Effectiveness of Radial Extracorporeal Shockwave Therapy on Tennis Elbow

NCT ID: NCT02596659

Last Updated: 2015-11-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-30

Study Completion Date

2015-05-31

Brief Summary

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Background:

Tennis elbow, also known as lateral epicondylitis, is the inflammatory status of insertion site of common extensor tendon to humerus. It is usually related to overuse of local muscle. Radial extracorporeal shock wave therapy (rESWT) is a non-invasive physical treatment. It applies shockwave energy to the lesion site, enhancing the growth of microvascularity, inducing tissue repair, and thus relieving the symptom.

The purpose of this study is to understand the therapeutic effect of rESWT to tennis elbow.

Material and Methods

* Subjects: 30 patients will be recruited from outpatient department of physical medicine and rehabilitation department.
* Duration: 2013.09.01-2015.05.31
* Methods: The patients will be randomly divided into the experimental group and the control group through the draw, with 15 patients in each group. Patients in the experimental group receive rESWT plus routine rehabilitation program. Patients in the control group receive sham shockwave therapy plus routine rehabilitation program.
* Assessment: Before the therapy starts, patients who match the inclusion criteria will be evaluated using tools mentioned below:
* General data: age, sex, body height, body weight, affected side, medical history
* Assess upper extremity function and symptom with Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH)
* Assess severity of pain with Visual Analogue Scale (VAS)
* Assess grip strength with grip strength dynamometer
* Measure the size of tear (if any) of common extensor tendon through ultrasonography, and assess the texture of common extensor tendon through real-time sonoelastography (RTS)

Patients will be followed up 6 weeks, 3months, and 6 months after therapy starts. They will be re-assessed of upper extremity function and symptom, severity of pain, grip strength, and presentation on ultrasonography and RTS.

Detailed Description

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Conditions

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Lateral Epicondylosis Lateral Epicondylitis Tennis Elbow

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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The experimental group

Participants in the experimental group received radial extracorporeal shock wave therapy (rESWT) plus physical therapy for 3 weeks.

Group Type EXPERIMENTAL

Radial extracorporeal shock wave therapy (rESWT)

Intervention Type PROCEDURE

Each participant in the experimental group received rESWT for 3 sessions, consisting of 2000 impulses for each session, and one session per week over 3 weeks (a total of 6000 shock waves were given). The pneumatic pressure was set at the maximum level tolerable for each patient. The frequency of pulses was set at 10 Hz.

Physical therapy

Intervention Type PROCEDURE

The physical therapy program was performed 3 times a week over the same 3 weeks as rESWT, and consisted of 5 minutes of ultrasound diathermy, 15 minutes of transcutaneous electrical nerve stimulation (TENS), and 10 minutes of therapeutic exercise, including wrist common extensor stretching and self-massage.

The control group

Participants in the control group received sham shockwave therapy plus physical therapy for 3 weeks.

Group Type SHAM_COMPARATOR

sham shockwave therapy

Intervention Type PROCEDURE

Sham shockwave therapy were given by the same physiatrist using the same machine as the experimental group, with the same rESWT protocol (3 sessions, 2000 impulses for each session, one session per week over 3 weeks) and the same frequency (10 Hz) of impulses, but the pneumatic pressure was set at 0.1 bar, with a similar sound to the regular rESWT but without actual energy conduction.

Physical therapy

Intervention Type PROCEDURE

The physical therapy program was performed 3 times a week over the same 3 weeks as rESWT, and consisted of 5 minutes of ultrasound diathermy, 15 minutes of transcutaneous electrical nerve stimulation (TENS), and 10 minutes of therapeutic exercise, including wrist common extensor stretching and self-massage.

Interventions

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Radial extracorporeal shock wave therapy (rESWT)

Each participant in the experimental group received rESWT for 3 sessions, consisting of 2000 impulses for each session, and one session per week over 3 weeks (a total of 6000 shock waves were given). The pneumatic pressure was set at the maximum level tolerable for each patient. The frequency of pulses was set at 10 Hz.

Intervention Type PROCEDURE

sham shockwave therapy

Sham shockwave therapy were given by the same physiatrist using the same machine as the experimental group, with the same rESWT protocol (3 sessions, 2000 impulses for each session, one session per week over 3 weeks) and the same frequency (10 Hz) of impulses, but the pneumatic pressure was set at 0.1 bar, with a similar sound to the regular rESWT but without actual energy conduction.

Intervention Type PROCEDURE

Physical therapy

The physical therapy program was performed 3 times a week over the same 3 weeks as rESWT, and consisted of 5 minutes of ultrasound diathermy, 15 minutes of transcutaneous electrical nerve stimulation (TENS), and 10 minutes of therapeutic exercise, including wrist common extensor stretching and self-massage.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Aged \> 18 years old
* Lateral elbow pain lasting \> 3 months
* Pain induced by direct compression on the lateral epicondyle or common extensor tendon, resistant wrist extension and pronation in the elbow extension position, or static stretching of common extensor tendon through the palmer flexion in wrist pronation and elbow extension position

Exclusion Criteria

* Generalized inflammatory arthritis (e.g., rheumatic arthritis)
* Pain at the proximal part of involved arm (e.g., shoulder pain, neck pain)
* Pain other than elbow pain at the involved arm
* Abnormal neurogenic symptom over the involved arm (e.g., radicular pain, hands numbness, hemiplegia)
* Wound or skin lesion at the elbow of the involved arm
* Pregnancy
* Severe local or systemic infection
* Malignancy
* Coagulopathy
* Cardiac pacemaker
* History of surgical treatment at the elbow of the involved arm
* Non-steroid anti-inflammatory drug (NSAID) use orally or topically at the elbow of the involved arm in the past week
* Local steroid injection at the elbow of the involved arm in the past 3 months
* Oral steroid use in the past 6 weeks
* Refusal to sign the informed consent
* Impairment in self-expression (e.g., dementia, aphasia)
* Inability/unwillingness to participate in all the measurements.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Chang Gung Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Tsung-Hsun Yang, MD

Role: PRINCIPAL_INVESTIGATOR

Kaohsiung Chang Cung Memorial Hospital

Locations

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Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital

Kaohsiung City, , Taiwan

Site Status

Countries

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Taiwan

References

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Khoury V, Cardinal E. "Tenomalacia": a new sonographic sign of tendinopathy? Eur Radiol. 2009 Jan;19(1):144-6. doi: 10.1007/s00330-008-1112-9. Epub 2008 Aug 2.

Reference Type BACKGROUND
PMID: 18677489 (View on PubMed)

De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, Klauser AS. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 2009 Jul;193(1):180-5. doi: 10.2214/AJR.08.2020.

Reference Type BACKGROUND
PMID: 19542412 (View on PubMed)

Kwon DR, Park GY, Lee SU, Chung I. Spastic cerebral palsy in children: dynamic sonoelastographic findings of medial gastrocnemius. Radiology. 2012 Jun;263(3):794-801. doi: 10.1148/radiol.12102478. Epub 2012 Apr 10.

Reference Type BACKGROUND
PMID: 22495685 (View on PubMed)

Ahn KS, Kang CH, Hong SJ, Jeong WK. Ultrasound elastography of lateral epicondylosis: clinical feasibility of quantitative elastographic measurements. AJR Am J Roentgenol. 2014 May;202(5):1094-9. doi: 10.2214/AJR.13.11003.

Reference Type BACKGROUND
PMID: 24758665 (View on PubMed)

Speed C. A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med. 2014 Nov;48(21):1538-42. doi: 10.1136/bjsports-2012-091961. Epub 2013 Aug 5.

Reference Type BACKGROUND
PMID: 23918444 (View on PubMed)

Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Eura Medicophys. 2005 Mar;41(1):17-25.

Reference Type BACKGROUND
PMID: 16175767 (View on PubMed)

Ilieva EM, Minchev RM, Petrova NS. Radial shock wave therapy in patients with lateral epicondylitis. Folia Med (Plovdiv). 2012 Jul-Sep;54(3):35-41. doi: 10.2478/v10153-011-0095-5.

Reference Type BACKGROUND
PMID: 23270205 (View on PubMed)

Gunduz R, Malas FU, Borman P, Kocaoglu S, Ozcakar L. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison. Clin Rheumatol. 2012 May;31(5):807-12. doi: 10.1007/s10067-012-1939-y. Epub 2012 Jan 27.

Reference Type BACKGROUND
PMID: 22278162 (View on PubMed)

Other Identifiers

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RESWTonLE201309

Identifier Type: -

Identifier Source: org_study_id

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