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Crafford S.1, Godlwana L.2, Naidoo V.1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2Lonwabo Physiotherapists INC, Physiotherapy, Johannesburg, South Africa
Background: Lateral elbow tendinopathy (LET) more commonly known as tennis elbow, is the most common chronic musculoskeletal pain condition of the elbow, it affects from 1-3% of active working people. Good quality evidence of effective physiotherapy-based treatment for chronic lateral elbow tendinopathy is lacking. Radial Shockwave is a non-invasive modality that uses single-pulsed acoustic or sonic waves to treat tendinopathies by initiating tissue regeneration.
Purpose: This trial assessed the effect of radial shockwave therapy compared to placebo in the treatment of chronic lateral elbow tendinopathy.
Methods: This non-randomised controlled trial assessed the effects of radial shockwave treatment for lateral elbow tendinopathy persisting for two months and longer, and not reacting to other conservative treatment. A pilot study with seven participants was conducted before undertaking the clinical trial. Forty-one participants with chronic lateral elbow tendinopathy were included in the study. The participants were systematically allocated to the intervention(n=21) and control(n=20) groups. They received three interventions of radial shockwave (2000 shots, 45% pressure and a frequency of 8Hz)- or placebo treatment once a week, as well as an eccentric exercise programme. Their outcomes [Thomsen VAS-score for pain, VAS and Total score of the McGill pain questionnaire-short form (MPQ-SF), grip-strength measured in kg/cm2 with a dynamometer and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb function] were assessed at baseline, one-week and three-months post treatment. The data was analysed with Statistica (Version 12.7) using the Mann-Whitney U test- and Fisher exact p, two-tailed test (categorical data).
Results: The groups did not differ on demographic or clinical characteristics at baseline. There was an improvement in both the intervention and placebo groups in pain, grip-strength and upper limb function with follow-up; however, no statistical significance was found between the two groups p-value (p≤0.05) at one-week and three-months post intervention. The difference in sample size from baseline to three-months follow up is due to participants not returning for follow up.
Conclusion(s): There was no significant difference between the intervention and control group suggesting that the placebo treatment could be just as effective as radial shockwave therapy.
Implications: Further research is required with a larger sample size and longer follow up after the intervention, as well as evidence-based dosage parameters to support or refute the use of radial shockwave therapy in the treatment of lateral elbow tendinopathy.
Funding acknowledgements: With special thanks to the Paul and Stella Lowenstein trust for their scholarship
Topic: Musculoskeletal: upper limb
Ethics approval:
Ethics approval was granted by the Human Research ethics committee(Medical).
Clearance certificate no.M130517
All authors, affiliations and abstracts have been published as submitted.
