Pain and Functional Recovery in Lateral Epicondylitis: An Evaluation of ESWT and Ultrasound Therapy

Open Access

Abstract

Background: Lateral epicondylitis is a common degenerative tendinopathy of the elbow that causes pain and functional impairment, particularly in individuals involved in repetitive upper-limb activities. Extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound therapy (UST) are widely used conservative treatment modalities; however, comparative evidence regarding their effectiveness remains limited. Aim of the study: To compare the effectiveness of extracorporeal shock wave therapy and therapeutic ultrasound therapy on pain reduction and functional recovery in patients with lateral epicondylitis. Methods & Materials: This prospective comparative interventional study was conducted at the Department of Physical Medicine and Rehabilitation, Dhaka Medical College Hospital, from June 2019 to May 2020. Sixty patients with clinically diagnosed lateral epicondylitis were allocated into two groups: ESWT (n = 30) and UST (n = 30). Both groups received their respective modalities along with NSAIDs, activity-of-daily-living advice, and therapeutic exercises for three weeks. Pain intensity was assessed using the Visual Analog Scale (VAS) at rest and during resisted wrist extension (RWE). Functional recovery was evaluated using hand grip strength and the Patient-Rated Tennis Elbow Evaluation (PRTEE) score. Outcomes were assessed at baseline and at the fourth follow-up. Result: Both ESWT and UST groups demonstrated statistically significant improvements in pain and functional outcomes. VAS scores at rest and during RWE significantly decreased in both groups by the fourth follow-up (p ≤ 0.001). Grip strength significantly improved, and PRTEE scores markedly decreased in both groups (p < 0.001). Although improvements were observed in both modalities, the UST group showed slightly greater reductions in pain during resisted wrist extension and marginally better functional outcomes; however, these differences were not consistently statistically significant. Treatment adherence, patient satisfaction, and recurrence rates were comparable between groups. Conclusion: Both extracorporeal shock wave therapy and therapeutic ultrasound therapy are effective, safe, and well-tolerated treatment options for reducing pain and improving functional outcomes in patients with lateral epicondylitis. Therapeutic ultrasound demonstrated slightly better short-term pain relief and functional recovery, though both modalities can be recommended as part of conservative management.