Role of Physical Modalities in Chronic Lateral Epicondylitis: A Comparative Perspective

Open Access

Abstract

Background: Chronic lateral epicondylitis is a common musculoskeletal disorder that leads to persistent elbow pain and functional limitation, significantly affecting daily activities and work productivity. Physical modalities such as extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound are widely used, yet comparative evidence regarding their relative efficacy remains limited, particularly in low- and middle-income settings. Aim of the study: To compare the effectiveness of focused extracorporeal shock wave therapy and conventional therapeutic ultrasound in reducing pain and improving functional outcomes in patients with chronic lateral epicondylitis. Methods & Materials: This prospective comparative study was conducted at the Outpatient Department of Physical Medicine and Rehabilitation, Dhaka Medical College Hospital, Bangladesh, between June 2019 and May 2020. Sixty patients with clinically diagnosed chronic lateral epicondylitis were enrolled and allocated into two treatment groups: ESWT (n = 30) and therapeutic ultrasound (n = 30). ESWT was administered using focused shock waves, while the ultrasound group received pulsed therapeutic ultrasound, both delivered three times weekly for four weeks. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at baseline, 4 weeks, and 8 weeks. Statistical analyses included between-group and within-group comparisons using appropriate parametric or non-parametric tests, with effect sizes calculated using Cohen's d. Result: Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). Both interventions resulted in significant improvements in pain and function over time (p < 0.001). However, the ESWT group demonstrated significantly greater reductions in VAS scores at 4 weeks (mean difference −0.70, p = 0.01) and 8 weeks (mean difference −1.10, p < 0.001), with moderate to large effect sizes. Similarly, functional improvement measured by PRTEE was significantly greater in the ESWT group at 4 weeks (mean difference −6.30, p = 0.004) and 8 weeks (mean difference −8.40, p < 0.001). A higher proportion of patients in the ESWT group achieved minimal clinically important differences for both pain and function. Adverse events were mild and comparable between groups, while patient satisfaction was significantly higher in the ESWT group (80.0% vs. 60.0%, p = 0.04). Conclusion: Focused extracorporeal shock wave therapy is more effective than therapeutic ultrasound in reducing pain and improving functional outcomes in patients with chronic lateral epicondylitis. ESWT appears to be a safe, well-tolerated, and clinically superior physical modality and may be considered a preferred treatment option in the conservative management of this condition.