Effect of Low-energy Extracorporeal Shock Wave Therapy on Calcifying Epicondylitis: Sonographic Follow-up

Hwang, Ji Hye; Lee, Yong Taek

Abstract

OBJECTIVE
To evaluate the effect of low-energy extracorporeal shock wave therapy (ESWT) in refractory calcifying epicondylitis. METHOD: Twelve patients (1 man, 11 women, mean age 49), who suffered from refractory medial or lateral epicondylitis (mean duration 22 months) with sonographically verified calcification, were included. Subjects were classified according to radiologic and sonographic findings of calcification. Visual analogue scale (VAS) at rest and activities of daily living (ADL) as well as Nirschl score were evaluated before and 3 months after low-energy (0.06~0.12 mJ/mm2, 1,500~2,000 shocks) extracorporeal shock wave therapy (ESWT). Sonographic changes and Roles and Maudsley score were assessed 3 months after ESWT.
RESULTS
VAS at rest and ADL as well as Nirschl score were significantly decreased (p<0.05) after ESWT. Roles and Maudsley score was "Good" in six patients (50%), "Acceptable" in 3 (25%) and "Poor" in 3 (25%) after 3 months. In sonographic classification, "Fragmented type" was observed in five (42%), "Nodular" in 3 (25%), "Small" in 4 (33%). All of eight radiologically positive patients (67%) showed sonographic changes of calcification including one complete resorption (8%), 3 disintegration (25%) and 4 decrease of size or number (33%). All of four radiologically negative patients (33%) were "Small type" and did not show any change of calcification on sonography.
CONCLUSION
Low-energy ESWT can help the clinical improvement and resorption of calcification in refractory calcifying medial or lateral epicondylitis. Radio-opaque calcification may be a good indicator of resorption of calcification on sonography after low-energy ESWT.