Radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow): A double-blinded randomised controlled trial

Background: Investigating outcomes following radial extracorporeal shockwave therapy (rESWT) for patients with chronic lateral elbow tendinopathy (tennis elbow). Methods: 43 patients with chronic lateral elbow tendinopathy were recruited from a single NHS Sport Medicine clinic. Participants were randomised equally within this double-blinded randomised controlled trial to receive either three sessions of 'therapeutic-dose' or 'minimal-dose' rESWT, respectively, alongside a structured and progressive home exercise programme. Participants: 63% female, 70% affecting the dominant arm, mean age 47.9 ± 8.0 years, symptom duration: 31.7 ± 25.4 months. Maximum six-month follow-up, with interim data at six weeks and three months. Results: Improvements were seen in both groups, but no between-group differences were seen with any measure at any time point, suggesting no benefit from 'therapeutic' levels of extracorporeal shockwave therapy (ESWT) above minimal dosage. Self-reported 'average' pain improved by 27% at six weeks, rising to 40% at three months, and 52% at six months, irrespective of ESWT 'dose'. Improvements were seen across different validated patient-reported outcome measures. Conclusion: This study has not shown superiority of rESWT compared to 'minimal-dose' rESWT in patients with chronic lateral elbow tendinopathy (tennis elbow), when performed alongside a structured progressive loading home exercise programme. This study does not support the use of rESWT performed at the 'maximally comfortably tolerated dose' as per manufacturer recommendations. Level of evidence: Level I - Randomised controlled trial.