Ann Rehabil Med.  2016 Apr;40(2):294-300. 10.5535/arm.2016.40.2.294.

Comparison of Therapeutic Effect of Extracorporeal Shock Wave in Calcific Versus Noncalcific Lateral Epicondylopathy

Affiliations
  • 1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. guitarren.kim@samsung.com

Abstract


OBJECTIVE
To assess the therapeutic effect of extracorporeal shock wave therapy (ESWT) in lateral epicondylopathy with calcification, and compare it to the effect of ESWT in lateral epicondylopathy without calcification.
METHODS
A retrospective study was conducted. Forty-three patients (19 with calcific and 24 with noncalcific lateral epicondylopathy in ultrasound imaging) were included. Clinical evaluations included the 100-point score, Nirschl Pain Phase scale before and after ESWT, and Roles and Maudsley (R&M) scores after ESWT. ESWT (2,000 impulses and 0.06-0.12 mJ/mm2) was performed once a week for 4 weeks.
RESULTS
The 100-point score and Nirschl Pain Phase scale changed significantly over time (p<0.001), but there was no significant difference between groups (p=0.555). The R&M scores at 3 and 6 months after ESWT were not significantly different between groups. In the presence of a tendon tear, those in the calcific lateral epicondylopathy group showed poor improvement of 100-point scores compared to the noncalcific group (p=0.004).
CONCLUSION
This study demonstrated that the therapeutic effect of ESWT in calcific lateral epicondylopathy was not significantly different from that in noncalcific lateral epicondylopathy. When a tendon tear is present, patients with calcific lateral epicondylopathy might show poor prognosis after ESWT relative to patients with noncalcific lateral epicondylopathy.

Keyword

Epicondylitis; Extracorporeal shockwave

MeSH Terms

Humans
Prognosis
Retrospective Studies
Shock*
Tears
Tendons
Ultrasonography

Figure

  • Fig. 1 The temporal changes in the 100-point scores (A) and Nirschl Pain Phase scale (B) in the calcific and noncalcific lateral epicondylopathy groups were presented. Error bars represent one standard error. The 100-point scores and Nirschl Pain Phase scale in the calcific and noncalcific groups changed significantly over time, but did not show any difference between groups.

  • Fig. 2 Roles and Maudsley scores in the calcific and noncalcific groups at 3 and 6 months after extracorporeal shock wave therapy were presented. The Roles and Maudsley scores at 3 and 6 months were not significantly different between groups.

  • Fig. 3 The temporal changes in the 100-point scores were analyzed according to the ultrasound findings: (A) hypoechogenicity, (B) no hypoechogenicity, (C) tendon tear, and (D) no tendon tear. Patients of the calcific and noncalcific lateral epicondylopathy groups who had a tendon tear showed a difference in temporal changes in the 100-point score and the calcific group showed poor improvement of 100-point scores compared to the noncalcific group.


Reference

1. Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med. 2013; 126:357.e1–357.e6. PMID: 23398951.
Article
2. Mishra A, Collado H, Fredericson M. Platelet-rich plasma compared with corticosteroid injection for chronic lateral elbow tendinosis. PM R. 2009; 1:366–370. PMID: 19627920.
Article
3. Connell D, Datir A, Alyas F, Curtis M. Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. Br J Sports Med. 2009; 43:293–298. PMID: 19224912.
Article
4. Struijs PA, Spruyt M, Assendelft WJ, van Dijk CN. The predictive value of diagnostic sonography for the effectiveness of conservative treatment of tennis elbow. AJR Am J Roentgenol. 2005; 185:1113–1118. PMID: 16247118.
Article
5. Vicenzino B, Smith D, Cleland J, Bisset L. Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia. Man Ther. 2009; 14:550–554. PMID: 18838330.
Article
6. Foldager CB, Kearney C, Spector M. Clinical application of extracorporeal shock wave therapy in orthopedics: focused versus unfocused shock waves. Ultrasound Med Biol. 2012; 38:1673–1680. PMID: 22920552.
7. Mouzopoulos G, Stamatakos M, Mouzopoulos D, Tzurbakis M. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review. Skeletal Radiol. 2007; 36:803–811. PMID: 17415561.
Article
8. Vetrano M, d'Alessandro F, Torrisi MR, Ferretti A, Vulpiani MC, Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surg Sports Traumatol Arthrosc. 2011; 19:2159–2168. PMID: 21617986.
Article
9. Speed C. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med. 2014; 48:1538–1542. PMID: 23918444.
10. Melikyan EY, Shahin E, Miles J, Bainbridge LC. Extracorporeal shock-wave treatment for tennis elbow: a randomised double-blind study. J Bone Joint Surg Br. 2003; 85:852–855. PMID: 12931804.
11. Speed CA, Nichols D, Richards C, Humphreys H, Wies JT, Burnet S, et al. Extracorporeal shock wave therapy for lateral epicondylitis: a double blind randomised controlled trial. J Orthop Res. 2002; 20:895–898. PMID: 12382950.
12. Peters J, Luboldt W, Schwarz W, Jacobi V, Herzog C, Vogl TJ. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Skeletal Radiol. 2004; 33:712–718. PMID: 15480643.
Article
13. Chard MD, Cawston TE, Riley GP, Gresham GA, Hazleman BL. Rotator cuffdegeneration and lateral epicondylitis: a comparative histological study. Ann Rheum Dis. 1994; 53:30–34. PMID: 8311552.
14. Wang CJ, Chen HS. Shock wave therapy for patients with lateral epicondylitis of the elbow: a one- to two-year follow-up study. Am J Sports Med. 2002; 30:422–425. PMID: 12016085.
15. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Orthop Surg. 2009; 1:123–127. PMID: 19885046.
Article
16. Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992; 11:851–870. PMID: 1423702.
Article
17. Clarke AW, Ahmad M, Curtis M, Connell DA. Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. Am J Sports Med. 2010; 38:1209–1214. PMID: 20335508.
18. Al-Abbad H, Simon JV. The effectiveness of extracorporeal shock wave therapy on chronic Achilles tendinopathy: a systematic review. Foot Ankle Int. 2013; 34:33–41. PMID: 23386759.
19. Han SH, Lee JW, Guyton GP, Parks BG, Courneya JP, Schon LC. J.Leonard Goldner Award 2008. Effect of extracorporeal shock wave therapy on cultured tenocytes. Foot Ankle Int. 2009; 30:93–98. PMID: 19254500.
20. Carcia CR, Scibek JS. Causation and management of calcific tendonitis and periarthritis. Curr Opin Rheumatol. 2013; 25:204–209. PMID: 23370373.
Article
21. Harniman E, Carette S, Kennedy C, Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004; 17:132–151. PMID: 15162101.
Article
22. Haake M, Deike B, Thon A, Schmitt J. Value of exact focusing of extracorporeal shock waves (ESWT) in therapy of tendinitis calcarea: a prospective randomized study. Biomed Tech (Berl). 2001; 46:69–74. PMID: 11324149.
23. Hashimoto T, Nobuhara K, Hamada T. Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res. 2003; 415:111–120. PMID: 14612637.
Article
24. Galliani I, Columbaro M, Ferri S, Valmori A, Cassiani G, Falcieri E. A case of calcific lateral epicondylitis: a histological and ultrastructural study. Br J Rheumatol. 1998; 37:235–236. PMID: 9569087.
Article
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