Comparison of local massage, steroid injection, and extracorporeal shock wave therapy efficacy in the treatment of lateral epicondylitis

Abstract

Objectives: This study aimed to compare the clinical outcomes of patients with lateral epicondylitis (LE) treated with local massage, corticosteroid (CS) injection, and extracorporeal shock wave therapy (ESWT).

Patients and methods: This randomized prospective study included 52 patients. Patients treated with local massage in Group 1 (n=17; 9 males, 8 females; mean age: 46.1±10.9 years; range, 27 to 64 years), CS injection in Group 2 (n=17; 7 males, 10 females; mean age: 46.0±8.8 years; range, 28 to 63 years), and ESWT in Group 3 (n=18; 12 males, 6 females; mean age: 46.7±11.3 years; range, 28 to 68 years) for LE were evaluated between March 2021 and June 2022. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and DASH-Work Model (DASH-WM) scoring systems at the initial examination at the beginning of the study and at two-week, three-month, and six-month follow-up controls.

Results: Similar results were observed between VAS, DASH, and DASH-WM scores measured during LE diagnosis. In the first two weeks of follow-up, statistically significant decreases were observed in VAS, DASH, and DASH-WM scores in all three groups. Compared to baseline values, Group 1 and 2 had significant difference in VAS and DASH scores at three months. Group 3 had a significant difference in all clinical evaluation scores. At six months, no significant difference was observed in Groups 1 and 2 in any of the scoring systems, while Group 3 showed significant improvements in all scoring systems.

Conclusion: Treatment with ESWT was superior to other treatments throughout the study and at the final follow-up. In patients receiving CS injections, the clinical outcomes worsened with time, evidenced by the six-month follow-up. Further studies on combined treatment modalities are needed on this subject.

Figure 1. Flowchart of the patients diagnosed with LE receiving local massage therapy, CS injection, and ESWT.: LE: Lateral epicondylitis; CS: Corticosteroid; ESWT: Extracorporeal shock wave therapy

Figure 2. The VAS scores of Groups 1, 2, and 3.: VAS: Visual Analog Scale; CS Inj: Corticosteroid injections; ESWT: Extracorporeal shock wave therapy

Figure 3. The DASH scores of Groups 1, 2, and 3.: DASH: Disabilities of the Arm, Shoulder, and Hand; CS Inj: Corticosteroid injections; ESWT: Extracorporeal shock wave therapy.

Figure 4. The DASH-WM scores of Groups 1, 2, and 3.: DASH-WM: Disabilities of the arm, shoulder, and hand-work model; CS Inj: Corticosteroid injections; ESWT: Extracorporeal shock wave therapy.

Figure 5. Patients switching treatment.: ESWT: Extracorporeal shock wave therapy; CS: Corticosteroid.

Figure 6. The VAS, DASH, and DASH-WM scores of patients removed from the groups.: VAS: Visual Analog Scale; DASH: Disabilities of the Arm, Shoulder, and Hand; DASH-WM: Disabilities of the arm, shoulder, and hand-work model.