title: Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain.
abstract: OBJECTIVE
  To determine the efficacy and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain.
  
  
  METHODS
  Systematic review of randomized controlled trials using Cochrane Collaboration methodology.
  
  
  RESULTS
  Nine placebo-controlled trials (1006 participants) and one trial of ESWT versus steroid injection (93 participants) were included. The 9 placebo-controlled trials reported conflicting results, although 11 of 13 pooled analyses found no significant benefit of ESWT over placebo, e.g., weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks (pooled analysis of 3 trials, 446 participants) was -9.42 (95% CI -20.70 to 1.86). Two pooled results favored ESWT, e.g., relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo (pooled analysis of 2 trials, 192 participants) was 2.2 (95% CI 1.55 to 3.12). However, this finding was not supported by the results of 4 other trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline [21/25 (84%) vs 29/48 (60%); p < 0.05]. Minimal adverse effects of ESWT were reported.
  
  
  CONCLUSIONS
  Based upon systematic review of 9 placebo-controlled trials, there is "platinum" level evidence that ESWT provides little or no benefit in terms of pain and function in lateral elbow pain. There is "silver" level evidence based upon one trial that steroid injection may be more effective than ESWT.
authors.affiliation: Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Australia. rachelle.buchbinder@med.monash.edu.au
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Youd
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Lesley
authors.initials: L
authors.lastname: Barnsley
authors.forename: Nynke
authors.initials: N
authors.lastname: Smidt
mesh_terms: D002986:Clinical Trials as Topic; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D013716:Tennis Elbow / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
chemical_list: D005938:Glucocorticoids