E. Melikyan, X. Yang, M. Beg, L.Bainbridge
Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby, UK
Tennis elbow is a common enthesopathy. Conservative treatment consists of physiotherapy and local steroid injections. Surgery is offered in intractable cases. Extracorporeal shock wave therapy (ESWT) has recently come into consideration for many orthopaedic conditions. A randomised, double blinded study is currently being conducted at the Pulvertaft Hand Centre to research the role of ESWT in tennis elbow. Patients who have already exhausted conservative treatment options and are therefore waiting for surgery are considered for such treatment. The treatment schedule consists of three sessions, each one week apart for both the treatment and control groups. A total energy flux of 1000 mJ/mm2 is administered under ultrasound guidance to the common extensor origin in the treatment group while energy application is prevented in the control group. Patients are assessed at the initial visit, and at one, three, and twelve months post-treatment using grip measurements, visual analogue scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. A pilot study was conducted on a limited number of patients to test and validate our study protocol. Fourteen patients (4 male, 10 female) were initially selected for this purpose and their agreement obtained after giving full information about the nature of the treatment. Two patients were excluded during the initial assessment and three others (1 male, 2 female) subsequently dropped out during later sessions. The treatment was completed in nine patients (2 male, 7 female) aged between 32-50 (mean 43) years. Six out of nine (67%) improved, and three (33%) remained unchanged at three months. The average pain score decreased from 4.4 to 1.2 points on the VAS during the loaded wrist extension test in the former group. Similarly, this group rated the pain perception over the previous week at 1.6 points after the treatment as opposed to 4.3 points before. Grip measurements similarly showed significant change. Grip strength with flexed elbow increased from 2.8 to 3.8 at three months and grip strength with extended elbow increased from 2.3 to 3.5 over a similar period. This group of patients would be reviewed at one year.