Comparison between effects of radial extracorporeal shock wave therapy and progressive resistive exercise in treatments of chronic lateral elbow tendinosis

Abstract

Background : Elbow tendinosis is the most common cause of elbow pain. Both radial extracorporeal shock wave therapy (rESWT) and progressive resistive exercise (PRE) are widely used and share evidences of effectiveness in treating elbow tendinosis. So far, there have not been any evidence that confirms better effectiveness of one treatment over the other.

Objective : To compare the effects between rESWT and PRE in chronic lateral elbow tendinosis regarding the improvement of pain, The Disabilities of the Arm, Shoulder and Hand (DASH) score, pressure pain threshold and pain-free handgrip strength.

Methods : Eighteen chronic lateral elbow tendinosis patients that had failed other conservative treatment. rESWT group underwent rESWT for 5 sessions, once a week, whereas PRE group did progressive resistive exercise using elastic band. Both groups met the researcher weekly for treatment sessions for 5 weeks; then continued their home exercise until 12 weeks. VAS pain score at rest, during activities, at night, during provocative test, DASH score, pressure pain threshold (PPT) and pain-free handgrip strength (PFHGS) were assessed at baseline, and 3, 6 and 12 weeks after starting treatment.

Results : The rESWT group demonstrated significant improvement of pain during activities (P = 0.005, 0.001,<0.001), pain at night (P = 0.035, 0.040, 0.008), pain during provocative test (P = 0.012, 0.011, <0.001), PPT (P = 0.025, 0.013, <0.001) and DASH score (P = 0.017, 0.004, <0.001)) at 3, 6 and 12 weeks, PFHGS at 6 and 12 weeks (P = 0.011, <0.001). The PRE group significantly improved pain during activities (P = 0.004), pain during provocative test (P = 0.001), and DASH score (P = 0.021) at 12 weeks. At 12 weeks, rESWT significantly improved pain during activities (P = 0.042), DASH score (P = 0.038), PPT (P = 0.002), and PFHGS (P = 0.013) when compared with PRE.

Conclusion : rESWT results in greater improvement of pain during activities, DASH score, pressure pain threshold, and pain-free hand grip strength than PRE in patients with chronic lateral elbow tendinosis. rESWT can improve pain at rest, at night and during provocative test compared to the baseline but it shows no significant benefit over PRE in these parameters.