Trigger Point Extracorporeal Shock Wave Therapy in Patients With Lateral Epicondylitis

Lateral epicondylitis is a common tendinopathic condition characterized by pain over the lateral elbow, reduced grip strength, and limitation in upper extremity function. The extensor carpi radialis brevis tendon and the common extensor tendon origin are frequently involved. Myofascial trigger points in the extensor carpi radialis brevis muscle may also contribute to pain and functional impairment.

This prospective randomized controlled single-blind study investigates whether extracorporeal shock wave therapy applied to the extensor carpi radialis brevis trigger point provides additional clinical and ultrasonographic benefit in patients with lateral epicondylitis. Participants are allocated to two parallel groups. Both groups receive active extracorporeal shock wave therapy to the lateral epicondyle region once weekly for three sessions. The intervention group also receives active extracorporeal shock wave therapy to one trigger point in the extensor carpi radialis brevis muscle. The comparator group receives sham extracorporeal shock wave therapy to the same trigger point area.

Outcome assessments are performed at baseline and at week 4. Pain intensity is assessed using the Visual Analog Scale. Grip strength is measured with a Jamar hand dynamometer. Hand function is assessed using the Duruöz Hand Index. Common extensor tendon thickness is measured by ultrasonography. The primary aim is to determine whether active trigger point extracorporeal shock wave therapy provides additional improvement compared with sham trigger point application when both groups receive active treatment to the lateral epicondyle region.

Inclusion criteria

• Age between 18 and 50 years
• Clinical diagnosis of lateral epicondylitis
• Tenderness over the lateral epicondyle
• Presence of trigger point in the extensor carpi radialis brevis muscle
• Ability to provide written informed consent

Exclusion criteria

• Peripheral nerve disease involving the ulnar, median, or radial nerve
• Other elbow pathologies such as instability, arthritis, or dermatologic lesions
• Radicular pain
• Previous elbow surgery
• Platelet-rich plasma injection, stem cell injection, corticosteroid injection, or extracorporeal shock wave therapy to the affected elbow within the previous month
• Presence of a pacemaker
• Pregnancy