What is Shockwave Therapy for Tennis Elbow (Lateral Epicondylitis)?
Shockwave therapy, also known as Extracorporeal Shockwave Therapy (ESWT), is a non-invasive treatment method used to treat various musculoskeletal conditions, including Tennis Elbow (lateral epicondylitis). Tennis Elbow is characterized by pain and tenderness around the outer part of the elbow, typically caused by overuse of the forearm muscles and tendons. ESWT therapy involves delivering shockwaves (acoustic waves) to the affected area. The waves are created by compressed air which is then applied by the therapist onto the affected area via a handheld device. These shockwaves promote healing by increasing blood flow, stimulating cell regeneration, and reducing pain.
Anatomy
The elbow is a joint made up of three bones: the upper arm bone, the humerus, and the two forearm bones, the radius and ulna. The lower end of the humerus has bony bumps called epicondyles that serve as sites of attachment for major tendons and muscles that help in arm movement. The bump on the outside of the elbow is called the lateral epicondyle. It helps in the attachment of the tendons and muscles that help extend your fingers and wrist.
Indications for Shockwave Therapy for Tennis Elbow (Lateral Epicondylitis)
Shockwave therapy for tennis elbow is typically indicated in the following scenarios:
- Persistent pain in the lateral elbow lasting for more than 6 months despite conservative treatments, such as rest, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), bracing, and corticosteroid injections.
- Lack of significant improvement even after trying conservative treatments.
- Significant impact on daily activities and work due to pain and reduced elbow function (functional impairment).
- The patient desires to avoid more invasive treatments like surgery or long-term medication use.
Contraindications for Shockwave Therapy for Tennis Elbow (Lateral Epicondylitis)
Shockwave therapy is typically contraindicated if you:
- Have bleeding disorders
- Have tumors in the treatment area
- Have active infections or wounds at or near the treatment area
- Have nerve disorders in the treatment area
- Are pregnant
- Are being treated for cancer
- Have metal pins, plates, or prostheses in the treatment area
Preparation for Shockwave Therapy for Tennis Elbow (Lateral Epicondylitis)
Preparation for shockwave therapy for tennis elbow may include the following:
- A review of your medical history with your healthcare provider, including any medications you are taking and any underlying health conditions to determine if the procedure is appropriate for you.
- Your provider will perform a physical examination of your elbow to confirm the diagnosis and assess the severity of your condition.
- In some cases, imaging such as X-rays or MRI may be used to rule out other conditions and to get a detailed view of the elbow structures.
- Your doctor will advise you to stop taking any anti-inflammatory medications such as aspirin or ibuprofen before the treatment as this can interfere with the healing process.
- If you are on blood-thinning medications, your provider may advise you to adjust or temporarily discontinue them to reduce the risk of bleeding or bruising.
- A signed informed consent form will be obtained from you after the pros and cons of the procedure have been explained.
Procedure for Shockwave Therapy for Tennis Elbow (Lateral Epicondylitis)
In general, the procedure for shockwave therapy for tennis elbow may include the following steps:
- The patient is positioned comfortably, usually sitting or lying down with the affected arm supported.
- The area around the elbow is cleaned, and a conductive gel is applied to ensure efficient transmission of shockwaves.
- The healthcare provider palpates the elbow to locate the exact site of pain and tenderness.
- The target area is marked to ensure accurate delivery of shockwaves.
- Shockwaves are then delivered through a hand-held device connected to a control unit.
- The device is moved over the treatment area to deliver compressed air pulses in a systematic manner through the gel.
- The shock waves penetrate the skin of the treatment area to stimulate healing.
- The provider adjusts the settings on the device, including the intensity and frequency of the shockwaves, based on the patient’s condition and tolerance.
- Each session typically lasts between 15 to 20 minutes. Most treatment plans involve 3 to 5 sessions, and the therapy is usually administered once a week.
Post-Treatment Care
In general, post-treatment care may include the following:
- Mild pain or discomfort may be felt after the treatment. The provider may suggest over-the-counter pain relievers if needed.
- If there is swelling or significant discomfort, apply an ice pack to the treated area for 10-15 minutes at a time, several times a day.
- Allow the treated area to rest for a day or two. Avoid any activities that might strain the elbow.
- Gradually reintroduce activities that involve the use of the treated arm, avoiding anything that causes pain.
- Follow-up appointments will be scheduled to monitor progress and adjust the treatment plan if necessary.
Risks and Side Effects
Risks and side effects of shockwave therapy for tennis elbow may include:
- Swelling
- Skin reddening
- Bruising
- Skin damage around the treatment site
Benefits
Shockwave therapy for tennis elbow offers several benefits over traditional treatment methods. These include:
- Non-invasive treatment (no cutting of skin and no introduction of any medical device in the body)
- Promotes natural healing
- Minimal recovery time
