Table 1.
Characteristics of the included studies
| Study | Participants (experimental/comparison groups) | ESWT group | Comparison group | Outcome measures |
| Capan et al. [8] | n = 28/28 | Type: radial intensity (bar): 1.8 | Without contact of the applicator | Pain: VAS score |
| Age (years): 48.4 ± 9.0/46.2 ± 7.4 | Impulse: 2000 × 3 | Roles and Maudsley score | ||
| Sex (M/F): 2/44 | Frequency: 10 Hz | PRTEE results | ||
| Duration (months): 7.9 ± 5.2/7.7 ± 5.2 | Three sessions at weekly intervals | Grip strength | ||
| Site: epicondylar area of maximum pain, tenderness | Follow-up: 1 and 3 months | |||
| Local anesthesia: NR | ||||
| Chung and Wiley [9] | n = 31/29 | Type: focused (electromagnetic) intensity (mJ/mm2): 0.03-0.17, determined by the participant’s pain tolerance | An air buffer pad was placed between the head of the machine and the skin of the participant’s elbow | Pain: VAS score (overall, night, sleep, activity, worst, and least) |
| Age (years): 46.8 ± 9.2/45.5 ± 6.6 | Impulse: 2000 × 3 | Intensity (mJ/mm2): 0.03 | EuroQol 5D results | |
| Sex (M/F): 37/23 | Frequency: NR | Grip strength | ||
| Duration (weeks): 19.3 ± 13.2/22.1 ± 15.7 | Three sessions at weekly intervals | Follow-up: 2 and 6 weeks | ||
| Site: at the point of maximum pain | ||||
| Local anesthesia: no | ||||
| Collins et al. [12] | n = 93/90 | Type: focused (electrohydraulic) intensity (kV): 18 | Styrofoam block to absorb shock waves | Pain: VAS score (activity) |
| Age (years): 44 ± 7.61/46 ± 7.52 | Impulse: 1500 | Fluid-filled intravenous bag between the Styrofoam block and the patient’s elbow to mimic the feel of the coupling membrane | SF-36 results | |
| Sex (M/F): 96/87 | Frequency: NR | Follow-up: 4 and 8 weeks | ||
| Duration (years): 1.9 (range 5 months to 13.5 years/2.1 (range 4 months to 22 years) | One session | |||
| Site: NR | ||||
| Local anesthesia: yes or Bier block | ||||
| Eraslan et al. [13] | n = 15/15 | Type: NR | No treatment | Pain: VAS score (worst, rest, night, repeated elbow movement, and carrying heavy object) |
| Age (years): 48 ± 5.7/47.2 ± 8.5 | Intensity (mJ/mm2): 0.06-0.12 | Physiotherapy only | Cyriax’s resisted muscle test results | |
| Sex (M/F): NR | Impulse: 2000 × 3 | Grip strength | ||
| Duration (years): NR | Frequency: NR | PRTEE results | ||
| Three sessions at weekly intervals | Follow-up: 1 week | |||
| Site: point of maximal tenderness | ||||
| Local anesthesia: NR | ||||
| Combined with physiotherapy | ||||
| Guler et al. [15] | n = 20/20 | Type: radial intensity (bar): 2.4/1.8 | No electric current applied | VAS score (rest, compression, and activity) |
| Age (years): 46.3 ± 8.1/45.8 ± 10.8 | Impulse: 1500 + 1500 | PRTEE results | ||
| Sex (M/F): 12/28 | Frequency: 15/21 Hz | Roles and Maudsley score | ||
| Duration (months): 4.1 ± 2.4/4.4 ± 2.2 | One session | Grasp force | ||
| Site: marked area/peripheral muscles | Pinch force | |||
| Local anesthesia: no | Follow-up: 0 and 1 months | |||
| Haake et al. [17] | n = 135/137 | Type: NR | Polyethylene foil filled with air and fixed with ultrasound gel in front of a coupling cushion totally reflected the shock waves | Pain: 11-point scale score |
| Age (years): 46.9 ± 8.5/46.3 ± 9.6 | Intensity (mJ/mm2): 0.07-0.09 | Grip strength | ||
| Sex (M/F): 128/143 | Impulse: 2000 × 3 | Roles and Maudsley score | ||
| Duration (months): 27.6 ± 35.5/22.8 ± 21.4 | Frequency: 3 Hz | Follow-up: 6 and 12 weeks | ||
| Three sessions at weekly intervals | ||||
| Site: continuous ultrasound imaging, insertion of the muscles at the lateral epicondyle of the humerus | ||||
| Local anesthesia: yes (3 mL of 1% mepivacain) | ||||
| Pettrone and McCall [35] | n = 56/58 | Type: focused (electromagnetic) intensity (mJ/mm2): 0.06 | Sound-reflecting pad between the patient and the application head of the machine | Pain: VAS score (Thompson test) |
| Age (years): 47.0 (range 35-71)/47.3 (range 35-60) | Impulse: 2000 × 3 | Upper-extremity function scale score | ||
| Sex (M/F): 54/60 | Frequency: NR | Subjective evaluation results of the disease status | ||
| Duration (months): 21.3 (range 6-178)/20.8 (range 6-176) | Three sessions at weekly intervals | Patient-specific activity score | ||
| Site: maximal tenderness on the lateral epicondyle | Grip strength | |||
| Local anesthesia: no | Follow-up: 1, 4, 8, and 12 weeks | |||
| Rompe et al. [39] | n = 50/50 | Type: focused (electromagnetic) intensity (mJ/mm2): 0.08 | Same protocol with impulse of 10 × 3 | Pain: VAS score (night, rest, pressure, Thompson test, finger extension, and chair test) |
| Age (years): 43.9 (range 26-61)/41.9 (range 26-58) | Impulse: 1000 × 3 | Grip strength | ||
| Sex (M/F): 42/58 | Frequency: 3 Hz | Roles and Maudsley score | ||
| Duration (months): 24.8 (range 10-20)/21.9 (range 10-46) | Three sessions at weekly intervals | Follow-up: 0, 3, 6, and 24 weeks | ||
| Site: anterior aspect of the lateral epicondyle and at three points around this site at a radius of 1.5 cm to 2 cm | ||||
| Local anesthesia: no | ||||
| Rompe et al. [38] | n = 38/40 | Type: focused (electromagnetic) intensity (mJ/mm2): 0.09 | Polyethylene foil filled with air and fixed with ultrasound gel in front of a coupling cushion totally reflected the shock waves | Pain: VAS score (Thompson test) |
| Age (years): 45.9 ± 12.3/46.2 ± 11.2 | Impulse: 2000 × 3 | Roles and Maudsley score | ||
| Sex (M/F): 40/38 | Frequency: 4 Hz | Upper-extremity function score | ||
| Duration (months): 23.3 (range 12-120)/25.1 (range 12-131) | Three sessions at weekly intervals | Grip strength | ||
| Site: maximal reproduction of discomfort | Overall satisfaction | |||
| Local anesthesia: No | Follow-up: 3 and 12 months | |||
| Spacca et al. [44] | n = 31/31 | Type: radial intensity (bar): 1.2/1 | Intensity (bar): 1.2/1 | Pain score (rest, palpation, and Thompson test) |
| Age (years): 46.8 ± 9.5/47.0 ± 9.2 | Impulse: (500 + 1500) × 4 | Impulse: (5 + 15) × 4 | Grip strength | |
| Sex (M/F): 32/30 | Frequency: 4/10 Hz | Frequency: 4/10 Hz | DASH score | |
| Duration (months): 12 ± 5.0/13 ± 5.0 | Four sessions at weekly intervals | Follow-up: 0 and 6 months | ||
| Site: insertion of the wrist’s extensors muscles, on the lateral epicondyle | ||||
| Local anesthesia: no | ||||
| Speed et al. [46] | n = 40/35 | Type: focused (electromagnetic) intensity (mJ/mm2): 0.12 | The treatment head was deflated | Pain: VAS score (day and night) |
| Age (years): 46.5 (range 26-70)/48.2 (range 31-65) | Impulse: 500 × 3 | No coupling gel was applied | Follow-up: 1 month | |
| Sex (M/F): 33/42 | Frequency: NR | Standard contact with the skin was avoided | ||
| Duration (months): 15.9 (range 3-42)/12 (range 3-40) | Three sessions at monthly intervals | Intensity (mJ/mm2): 0.04 | ||
| Site: ultrasonographic localization, site of maximum reproduction of local pain | ||||
| Local anesthesia: no | ||||
| Staples et al. [47] | n = 36/32 | Type: focused (electromagnetic) intensity (mJ/mm2): maximum level tolerated by the patient | Intensity (mJ/mm2): not exceeding 0.03 | Pain: VAS score (overall) |
| Age (years): 49.8 ± 7.4/49.1 ± 8.8 | Impulse: 2000 × 3 | Impulse: subtherapeutic dose of 100 shocks × 3 | Upper-limb function | |
| Sex (M/F): 40/28 | Frequency: 4 Hz | Frequency: 1.5 | Pain-free function index | |
| Duration (weeks): 52.6 ± 64.3/68.0 ± 98.8 | Three sessions at weekly intervals | DASH score | ||
| Site: area of maximal tenderness, origin of the common extensor tendon | SF-36 results | |||
| Local anesthesia: NR | Grip strength | |||
| PET results | ||||
| Follow-up: 6 weeks and 3 and 6 months | ||||
| Yang et al. [51] | n = 15/13 | Type: radial intensity (bar): maximum level tolerated by each patient | Intensity (bar): 0.1 | Pain: VAS score |
| Age (years): 50.9 ± 8.4/51.1 ± 9.5 | Impulse: 2000 × 3 | Grip strength | ||
| Sex (M/F): 12/16 | Frequency: 10 Hz | DASH score | ||
| Duration (months): 6.5 ± 6.5/7.3 ± 7.6 | Three sessions at weekly intervals | Ultrasonographic results | ||
| Site: NR | Real-time sonoelastographic results | |||
| Local anesthesia: NR | Follow-up: 4, 10, and 22 weeks |
M = male; F = female; NR = not reported; PRTEE = patient-related tennis elbow evaluation; PET = problem elicitation technique.