Comparative efficacy of extracorporeal shockwave therapy and ultrasound on pain and functional outcomes in lateral epicondylitis: a systematic review and meta-analysis.

BACKGROUND

Lateral epicondylitis (tennis elbow) is a common musculoskeletal condition characterized by lateral elbow pain and functional impairment. While both extracorporeal shockwave therapy (ESWT) and ultrasound therapy are frequently used interventions, their relative effectiveness remains uncertain. This systematic review and meta-analysis aimed to compare the efficacy of ESWT versus ultrasound therapy in improving pain and functional outcomes in patients with lateral epicondylitis through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Searches were conducted across databases including Scopus, Web of Science, PubMed, and Cochrane Central up until August 2024. We selected studies comparing ESWT and ultrasound for lateral epicondylitis. The primary outcome was pain intensity, assessed using the visual analog scale (VAS). The secondary outcome was functional status, evaluated using the patient-rated tennis elbow evaluation (PRTEE) score. The Cochrane Risk of Bias (ROB2) tool was used to assess evidence quality, and data analysis was performed using RevMan 5.4.

RESULTS

Nine RCTs involving 654 participants were included. ESWT demonstrated significantly greater pain reduction than ultrasound (MD =  - 0.90, 95% CI [- 1.28, - 0.52], p < 0.0001). However, there was no statistically significant difference in functional outcomes as measured by PRTEE (MD =  - 5.28, 95% CI [- 10.61, 0.04], p = 0.05). Substantial heterogeneity was noted for both outcomes.

CONCLUSION

ESWT appears more effective than ultrasound therapy in reducing pain in lateral epicondylitis. However, this superiority does not extend to functional improvement. Given the observed heterogeneity and borderline statistical significance in functional outcomes, further high-quality trials are warranted.