Radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow): A double-blinded randomised controlled trial.

Abstract

Investigating outcomes following radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow). 43 patients with chronic lateral elbow tendinopathy were recruited from a single NHS Sport Medicine clinic. Participants were randomised equally within this double-blinded randomised controlled trial to receive either three sessions of 'therapeutic-dose' or 'minimal-dose' rESWT, respectively, alongside a structured and progressive home exercise programme. Participants: 63% female, 70% affecting the dominant arm, mean age 47.9 ± 8.0 years, symptom duration: 31.7 ± 25.4 months. Maximum six-month follow-up, with interim data at six weeks and three months. Improvements were seen in both groups, but no between-group differences were seen with any measure at any time point, suggesting no benefit from 'therapeutic' levels of extracorporeal shockwave therapy (ESWT) above minimal dosage. Self-reported 'average' pain improved by 27% at six weeks, rising to 40% at three months, and 52% at six months, irrespective of ESWT 'dose'. Improvements were seen across different validated patient-reported outcome measures. This study has not shown superiority of rESWT compared to 'minimal-dose' rESWT in patients with chronic lateral elbow tendinopathy (tennis elbow), when performed alongside a structured progressive loading home exercise programme. This study does not support the use of rESWT performed at the 'maximally comfortably tolerated dose' as per manufacturer recommendations. Level I - Randomised controlled trial.