Can Extracorporeal Shockwave Therapy Treat Lateral Epicondylitis?


Many different groups of people suffer from lateral epicondylitis. It often affects middle-aged individuals who are under 50 years old. Dentists, violin players, typists and tennis enthusiasts frequently develop the condition. People who play tennis recreationally experience it more frequently than professionals. Some patients suffer from this health problem after using computer mice or performing housework for long periods of time.

Treatment Options

Doctors offer a wide range of remedies, and the solutions include highly sophisticated therapies. The problem is that conventional treatments often fail to deliver lasting results. After receiving medical attention for 90 days, many people have yet to see any major improvements. Some physicians are embracing new therapies to achieve better outcomes.

History of ESWT

Doctors began to employ extracprporeal shockwave therapy over 35 years ago. They used it to break kidney stones into smaller fragments. Medical experts in Germany soon found orthopedic purposes for the technology. It made significant advancements in the years leading up to 1991. After another decade, physicians started using it to treat musculoskeletal problems like lateral epicondylitis.

A Recent Study

Medical professionals in Romania wanted to determine if ESWT could successfully treat people with this condition. They performed a study that lasted 35 days. It only involved people who had reached 40 to 50 years of age. Researchers published the results in a University of Bacau publication during the summer of 2014.

Study Participants

Forty-three people took part in this clinical trial. They included women and men in a variety of occupations. All participants received conventional health treatments in the years prior to the study. None of these remedies had succeeded in curing them or reducing the amount of pain that they experienced.

  • Both genders, various careers and hobbies
  • Had previously undergone ineffective treatments
  • Researchers treated and monitored 43 patients

Treatment Method

Each patient underwent a total of 10 shockwave therapy sessions, and the treatments occurred twice weekly. Researchers used the powerful BTL-5000 system. To gauge the results, they examined people before and after the five-week period. Study participants reported their discomfort levels during these examinations. The patients also told doctors about the intensity of the pain that they experienced while performing normal everyday tasks.

Measuring Pain

It’s not always easy for physicians to assess discomfort levels. Some people can tolerate more pain than others. This study used a well-accepted rating system known as the Visual Analog Scale. It helps patients precisely report how much discomfort they feel. Researchers compared the VAS ratings collected before and after treatment. Most study participants experienced less discomfort after receiving shockwave therapy for 35 days.

  • Patients reported their pain levels
  • Discomfort greatly reduced after treatment
  • Results were compiled after 10 sessions

Patients generally reported substantial reductions in discomfort, and some individuals even found that pain came to an end. The researchers determined that ESWT offers an effective treatment option for lateral epicondylitis patients. However, this study only confirmed its ability to benefit middle-aged people who have received unsuccessful standard treatments in the past.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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