Intervention Review

Shock wave therapy for lateral elbow pain

  1. Rachelle Buchbinder1,*,
  2. Sally Green2,
  3. Joanne M Youd3,
  4. Willem JJ Assendelft4,
  5. Les Barnsley5,
  6. Nynke Smidt6

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 14 JUL 2005

DOI: 10.1002/14651858.CD003524.pub2

How to Cite

Buchbinder R, Green S, Youd JM, Assendelft WJJ, Barnsley L, Smidt N. Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003524. DOI: 10.1002/14651858.CD003524.pub2.

Author Information

  1. 1

    Department of Epidemiology and Preventive Medicine, Monash University, Monash Department of Clinical Epidemiology at Cabrini Hospital, Malvern, Victoria, Australia

  2. 2

    Monash University, Monash Institute of Health Services Research, Clayton, Victoria, Australia

  3. 3

    St John of God Hospital Subiaco, c/- Ivy Suite Bendat Family Comprehensive Cancer Centre, Subiaco, Australia

  4. 4

    Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, Netherlands

  5. 5

    Concord Hospital, Department of Rheumatology, Concord, New South Wales, Australia

  6. 6

    Leiden University Medical Center, Department of Public Health and Primary care, Leiden, Netherlands

*Rachelle Buchbinder, Monash Department of Clinical Epidemiology at Cabrini Hospital, Department of Epidemiology and Preventive Medicine, Monash University, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, Victoria, 3144, Australia.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 OCT 2005




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


This review is one in a series of reviews of interventions for lateral elbow pain.


To determine the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain.

Search methods

Searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2004), MEDLINE, EMBASE, CINAHL, and Science Citation Index (SCISEARCH) were conducted in February 2005, unrestricted by date.

Selection criteria

We included nine trials that randomised 1006 participants to ESWT or placebo and one trial that randomised 93 participants to ESWT or steroid injection.

Data collection and analysis

For each trial two independent reviewers assessed the methodological quality and extracted data. Methodological quality criteria included appropriate randomisation, allocation concealment, blinding, number lost to follow up and intention to treat analysis. Where appropriate, pooled analyses were performed. If there was significant heterogeneity between studies or the data reported did not allow statistical pooling, individual trial results were described in the text.

Main results

Eleven of the 13 pooled analyses found no significant benefit of ESWT over placebo. For example, the weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks from a pooled analysis of three trials (446 participants) was -9.42 (95% CI -20.70 to 1.86) and the weighted mean difference for improvement in pain (on a 100-point scale) provoked by resisted wrist extension (Thomsen test) from baseline to 12 weeks from a pooled analysis of three trials (455 participants) was -9.04 (95% CI -19.37 to 1.28). Two pooled results favoured ESWT. For example, the pooled relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo from a pooled analysis of two trials (192 participants) was 2.2 (95% CI 1.55 to 3.12). However this finding was not supported by the results of four other individual 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%) versus 29/48 (60%), p<0.05). Minimal adverse effects of ESWT were reported. Most commonly these were transient pain, reddening of the skin and nausea and in most cases did not require treatment discontinuation or dosage adjustment.

Authors' conclusions

Based upon systematic review of nine placebo-controlled trials involving 1006 participants, there is "Platinum" level evidence that shock wave therapy provides little or no benefit in terms of pain and function in lateral elbow pain. There is "Silver" level evidence based upon one trial involving 93 participants that steroid injection may be more effective than ESWT.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

Shock wave therapy for elbow pain

Does shock wave therapy work to treat tennis elbow and is it safe?
To answer this question, scientists analyzed 9 studies testing over 1000 people who had tennis elbow. Most people had pain for a long period of time and the pain had not improved with other treatments. People tested received either shock wave therapy or fake therapy 3 times over 3 weeks to 3 months. Improvement was tested after 1 week to 12 months. These studies provide the best evidence we have today.

What is tennis elbow and how could shock wave therapy help?
Tennis elbow or lateral epicondylitis can occur for no reason or be caused by too much stress on the tendon at the elbow. It can cause the outside of the elbow and the upper forearm to become painful and tender to touch. Pain can last for 6 months to 2 years, and may get better on its own. Many treatments have been used to treat tennis elbow, but it is not clear whether these treatments work or if the pain simply goes away on its own. Shock wave therapy involves sending sound waves to the elbow by a machine. It is not well known why and how it might work to improve pain.

What did the studies show?
Five studies show that pain, function and grip strength was the same or slightly more improved with shock wave therapy than with fake therapy. Four studies show more improvement with shock wave therapy.

But when the results from some of the studies were pulled together, overall shock wave therapy improved symptoms just as well as fake therapy.

One study compared shock wave therapy to steroid injections. It shows that steroid injections may improve symptoms more than shock wave therapy.

Were there side effects?
Side effects usually did not last long and went away after therapy. Side effects included pain and reddening of the skin where the shock wave therapy was given, and some people had nausea.

What is the bottom line?
There is "Platinum" level evidence that shock wave therapy provides little or no benefit in terms of improving pain and function in tennis elbow. Shock wave therapy may cause pain, nausea and reddening of the skin.

This review does not support the use of shock wave therapy.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







Cochrane Controlled Trials Register(コクラン・ライブラリ2004年第2号)、MEDLINE、EMBASE、CINAHLおよびScience Citation Index(SCISEARCH)を日付に制約を設けずに、2005年2月に検索した。










監  訳: 吉田 雅博,2008.1.11

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要





研究體外震波治療 (ESWT)治療手肘外側的肱骨外上髁炎之療效及其安全性


搜尋包括Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2004), MEDLINE, EMBASE, CINAHL, and Science Citation Index (SCISEARCH 直到2005年2月)。






13篇研究中的11篇研究統合發現震波與安慰劑治療,無統計上差異。例如由基礎日到4到6週之疼痛(on a 100point scale)加權平均差異在3篇446位患者分析為 −9.4 95% CI −20.70 to 1.86),且3篇455位患者由基礎日到12週之腕部伸展疼痛(Thomsen test)加權平均差異為 −9.0 95% CI −19.37 to 1.28)。2篇研究傾向體外震波治療,例如治療成功﹝在3個月後在疼痛及腕部伸展疼痛至少50% 進步﹞相對風險在2篇研究192人,為2. 95% CI 1.55 to 3.12)。但另4篇無法統合之個別實驗並不支持此有效性。在3個月時,類固醇局部注射比ESWT有效﹝定義為疼痛由基礎減少50% ﹞(21/25 (84%)比上29/48 (60%), p < 0.05)。震波治療很少副作用被報告。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


是否體外震波治療可治療網球肘並且是否安全?要回答這個問題,科學家分析了9個研究,試驗已超過 1000位網球肘患者。大多數人已經長期疼痛一大段時間,其他治療方法沒有改善疼痛情況。患者接受體外震波治療測試 3次超過 3個星期至3個月。再 1週~12個月後進行症狀是否改善的測試。這些研究提供了今日我們擁有的最好證據。什麼是網球肘,以及體外震波如何幫助治療?外側上髁炎或網球肘可沒有理由地發生或發生在肘部肌腱承受太大壓力時。它會引起肘部外面和前臂上端疼痛和壓痛。疼痛可以持續 6個月至2年,可能會自己變好。許多治療方法已被用於治療網球肘,但目前尚不清楚是否這些治療是有用的,或疼痛其實是自己消失的。體外震波治療包括經由一台機器發送聲波到肘部。體外震波治療如何作用以及緩解疼痛的原因還沒有完全被知道。研究表明了什麼?5項研究表明;比起假治療,體外震波治療對於疼痛,握力和功能的效果是相同或略有改善。 4項研究顯示體外震波治療有更多的改善。但是,當這些研究結果放在一起統合分析時,體外震波治療改善症狀的能力與假治療相同。一項研究比較體外震波治療與類固醇注射。結果表明,注射類固醇改善症狀效果勝過體外震波治療。有沒有副作用?副作用通常並不長,治療後就會消失。副作用包括疼痛和體外震波處皮膚發紅,有些人會噁心。什麼是底線?有“白金”級的證據表明體外震波治療改善網球肘的疼痛和功能只能提供很少好處或根本沒有好處。體外震波治療可能引起疼痛,噁心和皮膚發紅。本次review不支持使用體外震波治療。