies of the elbow will focus on the pathophysiology and management of lateral elbow tendinopathy, frequently referred to as tennis elbow. Lateral elbow tendinopathy is a common condition with an incidence of 1 – 2%. The pathology arises from the origin of extensor carpi radialis brevis where changes, consistent with all tendinopathies, of angiofibroblastic hyperplasia occur secondary to repetitive micro trauma. It is not an inflammatory condition. Clinical history and examination is usually sufficient for diagnosis although MRI and ultrasound can be used. The many treatment options that have been proposed have a mixed quality of supporting evidence. Thus management protocols are difficult to define. Treatment depends on the length of symptoms. Acute presentation is managed through conservative measures including activity modification, topical NSAIDs and physiotherapy. For patients with recalcitrant symptoms, injection therapy with, for example, platelet rich plasma can be used. Alternatively surgical excision of the diseased tissue can be performed. This review article will consider the available evidence in order to identify both treatments that are effective and those that are not.
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Wong CWY, Ng EYL, Fung PW, Mok KM, Yung PSH, Chan KM. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2016; 7:21-26. [PMID: 29264270 PMCID: PMC5721919 DOI: 10.1016/j.asmart.2016.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/03/2022]
Abstract
Background Lateral epicondylitis is one of the most common overuse injuries, and has been reported to reduce function and affect daily activities. There is no standard therapy for lateral epicondylitis. In Hong Kong, acupuncture and extracorporeal shockwave therapy (ESWT) have been popular in treating lateral epicondylitis in recent years. Objective This study is to compare the treatment effects of acupuncture and ESWT on lateral epicondylitis. Methods In this study, we evaluated 34 patients (34 elbows) with lateral epicondylitis. Seventeen patients were treated by 3-week ESWT, one session per week. Another 17 were treated by 3-week acupuncture therapy, two sessions per week. The outcome measures included pain score by visual analogue scale, maximum grip strength by Jamar dynamometer, and level of functional impairment by disability of arms, shoulders, and hands questionnaire. Participants were assessed at three time points: baseline; after treatment; and 2-week follow-up. Results The two treatments showed no significant difference at any assessment time-point. Both treatment groups had significant improvement in pain score in longitudinal comparisons. No significant difference was found in maximum grip strength and functional impairment in either treatment group, but a trend of improvement could be observed. In addition, improvement in pain relief stopped when treatment ended for either groups. Conclusions The treatment effects of acupuncture and ESWT on lateral epicondylitis were similar. The pain relief persisted for at least two weeks after treatment.
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Affiliation(s)
- Clara Wing-Yee Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Elaine Yin-Ling Ng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui-Wa Fung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam-Ming Mok
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 2016; 51:97-104. [DOI: 10.1136/bjsports-2015-095858] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/15/2023]
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Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm. Orthop J Sports Med 2016; 4:2325967116670635. [PMID: 27833925 PMCID: PMC5094303 DOI: 10.1177/2325967116670635] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The term tendinopathy is used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments.
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Affiliation(s)
- Gev Bhabra
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Jay R Ebert
- School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Edwards
- School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia
| | - Monica Zheng
- Pulse Podiatry, Wembley, Western Australia, Australia
| | - Ming H Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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Park JW, Hwang JH, Choi YS, Kim SJ. Comparison of Therapeutic Effect of Extracorporeal Shock Wave in Calcific Versus Noncalcific Lateral Epicondylopathy. Ann Rehabil Med 2016; 40:294-300. [PMID: 27152280 PMCID: PMC4855124 DOI: 10.5535/arm.2016.40.2.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the therapeutic effect of extracorporeal shock wave therapy (ESWT) in lateral epicondylopathy with calcification, and compare it to the effect of ESWT in lateral epicondylopathy without calcification. Methods A retrospective study was conducted. Forty-three patients (19 with calcific and 24 with noncalcific lateral epicondylopathy in ultrasound imaging) were included. Clinical evaluations included the 100-point score, Nirschl Pain Phase scale before and after ESWT, and Roles and Maudsley (R&M) scores after ESWT. ESWT (2,000 impulses and 0.06–0.12 mJ/mm2) was performed once a week for 4 weeks. Results The 100-point score and Nirschl Pain Phase scale changed significantly over time (p<0.001), but there was no significant difference between groups (p=0.555). The R&M scores at 3 and 6 months after ESWT were not significantly different between groups. In the presence of a tendon tear, those in the calcific lateral epicondylopathy group showed poor improvement of 100-point scores compared to the noncalcific group (p=0.004). Conclusion This study demonstrated that the therapeutic effect of ESWT in calcific lateral epicondylopathy was not significantly different from that in noncalcific lateral epicondylopathy. When a tendon tear is present, patients with calcific lateral epicondylopathy might show poor prognosis after ESWT relative to patients with noncalcific lateral epicondylopathy.
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Affiliation(s)
- Jong Wook Park
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Seong Choi
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci 2015; 27:3755-8. [PMID: 26834345 PMCID: PMC4713784 DOI: 10.1589/jpts.27.3755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal
shock wave therapy and local corticosteroid injection in patients with lateral
epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were
randomly divided into extracorporeal shock wave therapy and steroid injection groups.
Patients were evaluated using hand grip strength, visual analog scale, and short-form
McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both
groups showed statistically significant increase in hand grip strength and decreases on
the visual analog scale and short form McGill pain questionnaire overtime. There was no
statistically significant difference in the percentage of improvement in hand grip
strength and on the short-form McGill pain questionnaire between groups at 4 weeks
post-treatment, whereas the extracorporeal shock wave therapy group showed better results
on the visual analog scale. The percentages of improvements in all 3 parameters were
higher in the extracorporeal shock wave therapy group than in the injection group at 12
weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid
injection were safe and effective in the treatment of lateral epicondylitis. However,
extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at
the long-term follow-up.
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Affiliation(s)
- Münevver Serdaroğlu Beyazal
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
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Long L, Briscoe S, Cooper C, Hyde C, Crathorne L. What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations. Health Technol Assess 2015; 19:1-134. [PMID: 25629427 DOI: 10.3310/hta19080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient's social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year. OBJECTIVES This systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET. DATA SOURCES A comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases. METHODS AND OUTCOMES We conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013. RESULTS A total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified. LIMITATIONS The summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect. CONCLUSIONS Clinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003593. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Linda Long
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Exeter, UK
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Rosso F, Bonasia DE, Marmotti A, Cottino U, Rossi R. Mechanical Stimulation (Pulsed Electromagnetic Fields "PEMF" and Extracorporeal Shock Wave Therapy "ESWT") and Tendon Regeneration: A Possible Alternative. Front Aging Neurosci 2015; 7:211. [PMID: 26617513 PMCID: PMC4637423 DOI: 10.3389/fnagi.2015.00211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022] Open
Abstract
The pathogenesis of tendon degeneration and tendinopathy is still partially unclear. However, an active role of metalloproteinases (MMP), growth factors, such as vascular endothelial growth factor (VEGF) and a crucial role of inflammatory elements and cytokines was demonstrated. Mechanical stimulation may play a role in regulation of inflammation. In vitro studies demonstrated that both pulsed electromagnetic fields (PEMF) and extracorporeal shock wave therapy (ESWT) increased the expression of pro-inflammatory cytokine such as interleukin (IL-6 and IL-10). Moreover, ESWT increases the expression of growth factors, such as transforming growth factor β(TGF-β), (VEGF), and insulin-like growth factor 1 (IGF1), as well as the synthesis of collagen I fibers. These pre-clinical results, in association with several clinical studies, suggest a potential effectiveness of ESWT for tendinopathy treatment. Recently PEMF gained popularity as adjuvant for fracture healing and bone regeneration. Similarly to ESWT, the mechanical stimulation obtained using PEMFs may play a role for treatment of tendinopathy and for tendon regeneration, increasing in vitro TGF-β production, as well as scleraxis and collagen I gene expression. In this manuscript the rational of mechanical stimulations and the clinical studies on the efficacy of extracorporeal shock wave (ESW) and PEMF will be discussed. However, no clear evidence of a clinical value of ESW and PEMF has been found in literature with regards to the treatment of tendinopathy in human, so further clinical trials are needed to confirm the promising hypotheses concerning the effectiveness of ESWT and PEMF mechanical stimulation.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto ITorino, Italy
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Król P, Franek A, Durmała J, Błaszczak E, Ficek K, Król B, Detko E, Wnuk B, Białek L, Taradaj J. Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study. J Hum Kinet 2015; 47:127-35. [PMID: 26557197 PMCID: PMC4633248 DOI: 10.1515/hukin-2015-0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm2) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.
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Affiliation(s)
- Piotr Król
- The Jerzy Kukuczka Academy of Physical Education, Department of Physiotherapy Basics, Katowice. Poland
| | - Andrzej Franek
- Medical University of Silesia, School of Medicine, Chair and Department of Medical Biophysics, Katowice. Poland
| | - Jacek Durmała
- Medical University of Silesia, School of Health Sciences, Chair Department of Rehabilitation, Katowice. Poland
| | - Edward Błaszczak
- Medical University of Silesia, School of Medicine, Chair and Department of Medical Biophysics, Katowice. Poland
| | - Krzysztof Ficek
- Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin. Poland
| | - Barbara Król
- Medical University of Silesia, School of Medicine, Chair and Department of Medical Biophysics, Katowice. Poland
| | - Ewa Detko
- Medical University of Silesia, School of Health Sciences, Chair Department of Rehabilitation, Katowice. Poland
| | - Bartosz Wnuk
- Medical University of Silesia, School of Health Sciences, Chair Department of Rehabilitation, Katowice. Poland
| | - Lidia Białek
- Medical University of Silesia, School of Medicine, Chair and Department of Medical Biophysics, Katowice. Poland
| | - Jakub Taradaj
- The Jerzy Kukuczka Academy of Physical Education, Department of Physiotherapy Basics, Katowice. Poland
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Thiele S, Thiele R, Gerdesmeyer L. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy. Int J Surg 2015; 24:165-70. [PMID: 26455532 DOI: 10.1016/j.ijsu.2015.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 12/30/2022]
Abstract
Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy.
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Affiliation(s)
- S Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany.
| | - R Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany
| | - L Gerdesmeyer
- Dept. Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, D-24105 Kiel, Germany
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50
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Trentini R, Mangano T, Repetto I, Cerruti P, Kuqi E, Trompetto C, Franchin F. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg 2015; 99 Suppl 1:S91-S97. [PMID: 25957547 DOI: 10.1007/s12306-015-0361-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. MATERIALS AND METHODS In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. RESULTS A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. CONCLUSIONS Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.
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Affiliation(s)
- R Trentini
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - T Mangano
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy.
| | - I Repetto
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - P Cerruti
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - E Kuqi
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - C Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, School of Medicine, University of Genova, Genoa, Italy
| | - F Franchin
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
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