Cheema Amarpal S, Doyon Jonathan, Lapner Peter
Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
JSES Int. 2022 Dec 10;7(2):351-356. doi: 10.1016/j.jseint.2022.11.002. eCollection 2023 Mar.
Consensus has not yet been reached regarding the optimal nonoperative treatment of lateral epicondylitis. Physiotherapy is often utilized, yet the specific modalities used can vary significantly, making this treatment arm quite broad. The role and efficacy of passive physiotherapy by way of transcutaneous electrical nerve stimulation (TENS) and extracorporeal shockwave therapy (ESWT) are not well understood. The purpose of this systematic review and meta-analysis was to compare transcutaneous electrical nerve stimulation (TENS) and extracorporeal shockwave therapy (ESWT) with no active treatment.
MEDLINE, Embase, and Cochrane were searched through till September 20, 2021. All English-language randomized trials comparing passive electrophysiotherapy treatments compared with no active treatment/placebo of patients >18 years of age with lateral epicondylitis with minimum 6-month follow-up were included.
In the pooled analysis of 2 trials, ESWT provided no benefit compared to no active treatment for pain (-7.063, 95% confidence interval [CI]: -19.16 to 3.89) or function (standardized mean difference [SMD]: 0.03, 95% CI: -0.31 to 0.38, = 0%). TENS showed no improvement in function compared with control with a mean difference in PRTEE scores of 2.93 points (95% CI -8.30 to 2.43) at 12 months, nor were differences seen in pain scores at 12 months ( = .139).
The available evidence does not support the use of passive electrophysiotherapy modalities, TENS or ESWT in the treatment of lateral epicondylitis.
关于外侧上髁炎的最佳非手术治疗方法尚未达成共识。物理治疗经常被采用，然而所使用的具体方式差异很大，使得这一治疗领域相当宽泛。经皮电刺激神经疗法（TENS）和体外冲击波疗法（ESWT）等被动物理治疗的作用和疗效尚未得到充分了解。本系统评价和荟萃分析的目的是比较经皮电刺激神经疗法（TENS）和体外冲击波疗法（ESWT）与无积极治疗的效果。
检索了MEDLINE、Embase和Cochrane数据库直至2021年9月20日。纳入所有比较被动电生理治疗与无积极治疗/安慰剂的英文随机试验，试验对象为年龄大于18岁的外侧上髁炎患者，随访时间至少6个月。
在2项试验的汇总分析中，与无积极治疗相比，ESWT在疼痛方面（-7.063，95%置信区间[CI]：-19.16至3.89）或功能方面（标准化均值差[SMD]：0.03，95%CI：-0.31至0.38，P = 0%）均无益处。与对照组相比，TENS在12个月时PRTEE评分的平均差异为2.93分（95%CI -8.30至2.43），功能无改善，12个月时疼痛评分也无差异（P = 0.139）。
现有证据不支持在外侧上髁炎治疗中使用被动电生理治疗方式，即TENS或ESWT。
