Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis

OBJECTIVES We investigated the effect of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. METHODS The study included 13 elbows of 12 patients (8 women, 4 men; mean age 40 years) who did not benefit from conservative therapy for lateral epicondylitis and refused surgical therapy. Under fluoroscopic guidance, extracorporeal shock wave therapy of 1200 pulses at 15-20 kV was administered at a mean of three sessions (range 3 to 7 sessions) with two-day intervals. No immobilization was applied after sessions. The patients were questioned about pain during rest and during dorsiflexion of the wrist against resistance before and after three and 12 months of treatment. The results were evaluated using the Roles and Maudsley pain scores. At the end of 12 months, the patients were asked to lift weight with the shoulder in flexion and the wrist in extension to measure grip strengths in comparison with the unaffected side. RESULTS The mean pain score which was 3.4 before treatment decreased to 2 after treatment. The mean grip strength of the affected extremities was 82.1% of the normal side. At final follow-ups, nine patients (10 elbows) (75%) stated that the treatment was beneficial; all these patients achieved at least 85% of grip strength of the normal side. Two patients (16.7%) reported no benefit from therapy and had a poor pain score. The result was fair in one patient (8.3%) who expressed dissatisfaction and had partial relief after the procedure. This patient achieved 60% of grip strength of the unaffected side. CONCLUSION Extracorporeal shock wave therapy is an alternative method for patients who do not benefit from conservative treatment and refuse surgical treatment.