Tennis elbow or lateral epicondylalgia is a common overuse injury in the upper extremity. Initially believed to be an inflammatory process or tendinitis newer research has instead found a degenerative process consistent with cellular turnover (remodeling) in tendon where the muscles of the wrist and fingers attach into the arm. Current Physical Therapy best practice includes patient education on activity modification to match a patient’s current activity to their elbow’s tissue tolerance, as well as, strengthening exercises to promote remodeling and tensile strength in the injured tendon. In addition, a steroid injection by a physician has also been shown to help some patients in the early phases of recovery. Other clinician have promoted the use of extracorporeal shockwave therapy, but a recent review of the literature describes the limitations of this modality.
The journal Clinical Rehabilitation recently published a systematic review and meta analysis of the available research behind the use of extracorporeal shockwave therapy on patient’s with elbow pain (Karanasios et al. 2021). Authors included 27 studies with over 1800 patients and described the effectiveness of this modality. They concluded “there are no clinical benefits of extracorporeal shockwave therapy compared to sham (placebo) interventions or corticosteroid injections”. Surprisingly despite this conclusion this modality out performed other low benefit modalities such as ultrasound and laser. Based on the results of this study patients are encouraged to pursue interventions with greater clinical effectiveness such as activity modification, manual therapy, and exercise.
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