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

Year 2019, Volume: 5 Issue: 4, 658 - 662, 04.07.2019

Yalçın Turhan Mehmet Arıcan Zekeriya Okan Karaduman

https://doi.org/10.18621/eurj.448849

Abstract

Objective: To evaluate the effectiveness of extracorporeal shock
wave therapy (ESWT) for the patients with isolated medial epicondylitis
refractory to other conservative methods.

Methods: A retrospective analysis of 57 patients with the
diagnosis of isolated medial epicondylitis refractory to conservative measures
was done. 36 of them who met our eligibility criteria were included. Patients
were subjected to three sessions of extracorporeal shock wave therapy with 2000
pulses per a session in a dose of 0.06-0.12 mJ/mm². Pain and
clinical/functional scores were measured by visual analogue scale (VAS) and
Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) respectively before the
treatment and at 1^st week and 12^th week of the last
session.

Results: Mean age of the patients was 47.3 (25-67) years and
there was a higher female presentation (24 female and 12 male patients). The
VAS scores were improved from a mean of 7.8 before the treatment to 5.3 at 1^st
week (p < 0.001) and to 2.9 at 12^th
week (p < 0.001). Also the results
of the Q-DASH showed a mean improvement from 50.4 before the treatment to 27.1
at 1^st week (p < 0.001)
and 9.6 at 12^th week (p <
0.001). There were no significant differences in the improvements of VAS and
Q-DASH scores by the time between the male and female patients.

Conclusion: According to the results of this study which will be
one of the limited studies about isolated medial epicondylitis; ESWT is a good
conservative treatment option for medial epicondylitis in refractory cases like
in lateral epicondylitis. 

Keywords

Medial epicondylitis, extracorporeal shock wave therapy, visual analogue scale, quick-disabilities of the arm shoulder and hand

References

• [1] Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 2006;164:1065-74.
• [2] Descatha A, Leclerc A, Chastang JF, Roquelaure Y. Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. J Occup Environ Med 2003;45:993-1001.
• [3] Wolf JM, Mountcastle S, Burks R, Sturdivant RX, Owens BD. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med 2010;175:336-9.
• [4] Boyd HB, Mcleod JR AC. Tennis elbow. J Bone Joint Surg Am 1973;55:1183-7.
• [5] Friedlander HL, Reid RL, Cape RF. Tennis elbow. Clin Orthop Relat Res 1967;51:109-16.
• [6] Furia JP. Safety efficacy of extracorporeal shock wave therapy for chronic lateral epicondylitis. Am J Orthop (Belle Mead, NJ) 2005;34:13-9.
• [7] Speed CA. Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions. J Bone Joint Surg Br 2004;86:165-71.
• [8] Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, et al. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med 2012;36:681-7.
• [9] Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996;29:602-8.
• [10] Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item- reduction approaches. J Bone Joint Surg Am 2005;87:1038-46.
• [11] Hamilton PG. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 1986;36:464-5.
• [12] Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg 2015;23:348-55.
• [13] Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med 2004;23:693-705.
• [14] Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Shoulder Elbow 2014;6:47-56.
• [15] Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint SurgAm 1997;79:1648-52.
• [16] Speed C. A systematic review of shockwave therapies in soft tissue conditions: Focusing on the evidence. Br J Sports Med 2014;48:1538-42.
• [17] Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012;7:11.
• [18] Rompe JD, Kirkpatrick CJ, Kullmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendon Achillis: A sonographic and histological study. J Bone Joint Surg Br 1998;80:546-52.
• [19] Oh JH, Yoon JP, C Oh HH, Jo KH, Gong HS. Dose related effect of extracorporeal shock wave therapy for lateral epicondylitis. J Korean Shoulder Elbow Soc 2009;12:21-6.
• [20] Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am 2005;87:1297-304.
• [21] Daecke W, Loew M, Schuknecht B, Kusnierzcak D. DerEinfluss der Applikationsdosis auf die Wirksamkeit der ESWA bei der Tendinosiscalcarea der Schulter. Orthop Praxis 1997;33:119-23.
• [22] Rompe JD, Rumler F, Hopf C, Nafe J. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. Clin Orthop 1995;321:196-201.
• [23] Shim JS, Chung SG, Bang H, Lee HJ, Kim K. Ulnar neuropathy after extracorporeal shockwave therapy: a case report. PMR 2015;7:667-70.
• [24] Hume PA, Reid D, Edwards T. Epicondylar injury in sport. Epidemiology, type, mechanisms, assessment, management and prevention. Sports Med 2006;36:151-70.
• [25] Speed CA, Nichols D, Richards C, Humphreys H, Wies JT, Burnet S, et al. Extracorporeal shock wave therapy for lateral epicondylitis – a double blind randomised controlled trial. J Orthop Res 2002;20:895-8.
• [26] Chung B, Wiley JP, Rose MS. Long-term effectiveness of extracorporeal shockwave therapy in previously untreated lateral epicondylitis. Clin J Sport Med 2005;15:305-12.
• [27] Lebrun CM. Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis. Clin J Sport Med 2005;15:401-2.