Study: Shock Wave Therapy Effective for Epicondylitis

Monday, November 7, 2005 | 0

A recent study published in The Journal of Bone and Joint Surgery has concluded that low-dose shock wave therapy without anesthetic is a safe and effective treatment for chronic lateral epicondylitis.

Epicondylitis, more commonly referred to as tennis elbow, but also commonly referred to as tendonitis, is a common, and troubling injury afflicting thousands of workers on a routine basis. While many respond to conservative treatment, surgical intervention is necessary in 4% to 11% of patients. While surgical intervention is often successful, it carries with it pain, risks, and costs that may be avoided with successful nonoperative management.

An alternative to surgery is Extracorporeal Shockwave Therapy or ESWT, which utilizes a concentrated stream of pulsed sound waves directed to a specific sight to be treated.

The treatment involves a soft, water-filled bladder at the end of a moveable arm placed against the area to be treated. The pulse-like soundwaves create several changes within the cells that aid in the healing process. During treatment:
1. Local nerve conduction is blocked resulting in a natural analgesic or numbing effect that may last up to 72 hours.
2. ESWT causes the body to respond by forming new blood vessels that eventually will lead to the repair of the tendon.

When treating a patient, the technician utilizes clinical palpation with patient input to determine the exact trigger point of the pain. The so called "sweet spot" is marked and the acoustic wave head is positioned for treatment.

Initially, the tech will administer 200 to 400 pulses in the surrounding area of the trigger point in order to create an analgesic affect. The tech will then position the acoustic wave head directly over the marked area and adjust the depth of the acoustic waves with patient input to the exact spot of pain for maximum effect.

The standard procedure is to administer approximately 2,000 pulses to the affected area to create a body reaction that results in a revascularizaton process that causes the body to essentially heal itself.

The special sound waves are generated and applied from outside the body to stimulate and initiate the body's own reparative processes.

Usually, a single session takes about 10-15 minutes. During treatment, the patient will feel a mild stinging sensation and pressure in the treated area.

Acoustic sound wave application will begin at a very low energy level. The energy level may be slowly increased to a level necessary to adequately treat your condition. If the sensation or pressure becomes too uncomfortable, the energy level may be adjusted.

Generally, the patient will experience a 30% to 40% improvement after the first treatment.

The second treatment provides up to 60% to 80% relief of pain.

The final treatment provides up to 100% of pain relief with long term positive results.

The study, by Frank A. Pettrone, MD, and Brian R. McCall, MD, involved 114 patients with a minimum six-month history of lateral epicondylitis that was unresponsive to conventional therapy. The patients were randomized into double-blind active treatment and placebo groups.

The patients were provided three weekly treatments of either low-dose shock wave therapy without anesthetic or a sham treatment. Patients had a physical examination, including provocation testing and dynamometry, at one, four, eight, and twelve weeks and at six and twelve months after treatment. Radiographs, laboratory studies, and electrocardiograms were also evaluated prior to participation and at twelve weeks. A visual analog scale was used to evaluate pain, and an upper extremity functional scale was used to assess function. Crossover to active treatment was initiated for nonresponsive patients who had received the placebo and met the inclusion criteria after twelve weeks.

Drs. Pettrone and McCall found that active treatment resulted in significant improvement compared with placebo with respect to the reduction of pain, functional scores, patient activity score, and subjective rating of the disease state by the patient at twelve weeks. While grip strength improvement with active treatment was not significantly different from that with placebo treatment, the functional score, a validated measure of upper extremity function that combines activities requiring power grip and wrist and/or finger extension, showed a significant improvement. The improvements gained by active treatment were maintained in almost all of the patients who were followed for twelve months. Furthermore, the placebo patients who had not responded and crossed over to active treatment showed significant improvement compared with their own scores during placebo treatment.

Parties interested in a copy of the study to support an ESWT treatment regimen can contact Joanna Robertson, VP Sales & Marketing, Ortho Shock Wave Therapy, Inc. at jrobertsonoswti@hotmail.com.

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