Forskning på trykkbølgebehandling

Background: A previous randomized controlled trial showed comparable effectiveness of standardized eccentric loading and of repetitive low-energy shock-wave treatment (SWT) in chronic midportion Achilles tendinopathy. No randomized trials had tested whether a combined approach might lead to even better results.

Purpose: To compare eccentric loading alone with eccentric loading plus repetitive low-energy shock-wave therapy.

Methods: Sixty-eight patients with chronic recalcitrant (more than 6 months) noninsertional Achilles tendinopathy were randomized. All had received unsuccessful management for more than 3 months. Analysis was intention-to-treat.

Results: At 4 months the VISA-A score increased from 50 to 73 with eccentric loading alone, and from 51 to 87 with eccentric loading plus SWT. Pain rating fell from 7 to 4 versus 7 to 2. Nineteen of 34 patients (56%) versus 28 of 34 (82%) reported themselves completely recovered or much improved. Groups differed significantly in favor of the combined approach at 4 months. At 1 year the difference was no longer present, partly because several patients in the exercise-only group later received the combined treatment.

Conclusion: At 4-month follow-up, eccentric loading alone was less effective than a combination of eccentric loading and repetitive low-energy shock-wave treatment.

Objective: To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared with local steroid injection.

Methods: Twenty-two newly diagnosed patients were randomized. The ESWT group (n = 12) received low-energy treatment once a week for 3 weeks (0.06–0.12 mJ/mm², 2000 shocks) with DolorClast. The injection group (n = 10) received one injection of triamcinolone 10 mg mixed with 1% lidocaine. Nirschl score and a 100-point score were assessed before treatment and after 1, 2, 4 and 8 weeks. Roles and Maudsley score was assessed at 1 and 8 weeks.

Results: Both groups improved significantly throughout. The injection group improved more in Nirschl score at week 1 and in the 100-point score at the first 2 weeks. By week 8 the proportion of excellent and good Roles and Maudsley grades had increased more in the ESWT group than in the injection group.

Conclusion: The ESWT group improved as much as the local steroid injection group. ESWT can be a useful option when local steroid injection is difficult.