POSTER ABSTRACTS - ISAKOS

E-poster #208
Shockwave Therapy in Tennis Elbow - Our first
Two years
Carlos Leal, COLOMBIA, Presenter
Bosque University, Bogota, COLOMBIA
Tennis Elbow is a relatively common pathology in
sports medicine, and it’s prevalence is of
approximately 4% in most European and
American statistics. It’s phisiopathology is related
to mechanical overuse at the insertion of the
extensor / supinator muscles of the forearm, wrist
and hand, in a biomechanically vulnerable point:
the lateral epicondyle of the elbow. The insertion
of the powerful medial epicondyle muscles, the
pronator / flexor group, has an osseous
prominence that provides a better biomechanical
advantage . The lateral epicondyle is more a soft
tissue prominence made of tendon and
fibrocartilage without a bone trochanter. The
causation of lateral epicondylitis of the elbow is
multifactorial. Histologic evidence of vascular
proliferation and focal hyaline degeneration in
surgical specimens suggests that chronic
refractory lateral epicondylitis is a degenerative
rather than an inflammatory process. The use of
shockwave therapy in tennis elbow has been
widely used in Europe since 1990, and in the US
since 1999. The basic principle of Extracorporeal
Shockwave Therapy (ESWT) is the
revascularization of chronically inflamed areas,
associated with a powerful analgesic effect due to
the mechanical and cavitation properties of
shockwaves. The literature is young in GCP
criteria and Evidence Based Medicine
Recommendations, and until 2001 we saw the first
papers in peer-reviewed journals. Most of the
data available comes still from the specialized
meetings and groups of interest all over the world,
showing promising results and phase one studies.
The mode of action of shock wave therapy is
uncertain. It has been suggested that shock waves
relieve pain by hyperstimulation analgesia. Shock
wave therapy has been shown to have an 80%
success rate in the treatment of pseudarthrosis,
and a 56% to 90% success rate in the treatment
soft tissue disease including calcifying tendinitis
of the shoulder, tendinopathy of the elbow, and
painful heels. Although the early results have
been encouraging, a longer follow up is needed
for final conclusions. No device-related problems
and no systemic or local complications have been
observed. Our own early clinical results are
comparable with the results of others and the
success rates reported in the literature. We
observed that patients who did not respond well
enough to the first treatment were likely to have
improvement after a second treatment. It seemed
that repeated shock wave treatments resulted in a
cumulative positive effect on elbows with lateral
epicondylitis. Our own two year experience at the
ESWT center of the Bosque University
Orthopaedics Department in Bogota, shows good
and excellent results in most of our tennis elbow
patients. We have performed ESWT for tennis
elbow in 109 patients and completed a close
twelve month follow - up in 96. Our treatment
protocol is based in the application of 2000
shockwaves with a flux intensity of 0.2 0.4
mJ/mm2 in two sessions at weekly intervals. Our
follow up includes a visual analogue scale, a
functional scale measurement, and the ability to
return to sports evaluating the athletic level as
compared to the one previosus to the onset of the
symptoms. After twelve months, our patients
reduced their pain in an average 73% of the visual
analogue scale. 79% of our patients returned to
sports in a similar athletic level, and 18% in a
lower level. 3% of the patients did not return to
sports because of persistent pain. No patients
required surgery during this period. In the
functional scale we had 78% of good or excellent
results.The use of ESWT in tennis elbow is a clear
alternative in our patients with chronic
pathologies or tendinosis. Low energy shock
wave treatment seems to be effective for lateral
epicondylitis of the elbow in selected patients. It
is safe and complications are rare. This method
seems to offer substantial advantages for the
treatment of patients with lateral epicondylitis of
the elbow. It does not replace the conventional
treatment, but results in less number of surgical
procedures. We tend to use it before the
tendinitis becomes an irreversible tendinosis with
mixoid changes, in order to prevent chronic
tendinous diseases that might end in surgery
anyway. Even though this is a new alternative, the
FDA approval and widespread use in the world
will result in more clinical and basic research and
data in the future years.
E-poster #210
Endoscopic Olecranon Bursa Resection
Gonzalo Mora, Pamplona, SPAIN, Presenter
Juan Ramon Valenti, Pamplona, SPAIN
Clinica Universitaria de Navarra, PAMPLONA,
SPAIN