Lateral Epicondylitis: General Concepts and Shock Wave Treatment Evidence

Review Article | Volume 3 | Issue 1 | JRS Jun – June 2023 | Page 32-34 | Ricardo Kobayashi.
DOI: 10.13107/jrs.2023.v03.i01.81

Author: Ricardo Kobayashi [1]

[1] Pain Center, University of S£o Paulo, S£o Paulo, Brazil.

Address of Correspondence
Dr. Ricardo Kobayashi, MD, Phd,
Pain Center, University of S£o Paulo, S£o Paulo, Brazil.
E-mail: institutokobayashi@gmail.com

Abstract

Introduction:Lateral epicondylitis (LE) is one of the most common tendinopathies of the upper extremity characterized by lateral elbow pain, seriously affecting patients’ daily life and work.
Pathophysiology: Anatomically, the common extensor insertion on the lateral epicondyle of the humerus, mostly the extensor carpi radial is brevis tendon insertion, undergoes microtearing associated with a chronic repair process, but hardly any inflammation. The pathoanatomy of overuse tendinopathy is non-inflammatory angiofibroblastic tendinosis. For this reason, the term ‘‘tendinitis’’ is avoided, and ‘‘tendinosis’’ is preferred.
Diagnosis: LE is primarily a clinical diagnosis. The natural history is a gradual onset of pain in the absence of defined trauma. The most
common findings on physical examination are tenderness at the lateral epicondyle of the distal humerus and weakness or pain with resisted wrist extension (the Thomsen test).
Treatment: Non-surgical options are the mainstream treatment for LE, a small proportion of patients eventually undergoes surgery, although surgery for LE is no more effective than non-surgical treatment, based on evidence. Non-operative treatments including rest, application of ice, administration of analgesic medications, orthopedic devices, ultrasound, transcutaneous electrical nerve stimulation, eccentric training, and extracorporeal shock wave therapy (ESWT).
Shockwave Treatment of LE: There are many therapeutic options for treating LE. The existing evidence does not clearly support the efficacy of any of the available treatment methods for this clinical condition. ESWT is not the exception, although it was approved by the U.S. Food and Drug Administration for treating this disease in 2002 and much of the current evidence supports its indication for LE..

Keywords: Lateral epicondylitis, Tennis elbow, Tendinopathy, Shock waves.

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