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.