Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior?

  • Babak Vahdatpour 1. Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-3325-0538
  • Parisa Taheri 1. Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
  • Fatemeh Abasi 1. Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0001-5418-5547
Keywords: Extracorporeal Shockwave; Lateral Epicondylitis; Transdermal Drug Delivery


Background: Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. Materials and Methods: In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. Results: Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value0.05). Conclusion: The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences. [GMJ.2020;9:e1791]


Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):43-57.



Taspinar O, Kepekci M, Ozaras N, Aydin T, Guler M. Upper extremity problems in doner kebab masters. J Phys Ther Sci. 2014;26(9):1433-6.


PMid:25276030 PMCid:PMC4175251

Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci. 2015;27(12):3755-8.


PMid:26834345 PMCid:PMC4713784

Tahririan MA, Moayednia A, Momeni A, Yousefi A, Vahdatpour B. A randomized clinical trial on comparison of corticosteroid injection with or without splinting versus saline injection with or without splinting in patients with lateral epicondylitis. J Res Med Sci. 2014;19(9):813.

Lohrer H, Nauck T, Dorn-Lange NV, Schöll J, Vester JC. Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures. Foot Ankle Int. 2010;31(1):1-9.



van der Worp H, Zwerver J, Hamstra M, van den Akker-Scheek I, Diercks RL. No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2026-32.



Lee S, Lee D, Park J. Effects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability. J Phys Ther sci. 2014;26(1):7-10.


PMid:24567665 PMCid:PMC3927045

Yan C, Xiong Y, Chen L, Endo Y, Hu L, Liu M, et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. J Orthop Surg and Res. 2019;14(1):1-12.


PMid:31387611 PMCid:PMC6683364

Speed C, Nichols D, Richards C, Humphreys H, Wies J, Burnet S, et al. Extracorporeal shock wave therapy for lateral epicondylitis-a double blind randomized controlled trial. J Orthop Res. 2002;20(5):895-8.


Menon GK, Kollias N, Doukas AG. Ultrastructural evidence of stratum corneum permeabilization induced by photomechanical waves. J Invest Dermatol. 2003;121(1):104-9.



Prausnitz MR, Langer R. Transdermal drug delivery. Nat Biotechnol. 2008;26(11):1261.


PMid:18997767 PMCid:PMC2700785

Kassan DG, Lynch AM, Stiller MJ. Phys Enhanc of Dermatol Drug Deliv: iontophoresis and phonophoresis. J Am Acad Dermatol. 1996;34(4):657-66.


Dumitru D, Amato AA, Zwarts MJ. Electrodiagnostic medicine: Hanley & Belfus Philadelphia; 2002.


Capan N, Esmaeilzadeh S, Oral A, Basoglu C, Karan A, Sindel D. Radial extracorporeal shock wave therapy is not more effective than placebo in the management of lateral epicondylitis: a double-blind, randomized, placebo-controlled trial. Am J Phys Med & Rehabil. 2016;95(7):495-506.



Overend TJ, Wuori-Fearn JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther. 1999;12(1):31-7.


Vahdatpour B, Mokhtarian A, Raeissadat SA, Dehghan F, Nasr N, Mazaheri M. Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial. Adv Biomed Res. 2018;7.


PMid:29862211 PMCid:PMC5952528

Doukas AG, Kollias N. Transdermal drug delivery with a pressure wave. Adv Drug Deliv Rev. 2004;56(5):559-79.



Vahdatpour B, Sajadieh S, Bateni V, Karami M, Sajjadieh H. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Medi Sci. 2012;17(9):834.

Kodama T, Doukas AG, Hamblin MR. Shock wave-mediated molecular delivery into cells. Biochim Biophys Acta - Mol Cell Res. 2002;1542(1-3):186-94.


Vahdatpour B, Kiyani A, Dehghan F. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome. Adv Biomed Res. 2016;5.


PMid:27563630 PMCid:PMC4976534

Rao R, Nanda S. Sonophoresis: recent advancements and future trends. J Pharm Pharmacol. 2009;61(6):689-705.



Mehra A, Zaman T, Jenkin A. The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis. Surgeon. 2003;1(5):290-2.


Rompe JD, Decking J, Schoellner C, Theis C. Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players. Am J Sports Med. 2004;32(3):734-43.



Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. JBJS. 2005;87(6):1297-304.


Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Europace Med Phys. 2005;41(1):17-25.

Thiele S, Thiele R, Gerdesmeyer L. Lateral epicondylitis: this is still a main indication for extracorporeal shockwave therapy. Int J Surg. 2015;24:165-70.



Wong CW-Y, Ng EY-L, Fung P-W, Mok K-M, Yung PS-H, Chan K-M. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia Pac J Sports Med Arthrosc Rehabi Technol. 2017;7:21-6.


PMid:29264270 PMCid:PMC5721919

Vulpiani MC, Nusca SM, Vetrano M, Ovidi S, Baldini R, Piermattei C, et al. Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study. Muscles Ligaments Tendons J. 2015;5(3):167.


PMid:26605190 PMCid:PMC4617216

Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, et al. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med. 2012;36(5):681.


PMid:23185733 PMCid:PMC3503944

Gündüz R, Malas FÜ, Borman P, Kocaoğlu S, Özçakar L. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clin rheumatol. 2012;31(5):807-12.



Staples MP, Forbes A, Ptasznik R, Gordon J, Buchbinder R. A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol. 2008;35(10):2038-46.

Buchbinder R, Green S, Youd JM, Assendelft WJ, Barnsley L, Smidt N. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. 2005(4).


How to Cite
Vahdatpour, B., Taheri, P., & Abasi, F. (2020). Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior?. Galen Medical Journal, 9, e1791. https://doi.org/10.31661/gmj.v9i0.1791
Original Article