Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine.

OBJECTIVE: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow.

DESIGN: Prospective, matched single-blind control trial.

SETTING: University hospital clinic.

PATIENTS: Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head).

INTERVENTIONS: Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm(2) at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months.

MAIN OUTCOME MEASURES: The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion.

RESULTS: Neither group differed statistically before the study, with a poor rating for all patients (p >.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001).

CONCLUSION: ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.