Lateral Epicondylitis (Tennis Elbow)
Conditions
Keywords
Trigger Point, Extensor Carpi Radialis Brevis, Common Extensor Tendon, Ultrasonography
Brief summary
This randomized controlled study evaluates the effect of extracorporeal shock wave therapy applied to the extensor carpi radialis brevis trigger point in patients with lateral epicondylitis. Participants receive active extracorporeal shock wave therapy to the lateral epicondyle region. In addition, one group receives active extracorporeal shock wave therapy to the extensor carpi radialis brevis trigger point, while the other group receives sham extracorporeal shock wave therapy to the trigger point. Pain, grip strength, hand function, and common extensor tendon thickness are assessed before treatment and at week 4.
Detailed description
Lateral epicondylitis is a common tendinopathic condition characterized by pain over the lateral elbow, reduced grip strength, and limitation in upper extremity function. The extensor carpi radialis brevis tendon and the common extensor tendon origin are frequently involved. Myofascial trigger points in the extensor carpi radialis brevis muscle may also contribute to pain and functional impairment. This prospective randomized controlled single-blind study investigates whether extracorporeal shock wave therapy applied to the extensor carpi radialis brevis trigger point provides additional clinical and ultrasonographic benefit in patients with lateral epicondylitis. Participants are allocated to two parallel groups. Both groups receive active extracorporeal shock wave therapy to the lateral epicondyle region once weekly for three sessions. The intervention group also receives active extracorporeal shock wave therapy to one trigger point in the extensor carpi radialis brevis muscle. The comparator group receives sham extracorporeal shock wave therapy to the same trigger point area. Outcome assessments are performed at baseline and at week 4. Pain intensity is assessed using the Visual Analog Scale. Grip strength is measured with a Jamar hand dynamometer. Hand function is assessed using the Duruöz Hand Index. Common extensor tendon thickness is measured by ultrasonography. The primary aim is to determine whether active trigger point extracorporeal shock wave therapy provides additional improvement compared with sham trigger point application when both groups receive active treatment to the lateral epicondyle region.
Interventions
DEVICEExtracorporeal Shock Wave Therapy
Active extracorporeal shock wave therapy is applied to the lateral epicondyle region in both groups once weekly for three sessions. In the experimental group, active extracorporeal shock wave therapy is also applied to one trigger point in the extensor carpi radialis brevis muscle.
Sham extracorporeal shock wave therapy is applied to one trigger point in the extensor carpi radialis brevis muscle using a sham applicator that produces a similar sound but does not deliver therapeutic shock wave energy.
Sponsors
Gazi University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants were blinded to whether the trigger point extracorporeal shock wave therapy application was active or sham. The care provider administering the intervention was not blinded.
Intervention model description
Participants are randomized into two parallel groups. Both groups receive active extracorporeal shock wave therapy to the lateral epicondyle region. One group receives active extracorporeal shock wave therapy to the extensor carpi radialis brevis trigger point, while the other group receives sham extracorporeal shock wave therapy to the same trigger point area.
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 50 years * Clinical diagnosis of lateral epicondylitis * Tenderness over the lateral epicondyle * Presence of trigger point in the extensor carpi radialis brevis muscle * Ability to provide written informed consent
Exclusion criteria
* Peripheral nerve disease involving the ulnar, median, or radial nerve * Other elbow pathologies such as instability, arthritis, or dermatologic lesions * Radicular pain * Previous elbow surgery * Platelet-rich plasma injection, stem cell injection, corticosteroid injection, or extracorporeal shock wave therapy to the affected elbow within the previous month * Presence of a pacemaker * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Common Extensor Tendon Thickness | Baseline and week 4 | Common extensor tendon thickness is measured by ultrasonography using a linear probe with the elbow flexed at 90 degrees and the forearm in mid-supination. Measurements are performed on a longitudinal image at the lateral epicondyle region, perpendicular to the tendon fibers. The change from baseline to week 4 is evaluated |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain Intensity Assessed by Visual Analog Scale | Baseline and week 4 | Pain intensity is assessed using a 10-cm Visual Analog Scale. A score of 0 indicates no pain and a score of 10 indicates the worst pain. |
| Change in Grip Strength | Baseline and week 4 | Grip strength is measured using a Jamar hand dynamometer. Measurements are performed with the participant seated, the shoulder adducted, the elbow flexed at 90 degrees, the forearm in neutral position, and the wrist in neutral position. Three consecutive measurements are obtained from the affected side, and the mean value is used for analysis. The change from baseline to week 4 is evaluated. |
| Change in Functional Disability Assessed by the Duruöz Hand Index | Baseline and week 4 | functional disability is assessed using the Duruöz Hand Index. The scale includes 18 items evaluating difficulties in daily activities involving hand use. Total scores range from 0 to 90, with higher scores indicating greater disability. The change from baseline to week 4 is evaluated. |
Countries
Turkey (Türkiye)
Outcome results
None listed