Ultrasonographic Features of the Tennis Elbow: Which Is More Responsive for Extracorporeal Shock Wave Therapy?

Abstract

Objectives: To determine which ultrasonographic [US] features of epicondylitic lesions are more treatable using extracorporeal shock wave therapy [ESWT]. Methods: Thirty patients [9 men and 21 women; mean age 47.8 years] with chronic lateral epicondylitis lasting at least 12 months were included. They were diagnosed and classified by US into three groups: simple tendinosis, tendinosis with calcification, and tendinosis with tear. Each patient was treated with low-energy ESWT for three to four sessions of 2000 shocks. Clinical evaluations [the 100-point scoring system and the Nirschl score] to evaluate symptomatic or functional improvement were performed before, three, and six months after treatment. Success rates were measured three and six months after treatment using the Roles and Maudsley score. Follow-up US was performed three months after treatment. Results: Lesions with calcifications showed only 33.3 percent [4 of 12 patients] of improvement after treatment on follow-up US, which was much lower than other two groups with 73 percent [8 of 11 patients with simple tendinosis] and 71 percent [five of seven patients with tear] of US improvement, but there was no significant difference among results of clinical evaluations of three groups. The overall success rate six months after treatment was 63.3 percent, but patients classified as having tendinosis with tear showed a significantly lower success rate [14.3 percent, P = 0.008]. Conclusions: ESWT is effective for chronic lateral epicondylitis, especially lesions with simple tendinosis or soft tissue calcification detectable on US. In addition, US has value as a predictor for ESWT outcomes.