Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis

Abstract

Objective: To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. Data Sources: MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. Review methods: We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. Results: Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: −1.21, 95% confidence interval:−1.53, −0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: −1.54, 95% confidence interval: −2.60, −0.48, P = 0.005). Conclusion: Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively. Level of Evidence: Therapy, level 1a.

Efficacy of Osteopathic Manipulative Treatment (OMT) Vs Physiotherapy in Chronic Lateral Epicondylitis

“…Finally, ultrasound has not shown to be more effective than placebo in terms of decrease in pain and general improvement perceived by the patient. Similarly, shock waves were no more effective than placebo or other therapies [22,23]. Orthosis does not seem to be effective while dry needling is more effective than placebo and short-term ultrasounds [11,24].…”

"Radial Extracorporeal Shockwave Therapy and A Supervised Exercise Programme in Patients with Lateral Elbow Tendinopathy? A Research Protocol"

“…One such modality is RESWT which is a relatively new treatment approach, but it is reported to be used by clinicians worldwide [45]. Karanasios et al [46] found in their systematic review that ESWT (radial and focused) offers no benefit in the management of LET patients. On the other hand, two published meta-analyses in 2020 [47,48] reported superior outcomes of the ESWT (radial and focused) compared with sham or other passive treatments in pain reduction and function improvement.…”

Exercise-Based Interventions Are Effective in the Management of Patients with Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…The current tool is a valid and reliable tool for evaluating the quality of a study and includes a score from 0 to 10 [11,12]. For a PEDro score ≤ 4, the methodological quality was considered 'poor', for scores of 5 or 6 'moderate' and for scores ≥ 7 'high' [11,13]. Any disagreements were discussed in a consensus meeting including a third reviewer (GG).…”

“…Initially, the evidence was rated for each comparison as 'high certainty' and was downgraded for any of the previous reasons [10]. In comparison, including one trial, the evidence was graded as low certainty, and if this study was evaluated with low-quality evidence, it was graded as very low certainty [13,15].…”