Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study than 2 points in the VAS between the two groups is demonstrated in favour of the ESWT Group. Considering satisfactory results, significant differences between the two groups are observed at 6 (p=0.003) and 12 months (p <0.001) in favour of the ESWT Group where patients achieve a satisfactory rate over 50%. Conclusions IntroductionLateral epicondylitis (LE), commonly called tennis elbow, is one of the most prevalent arm disorders. Its prevalence varies between 1 and 3% in the general population 1 and between 2 and 23% among occupational populations 2 . It's considered a process characterized by angiofibroblastic degeneration or hyperplasia within the common extensor tendon of the elbow, particularly affecting the extensor carpi radialis brevis 3 . Its etiology derives from a multifactorial process, involving mechanical (repetitive/excessive mechanical loads, contusions) and structural factors (morphologic, cellular, metabolic) 4 . The treatments offered range from "wait and see", information and general advice, medication consisting mainly of non-steroidal anti-inflammatory drugs, to a variety of physical treatments, local corticosteroid or non-corticosteroid injections (sodium hyaluronate, botulinum toxin, prolotherapy), exercise or the use of different appliances or bandages 5,6 . Several studies have shown that physical modalities like pulsed magnetic fields, laser therapy, radiofrequency ablation, therapeutic ultrasound, low-intensity pulsed ultrasound (LIPUS) and extracorporeal shock waves promote tissue healing and are used in the management of tendon disorders 7 . Our study has focused on two of these: extracorporeal shock wave therapy and cryoultrasound therapy. The rationale for taking into account these modalities in our study is that both treatments use sound waves, albeit at different physical properties 8,9 , and that the physical stimuli induce the response of fibroblasts 10 . Extracorporeal shock wave therapy (ESWT) was introduced in Germany in the 1990's and then spread

Background: Greater trochanteric pain syndrome (GTPS) is a condition of lateral hip pain. Its physiopathology remains unknown, and there is no consensus on optimal management. The aim of this study was to assess the effectiveness of electromagnetic-focused extracorporeal shockwave treatment (F-ESWT) in patients with GTPS. Methods: This multicenter clinical trial included 103 patients with chronic GTPS randomly assigned to the treatment group, consisting of electromagnetic F-ESWT and a specific exercise protocol, or the control group, receiving sham F-ESWT and the same exercise protocol. Both groups were treated with 3 weekly sessions; the F-ESWT group received an energy flux density of 0.20 mJ/mm2, whereas the control group received 0.01 mJ/mm2. Patients were assessed at baseline and 1, 2, 3, and 6 months after treatment. A visual analogue scale (VAS) score for pain at 2 months was the primary outcome. The Harris hip score (HHS), Lower Extremity Functional Scale (LEFS), EuroQoL-5 Dimensions Questionnaire (EQ-5D), and Roles and Maudsley score were used as secondary outcomes. Complications were recorded. Results: The mean VAS score decreased from 6.3 at baseline in both groups to 2.0 in the F-ESWT group versus 4.7 in the control group at 2 months; the 2-month score differed significantly between groups (p < 0.001). All secondary outcomes at all follow-up intervals were significantly better in the F-ESWT group, except for the LEFS score at 1 month after treatment (p = 0.25). No complications were observed. Conclusions: F-ESWT in association with a specific exercise program is safe and effective for GTPS, with a success rate of 86.8% at 2 months after treatment, which was maintained until the end of follow-up. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Over the years, infiltrative oxygen-ozone therapy has shown clinical benefits in several musculoskeletal disorders, due to its potential analgesic, anti-inflammatory, antioxidant and immunomodulatory effect. Ultrasonography is a safe, non-invasive imaging, easily available, and has the additional advantage of being real time for imaging and image-guided procedures of the musculoskeletal system. This review explains the numerous promising ways in which ultrasonography can be useful in oxygen-ozone therapeutic practices for musculoskeletal disorders, in order to improve safety and accuracy of treatment.

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Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study than 2 points in the VAS between the two groups is demonstrated in favour of the ESWT Group. Considering satisfactory results, significant differences between the two groups are observed at 6 (p=0.003) and 12 months (p <0.001) in favour of the ESWT Group where patients achieve a satisfactory rate over 50%. Conclusions: ESWT has better clinical therapeutic results at 6-and 12-month follow-up as compared to Cryo-US therapy. Level of Evidence: 1B. SummaryBackground: the purpose of this study is to compare the therapeutic effects of extracorporeal shock wave therapy (ESWT) to those of cryoultrasound (Cryo-US) therapy in chronic lateral epicondylitis during a 12-month period. Methods: single-blinded, randomized, controlled study of 80 participants treated for chronic LE with 3 ESWT sessions at 48/72-hours intervals (n=40) or 12 Cryo-US therapy sessions (4 sessions per week) (n=40). VAS and satisfactory results, considered as the sum of excellent and good scores in the Roles and Maudsley score, were used as outcome measures at baseline and 3, 6 and 12 months post-treatment. Results: the results show statistically significant differences in VAS between the two groups at 6 (p<0.001) and 12 months (p<0.001) in favour of the ESWT Group. At 12 months, a difference of more