July 24, 2006

Shock Wave Therapy No Help for Tennis Elbow

NEW YORK (Reuters Health) - Shock wave therapy does nothing to relieve pain or disability due to tennis elbow, according to a review of ten studies that involved more than 1,000 participants.

Known medically as lateral elbow pain, tennis elbow generally improves on its own, Dr. Rachelle Buchbinder of the Monash Department of Clinical Epidemiology at Cabrini Medical Center in Melbourne, Australia and colleagues write in the Journal of Rheumatology. However, it may persist in a small percentage of people, who may even require surgery.

So-called extracorporeal shock wave therapy (ESWT) has been tried for tennis elbow, in which shock waves are focused on the problem area, with or without local anesthesia. ESWT is believed to work by causing microscopic injuries to the affected tissue that stimulate the healing process. There is little "high-quality" evidence for the benefits of many tennis elbow treatments, including shock wave therapy, the researchers note.

To investigate the effectiveness of ESWT, the researchers looked at nine studies in which it was compared to placebo for tennis elbow, including a total of 1,006 participants, and a tenth comparing shock wave therapy to steroid injections in 93 participants.

The researchers pooled the results of the trials, and found that, overall, shock wave therapy was no better than placebo. However, steroid injections produced a 50% reduction of pain after three months.

The use of shock wave therapy for soft tissue musculoskeletal problems remains a source of "considerable debate," Buchbinder and her team write, noting that their own randomized controlled trial of the technique failed to find that it hastened recovery in patients with a type of foot pain called plantar fasciitis.

"Based upon systematic review of nine placebo-controlled trials, there is 'platinum' level evidence that ESWT provides little or no benefit in terms of pain and function in lateral elbow pain," the researchers conclude.

SOURCE: Journal of Rheumatology, July 2006.