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Efffectiveness of Shockwave Treatment Compared With Eccentric Exercises and Mobilization for Chronic Lateral Epicondylitis of the Elbow. A Prospective, Randomized, Blinded, Multicentric Study
Jose Ramon Aranzabal (1), Mireia Gonzalez Osinalde (2), Javier Garcia-Ariño (1), Ricardo Trujillo (2), Jorge Martinez Ezquerra (2), Pilare Aranzamendi (1), Maria Isabel Hernandez (1), Maria Jose Fernandez (2), Jose Ignacio Emparanza (2), Jaime Usabiaga (2)

Institution:
(1) Hospital Bidasoa, (2) Hospital Universitario Donostia, Spain,

Device and producing company:
Epos Ultra Dornier

Introduction:
The purpose of this investigation is to evaluate the efficacy of High Energy ESWT without anesthesia compared to an Eccentric Exercises and Mobilization(EEM) protocol.

Methods:
A prospective, randomized, multicentric, single blinded study performed at the University of the Basque Country(UPV-EHU). CEIC of Hospital Donostia supervision.
78 patients who fulfilled the Inclusion and Exclusion Criteria included into ESWT and EEM groups.
ESWT: 4 treatments of High Energy focused ESWT without anesthetics. Four weeks interval.
The protocol of EEM: 16 weeks electrotherapy, Kinesitherapy and Elongating and Eccentric Exercises.
After 16 weeks, patients were evaluated by a blind Orthopaedic Surgeon. The tests included Subjective Pain VAS, Dynamometric Strength, Satisfaction and other provocation clinical tests.

Results:
During two years a total of 60 of the 78 randomized patients completed all treatments ( 30 ESWT and 30 in the EEM group).
All the tests demonstrated an improvement in both groups.
A significant difference(p=0,02) in pain reduction was observed in the ESWT(VAS initial mean 4,54 to final 7,94) group compared with the EEM group( 5,32 to 6,98).
No significant differences were observed in the other parameters evaluated. Discussion: Satisfaction, Strength and other Parameters improved in both groups but differences were not significant. Subjective pain score improved in both groups. The improvement was better in the ESWT group and a statistically significant difference (p=0,02) was observed between the groups.

Conclusion:
These results demonstrate that High Energy ESWT is useful in the treatment of the CLE. ESWT has been more efficient in Pain reduction than EEM.
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