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Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain

PainSci » bibliography » Buchbinder et al 2006
Tags: treatment, devices, tendinosis, elbow, pain problems, overuse injury, injury, arm, limbs

Two articles on PainSci cite Buchbinder 2006: 1. Tennis Elbow Guide2. Does Ultrasound Therapy Work?

PainSci commentary on Buchbinder 2006: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This biggish review of nine studies produced “platinum” level (better than gold!) evidence that “ESWT provides little or no benefit in terms of pain and function in lateral elbow pain.” That’s right: platinumly but negative. According to the best data available in 2006, as reviewed here, ESWT does not appear to work for tennis elbow. •sad trombone•

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To determine the efficacy and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain.

METHODS: Systematic review of randomized controlled trials using Cochrane Collaboration methodology.

RESULTS: Nine placebo-controlled trials (1006 participants) and one trial of ESWT versus steroid injection (93 participants) were included. The 9 placebo-controlled trials reported conflicting results, although 11 of 13 pooled analyses found no significant benefit of ESWT over placebo, e.g., weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks (pooled analysis of 3 trials, 446 participants) was -9.42 (95% CI -20.70 to 1.86). Two pooled results favored ESWT, e.g., relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo (pooled analysis of 2 trials, 192 participants) was 2.2 (95% CI 1.55 to 3.12). However, this finding was not supported by the results of 4 other trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline [21/25 (84%) vs 29/48 (60%); p < 0.05]. Minimal adverse effects of ESWT were reported.

CONCLUSION: Based upon systematic review of 9 placebo-controlled trials, there is "platinum" level evidence that ESWT provides little or no benefit in terms of pain and function in lateral elbow pain. There is "silver" level evidence based upon one trial that steroid injection may be more effective than ESWT.

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