BACKGROUND: There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow. HYPOTHESIS: Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extra-corporeal shock wave treatment. METHODS: Seventy-eight patients enrolled in a placebo-controlled trial. All patients were tennis players with recalcitrant MRI-confirmed tennis elbow of at least 12 months' duration. Patients were randomly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks (treatment group 1) or an identical placebo extracorporeal shock wave treatment (sham group 2). Main outcome measure was pain during resisted wrist extension at 3 months; secondary measures were > 50% reduction of pain and the Upper Extremity Function Scale. RESULTS: At 3 months, there was a significantly higher improvement in pain during resisted wrist extension in group 1 than in group 2 (mean (SD) improvement, 3.5 (2.0) and 2.0 (1.9); p = 0.001 for between-group difference of improvement) and in the Upper Extremity Function Scale (mean (SD) improvement, 23.4 (14.8) and 10.9 (14.9); p < 0.001 for between-group difference of improvement). In the treatment group, 65% of patients achieved at least a 50% reduction of pain, compared with 28% of patients in the sham group (p = 0.001 for between-group difference). CONCLUSION: Low-energy extracorporeal shock wave treatment as applied is superior to sham treatment for tennis elbow.

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