Corticosteroid Injection Verses High Energy Extracorporeal Shock Wave Therapy for Lateral Epicondylitis

Corticosteroid injections and high energy ESWT are standard therapies for lateral
epicondylitis at Walter Reed National Military Medical Center. While corticosteroid
injections have been shown to be moderately effective in the short term for the condition, a
significant minority of patients remains symptomatic. Low energy ESWT has mixed results in
the orthopaedic literature, but to date no study has specifically examined the effects of
high energy ESWT. The investigators plan to randomize a total of 80 patients with the
diagnosis of lateral epicondylitis to either corticosteroid injection or high energy ESWT,
and follow them for a total of 12 months. Primary outcomes will be Disabilities of the Arm,
Shoulder, and Hand (DASH) score, Patient Reported Tennis Elbow Evaluation (PRTEE) score,
Mayo Elbow Score, Veterans Rand-36, and return-to-work status. Patients will be surveyed at
baseline, 6 weeks, 3 months, and 6 months. All assessments will be done by an independent
physician examiner who is blinded to the treatment received.

Inclusion Criteria:

- All patients presenting to the WRNMMC orthopaedic hand surgery clinic for complaints
of lateral elbow pain will be evaluated for inclusion in the study. Inclusions
criteria will be:

- Clinical diagnosis of lateral epicondylitis based on primary complaint of lateral
elbow pain and either (a) tenderness over the lateral epicondyle with direct
palpation, or (b) exacerbation of pain at the lateral elbow with resisted
dorsiflexion of the wrist

- Failure of previous trial of non-operative management of at least 4wks duration (to
include rest/light duty, non steroidal anti-inflammatory drugs ,
physical/occupational therapy, home stretching regimen)

Exclusion Criteria:

- Age <18yo

- Pregnant or planning to become pregnant during study period (based on verbal
questioning)

- Steroid treatment (oral or injectable) within the previous 3mo

- Diagnosis of ipsilateral compressive neuropathy

- Allergy to Kenalog, lidocaine, or conductive ultrasound gel

- Diagnosis of inflammatory arthropathy or rheumatoid conditions

- Diagnosis of fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome,
or other chronic widespread pain syndromes