Document Type : Research articles


Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, Duzce, Turkey


Background: Extracorporeal shock wave therapy is a noninvasive, safe, and well- tolerated treatment method which is increasingly used in the treatment of lateral epicondylitis. However, the gold standard treatment protocol is still controversial.
Objectives: This study aimed to investigate and compare the efficacy of two different pneumatic pressure levels of radial extracor- poreal shockwave therapy (rESWT) in active patients with lateral epicondylitis, unresponsive to conservative treatment.
Methods: This retrospective comparative study was carried out in the Department of Orthopedics and Traumatology, Duzce Uni- versity School of Medicine in 2018. A total of 330 patients with lateral epicondylitis unresponsive to conservative treatment were underwent rESWT during years 2010 - 2017. The patients were divided into two groups of 181 patients (group 1) with a total of 1500 impulses of 10 Hz frequency at 1 bar of air pressure during five treatment sessions at 1 week intervals, and 149 patients (group 2) with a total of 2000 impulses of 10 Hz frequency at 2 bars of air pressure during five treatment sessions at 1 week intervals. Functional and clinical outcomes were assessed just before the treatment, at six weeks and six months after treatment using the visual analogue scale (VAS) and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score.
Results: The mean VAS score had significantly decreased in group 1 from 8.34 ± 1.22 to 2.59 ± 1.49 (P = 0.0001) and had also in group 2 from 8.56 ± 1.22 to 2.56 ± 1.76 (P = 0.0001). The mean Q-DASH score decreased significantly in both groups; from 58.92 ± 18.48 to 9.27 ± 5.85 (P = 0.0001), and from 65.36 ± 19.32 to 9.25 ± 6.28 (P = 0.0001) in group 1 and group 2, respectively. No significant difference was observed between the pretreatment VAS and the 6-month scores of groups 1 and 2 (P = 0.103). The mean difference in the Q-DASH pretreatment and 6-week scores and between the pretreatment and 6-month scores in group 2 were higher than those in group 1 (P = 0.011, P = 0.003).
Conclusions: Although both rESWT treatment regimens caused a decrease in pain and loss of function, the superior treatment protocol for rESWT appears to be five treatment sessions at 1-week intervals, with 2000 impulses per session and 2 bars. rESWT is a good option for treating lateral epicondylitis, as it is safe and effective and leads to no complications.