ESWT vs Cryo-US Therapy in the Treatment of Chronic Lateral Epicondylitis: One Year Follow up Study

Extracorporeal Shock Wave Therapy vs Cryoultrasound Therapy in the Treatment of Chronic Lateral Epicondylitis: One Year Follow up Study

Chronic lateral epicondylitis is usually managed conservatively. The purpose of this single-blinded, randomized, controlled study is to compare the clinical therapeutic effects of extracorporeal shock wave therapy (ESWT) in comparison with cryoultrasound (Cryo-US) therapy in chronic lateral epicondylitis (LE) during a period of 12 months.

Eighty participants with chronic LE were randomly assigned to receive 3 ESWT sessions at 48/72-hours intervals -2400 impulses at energy flux density 0.14-0.20 mJ/mm2 at each session- (ESWT Group, n=40) or 12 Cryo-US therapy sessions (4 daily sessions per week) in a continuous modality at 1.8 Watt/cm2 and -2˚C at each session- (Cryo-US Group, n=40). Visual Analogue Scale (VAS) and satisfactory results, considered as the sum of the 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.

Inclusion Criteria:

• an age range from 18 to 75 years
• clinical or instrumental diagnosis of chronic lateral epicondylitis, present for at least three months
• intensity of pain of more than 5 on the Visual Analogue Scale (VAS) performing a maximum voluntary resisted isometric wrist extension with the elbow in extension (Cozen test)
• the failure of conservative treatments previously made
• a wash-out period of at least 12 weeks since the last conservative therapy carried out before inclusion in the study
• capability of filling in the questionnaires and signing the consent form

Exclusion Criteria:

• Previous treatment with Cryo-US, ultrasound therapy, ESWT
• The conjoint presence of bilateral or lateral and medial epicondylitis
• Acute infection of the soft tissues or the bones adjacent to the area of treatment
• Local bleedings or skin lesions, pathologies of the blood coagulation, or use of anticoagulant drugs
• Pacemaker, pregnancy
• Neoplastic disease
• Raynaud's disease, altered thermal and pain sensitivity, or cold intolerance
• Evidence of elbow bursitis, or articular or synovial pathologies; signs of elbow laxity or instability
• Cervicobrachialgia; syndrome of ulnar, radial, or posterior interosseous nerve entrapment