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Piezoelectric Shockwave Therapy in Management Lateral Epicondylitis of the Elbow
Ayman Elwey Balabel, Eman Mohammed Alkhalfan, Amani Ahmed Yaccob

Institution:
Ahmadi Hospital, Kuwait

Device and producing company:
Piezoson 300

Introduction:
Tennis elbow is the common term used to describe the pain of un defined pathology over the common extensor origin at the lateral aspect of the elbow and that interferes with the activities of daily living, computer use, sport and at workplace . treatment for each case remains controversial and is based on the professional judgment of the health care provider. Tennis elbow is usually easily diagnosed by a physical examination. Up to 90% of cases can be remedied by nonsurgical treatments, non-steroidal anti-inflammatory medications, physiotherapy modalities in form of cold packs, and ultrasound additionally eccentric exercises program and elbow support brace, lastly is steroid, symptoms usually diminish within four to six weeks with appropriate treatment. Surgical treatment is necessary in 5 % of patients in case of failure to conservative line and still persist. The outcome of surgical treatment is not satisfactory.

Methods:
Retrospective study including 20 patients with tennis elbow, ages 30- 55 years old, with a pain VAS rating of 8-9, with pain in daily living activities and sometime at rest, they were clinically diagnosed as lateral epiconylitis elbow. Painful elbow present for a minimum of 3- 5 months, pregnancy, infectious or tumorous diseases were excluded. We performed the treatment as an outpatient procedure without anesthesia our protocol at least 3and maximum 5 Focused ESWT sessions every two weeks, with a 3000 pulses, energy level of 0,15 – 0,20 mJ/mm². All patients had been advised to start stretching exercise and eccentric loading exercises after 4 weeks after last treatment. Patients were advised to continue exercises for 12 weeks.

Results:
We followed patients after 5-6 month, and found that 16 patients showed 80% patients were free from pain, significantly better 10%, 2 patients, Pain had been reduced to VAS 2-3 and range of motion had significantly improved. 5 % of our patients were slightly better and 5 % no changes. Mean pain score before treatment was 8.78 ± 0.65 and after we recorded 4.35 ± 1.40. ROM changed from 27.50 ± 7.26 to 78.25 ± 10.11 with a highly significant P-value > 0.001.

Discussion:
Focused piezoelectric Shock wave therapy produces significant relief of pain, improves ROM in tennis elbow and decrease physical incapacity produced by tennis elbow.

Conclusion:
FESWT treatments should be considered as line of treatment in elbow epicondylities, it is very effective, noninvasive, and safe procedure with no complications or any side effects, exercise program is also recommended.
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