Piezoelectric Shockwave Therapy in Management Lateral
Epicondylitis of the Elbow
Ayman Elwey Balabel, Eman Mohammed Alkhalfan, Amani Ahmed Yaccob
Institution: Ahmadi Hospital, Kuwait
Device and producing company: Piezoson 300
Introduction: Tennis elbow is the common term used to describe the pain of un defined
pathology over the common extensor origin at the lateral aspect of the elbow and that
interferes with the activities of daily living, computer use, sport and at workplace .
treatment for each case remains controversial and is based on the professional
judgment of the health care provider. Tennis elbow is usually easily diagnosed by a
physical examination. Up to 90% of cases can be remedied by nonsurgical treatments,
non-steroidal anti-inflammatory medications, physiotherapy modalities in form of cold
packs, and ultrasound additionally eccentric exercises program and elbow support
brace, lastly is steroid, symptoms usually diminish within four to six weeks with
appropriate treatment. Surgical treatment is necessary in 5 % of patients in case of
failure to conservative line and still persist. The outcome of surgical treatment is not
satisfactory.
Methods: Retrospective study including 20 patients with tennis elbow, ages 30- 55
years old, with a pain VAS rating of 8-9, with pain in daily living activities and sometime
at rest, they were clinically diagnosed as lateral epiconylitis elbow. Painful elbow present
for a minimum of 3- 5 months, pregnancy, infectious or tumorous diseases were
excluded. We performed the treatment as an outpatient procedure without anesthesia
our protocol at least 3and maximum 5 Focused ESWT sessions every two weeks, with a
3000 pulses, energy level of 0,15 – 0,20 mJ/mm². All patients had been advised to start
stretching exercise and eccentric loading exercises after 4 weeks after last treatment.
Patients were advised to continue exercises for 12 weeks.
Results: We followed patients after 5-6 month, and found that 16 patients showed 80%
patients were free from pain, significantly better 10%, 2 patients, Pain had been reduced
to VAS 2-3 and range of motion had significantly improved. 5 % of our patients were
slightly better and 5 % no changes. Mean pain score before treatment was 8.78 ± 0.65
and after we recorded 4.35 ± 1.40. ROM changed from 27.50 ± 7.26 to 78.25 ± 10.11
with a highly significant P-value > 0.001.
Discussion: Focused piezoelectric Shock wave therapy produces significant relief of
pain, improves ROM in tennis elbow and decrease physical incapacity produced by
tennis elbow.
Conclusion: FESWT treatments should be considered as line of treatment in elbow
epicondylities, it is very effective, noninvasive, and safe procedure with no complications
