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Comparison 1 ESWT VERSUS PLACEBO, Outcome 1 Mean pain at rest (100 point scale).
Figuras y tablas -
Analysis 1.1

Comparison 1 ESWT VERSUS PLACEBO, Outcome 1 Mean pain at rest (100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 2 Mean pain with resisted wrist extension (Thomsen test)(100 point scale).
Figuras y tablas -
Analysis 1.2

Comparison 1 ESWT VERSUS PLACEBO, Outcome 2 Mean pain with resisted wrist extension (Thomsen test)(100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 3 Mean pain with typical daily activities.
Figuras y tablas -
Analysis 1.3

Comparison 1 ESWT VERSUS PLACEBO, Outcome 3 Mean pain with typical daily activities.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 4 Mean pain with resisted middle finger extension (100 point scale).
Figuras y tablas -
Analysis 1.4

Comparison 1 ESWT VERSUS PLACEBO, Outcome 4 Mean pain with resisted middle finger extension (100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 5 Mean pain with resisted supination of the wrist (Mills test)(100 point scale).
Figuras y tablas -
Analysis 1.5

Comparison 1 ESWT VERSUS PLACEBO, Outcome 5 Mean pain with resisted supination of the wrist (Mills test)(100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 6 Number of patients with significant improvement.
Figuras y tablas -
Analysis 1.6

Comparison 1 ESWT VERSUS PLACEBO, Outcome 6 Number of patients with significant improvement.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 7 Failure of treatment defined by Roles and Maudsley score of 4.
Figuras y tablas -
Analysis 1.7

Comparison 1 ESWT VERSUS PLACEBO, Outcome 7 Failure of treatment defined by Roles and Maudsley score of 4.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 8 Failure of treatment defined by Roles and Maudsley score of 3 or 4 and/or additional therapy.
Figuras y tablas -
Analysis 1.8

Comparison 1 ESWT VERSUS PLACEBO, Outcome 8 Failure of treatment defined by Roles and Maudsley score of 3 or 4 and/or additional therapy.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 9 Number of patients who eventually underwent surgical release of common extensor origin.
Figuras y tablas -
Analysis 1.9

Comparison 1 ESWT VERSUS PLACEBO, Outcome 9 Number of patients who eventually underwent surgical release of common extensor origin.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 10 Mean grip strength.
Figuras y tablas -
Analysis 1.10

Comparison 1 ESWT VERSUS PLACEBO, Outcome 10 Mean grip strength.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 11 Mean Upper Extremity Function Scale (range 8‐80).
Figuras y tablas -
Analysis 1.11

Comparison 1 ESWT VERSUS PLACEBO, Outcome 11 Mean Upper Extremity Function Scale (range 8‐80).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 12 Mean patient‐specific activity score.
Figuras y tablas -
Analysis 1.12

Comparison 1 ESWT VERSUS PLACEBO, Outcome 12 Mean patient‐specific activity score.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 13 Mean patient evaluation of their disease status (100mm VAS).
Figuras y tablas -
Analysis 1.13

Comparison 1 ESWT VERSUS PLACEBO, Outcome 13 Mean patient evaluation of their disease status (100mm VAS).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 14 Mean pain with palpation over the lateral epicondyle (100 point scale).
Figuras y tablas -
Analysis 1.14

Comparison 1 ESWT VERSUS PLACEBO, Outcome 14 Mean pain with palpation over the lateral epicondyle (100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 15 Mean pain with Chair test (100 point scale).
Figuras y tablas -
Analysis 1.15

Comparison 1 ESWT VERSUS PLACEBO, Outcome 15 Mean pain with Chair test (100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 16 Mean pain at night (100 point scale).
Figuras y tablas -
Analysis 1.16

Comparison 1 ESWT VERSUS PLACEBO, Outcome 16 Mean pain at night (100 point scale).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 17 Number of patients satisfied with their treatment.
Figuras y tablas -
Analysis 1.17

Comparison 1 ESWT VERSUS PLACEBO, Outcome 17 Number of patients satisfied with their treatment.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 18 Mean investigator assessment of pain to pressure over lateral epicondyle (10 cm VAS).
Figuras y tablas -
Analysis 1.18

Comparison 1 ESWT VERSUS PLACEBO, Outcome 18 Mean investigator assessment of pain to pressure over lateral epicondyle (10 cm VAS).

Comparison 1 ESWT VERSUS PLACEBO, Outcome 19 Number of patients reported pain during treatment.
Figuras y tablas -
Analysis 1.19

Comparison 1 ESWT VERSUS PLACEBO, Outcome 19 Number of patients reported pain during treatment.

Comparison 1 ESWT VERSUS PLACEBO, Outcome 20 Number of patients reported nausea during treatment.
Figuras y tablas -
Analysis 1.20

Comparison 1 ESWT VERSUS PLACEBO, Outcome 20 Number of patients reported nausea during treatment.

Comparison 2 ESWT VERSUS STEROID INJECTION, Outcome 1 Number of patients with successful treatment (defined as reduction in pain of 50% or greater at 3 months).
Figuras y tablas -
Analysis 2.1

Comparison 2 ESWT VERSUS STEROID INJECTION, Outcome 1 Number of patients with successful treatment (defined as reduction in pain of 50% or greater at 3 months).

Comparison 1. ESWT VERSUS PLACEBO

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean pain at rest (100 point scale) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 4‐6 weeks

3

446

Mean Difference (IV, Random, 95% CI)

‐9.42 [‐20.70, 1.86]

1.2 12 weeks

1

271

Mean Difference (IV, Random, 95% CI)

1.0 [‐5.43, 7.43]

1.3 24 weeks

1

100

Mean Difference (IV, Random, 95% CI)

‐25.2 [‐30.59, ‐19.81]

1.4 12 months

1

271

Mean Difference (IV, Random, 95% CI)

7.0 [2.83, 11.17]

2 Mean pain with resisted wrist extension (Thomsen test)(100 point scale) Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 1 week

1

114

Mean Difference (IV, Random, 95% CI)

‐8.42 [‐17.31, 0.47]

2.2 4 weeks

1

114

Mean Difference (IV, Random, 95% CI)

‐11.48 [‐21.08, ‐1.88]

2.3 6 weeks

2

371

Mean Difference (IV, Random, 95% CI)

‐16.20 [‐47.75, 15.36]

2.4 8 weeks

1

114

Mean Difference (IV, Random, 95% CI)

‐14.04 [‐23.95, ‐4.13]

2.5 12 weeks

3

455

Mean Difference (IV, Random, 95% CI)

‐9.04 [‐19.37, 1.28]

2.6 24 weeks

1

100

Mean Difference (IV, Random, 95% CI)

‐29.3 [‐35.83, ‐22.77]

2.7 12 months

1

271

Mean Difference (IV, Random, 95% CI)

‐1.0 [‐7.08, 5.08]

3 Mean pain with typical daily activities Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 4‐6 weeks

2

435

Mean Difference (IV, Fixed, 95% CI)

‐1.78 [‐6.70, 3.14]

3.2 8 weeks

1

165

Mean Difference (IV, Fixed, 95% CI)

‐8.40 [‐16.20, ‐0.60]

3.3 12 weeks

1

271

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐7.14, 7.14]

3.4 12 months

1

271

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐8.48, 2.48]

4 Mean pain with resisted middle finger extension (100 point scale) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 6 weeks

2

371

Mean Difference (IV, Random, 95% CI)

‐20.51 [‐56.57, 15.56]

4.2 12 weeks

1

271

Mean Difference (IV, Random, 95% CI)

‐2.0 [‐9.62, 5.62]

4.3 24 weeks

1

100

Mean Difference (IV, Random, 95% CI)

‐40.0 [‐45.52, ‐34.48]

4.4 12 months

1

271

Mean Difference (IV, Random, 95% CI)

‐1.0 [‐6.48, 4.48]

5 Mean pain with resisted supination of the wrist (Mills test)(100 point scale) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 6 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 12 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number of patients with significant improvement Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 50% improvement in overall pain at 1 month (4 weeks)

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.55, 1.90]

6.2 50% improvement in night pain at 1 month (4 weeks)

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.40, 1.40]

6.3 Success (at least 50% improved overall pain AND pain>4cm AND no pain meds for 2/52) (5 weeks)

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.62, 2.51]

6.4 Success (defined as no pain/occasional discomfort and no additional Rx at 3 months) (12 weeks)

1

246

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.66, 1.56]

6.5 Success (defined as at least 50% improvement in pain elicited by Thomsen test ) (12 weeks)

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

2.20 [1.55, 3.12]

6.6 significant improvement in pain of 3 or more points (on 10‐point VAS) (6 months)

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

10.0 [1.49, 67.29]

6.7 Number with at least 50% improvement in investigator‐assessed pain and 4 or less on 10cm VAS (8 weeks)

1

183

Risk Ratio (M‐H, Fixed, 95% CI)

1.60 [1.08, 2.37]

6.8 Number with at least 50% improvement in pain with activities and 4 or less on 10 cm VAS (8 weeks)

1

183

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.94, 1.78]

6.9 Number with no or rare use of pain medications (8 weeks)

1

183

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.94, 1.35]

6.10 Success (at least 50% improvement in investigator and participant ‐assessed pain and rare pain meds)(8 weeks)

1

183

Risk Ratio (M‐H, Fixed, 95% CI)

1.60 [0.99, 2.56]

7 Failure of treatment defined by Roles and Maudsley score of 4 Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 3 weeks

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.21 [0.09, 0.50]

7.2 6 weeks

2

371

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.08, 1.91]

7.3 12 weeks

2

349

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.32, 1.16]

7.4 24 weeks

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.14 [0.06, 0.33]

7.5 12 months

2

371

Risk Ratio (M‐H, Random, 95% CI)

0.44 [0.09, 2.17]

8 Failure of treatment defined by Roles and Maudsley score of 3 or 4 and/or additional therapy Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 12 weeks

2

349

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.81, 1.10]

9 Number of patients who eventually underwent surgical release of common extensor origin Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10 Mean grip strength Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 6 weeks

1

271

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.34, 0.14]

10.2 12 weeks (Haake et al = mmHg; Rompe = kg/cm2; Pettrone and McCall = lbs)

3

448

Std. Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.13, 0.24]

10.3 12 months (Haake et al = mmHg)

1

271

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.27, 0.21]

11 Mean Upper Extremity Function Scale (range 8‐80) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.1 1 week

1

110

Mean Difference (IV, Fixed, 95% CI)

‐3.84 [‐9.32, 1.64]

11.2 4 weeks

1

108

Mean Difference (IV, Fixed, 95% CI)

‐7.92 [‐13.47, ‐2.37]

11.3 8 weeks

1

107

Mean Difference (IV, Fixed, 95% CI)

‐8.0 [‐13.57, ‐2.43]

11.4 12 weeks

2

177

Mean Difference (IV, Fixed, 95% CI)

‐9.20 [‐13.56, ‐4.84]

12 Mean patient‐specific activity score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

12.1 12 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Mean patient evaluation of their disease status (100mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13.1 12 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Mean pain with palpation over the lateral epicondyle (100 point scale) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

14.1 3 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.2 6 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.3 24 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15 Mean pain with Chair test (100 point scale) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

15.1 3 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.2 6 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.3 24 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Mean pain at night (100 point scale) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

16.1 3‐4 weeks

2

175

Mean Difference (IV, Random, 95% CI)

‐10.01 [‐34.23, 14.21]

16.2 6 weeks

1

100

Mean Difference (IV, Random, 95% CI)

‐27.40 [‐32.98, ‐21.82]

16.3 24 weeks

1

100

Mean Difference (IV, Random, 95% CI)

‐25.2 [‐30.59, ‐19.81]

17 Number of patients satisfied with their treatment Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

17.1 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Mean investigator assessment of pain to pressure over lateral epicondyle (10 cm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

18.1 4 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18.2 8 weeks

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

19 Number of patients reported pain during treatment Show forest plot

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [1.48, 2.62]

20 Number of patients reported nausea during treatment Show forest plot

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

12.89 [2.50, 66.47]

Figuras y tablas -
Comparison 1. ESWT VERSUS PLACEBO
Comparison 2. ESWT VERSUS STEROID INJECTION

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of patients with successful treatment (defined as reduction in pain of 50% or greater at 3 months) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figuras y tablas -
Comparison 2. ESWT VERSUS STEROID INJECTION