Scaturro Dalila, Migliorino Domenico, Tomasello Sofia, Vecchio Michele, Moretti Antimo, Iolascon Giovanni, Letizia Mauro Giulia
Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy.
Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Palermo, Italy.
Front Rehabil Sci. 2025 Jun 11;6:1593909. doi: 10.3389/fresc.2025.1593909. eCollection 2025.
Numerous scientific papers have compared different treatment options in the management of lateral epicondylitis. Our study evaluated the efficacy of focal extracorporeal shock wave treatment (ESWT) combined with an integrative nutraceutical treatment of hyaluronic acid, collagen, vitamin C, and manganese, compared with single treatment in patients with lateral epicondylitis in terms of improvement of pain, functional capacity, muscle strength, and reduction of inflammation on ultrasound images.
A single-center, randomized controlled trial (RCT) was conducted in a population of patients with lateral epicondylitis. Patients were enrolled and randomly divided into 3 groups: Group A, consisting of 15 patients who were treated with twenty sessions of therapeutic exercise and five focal ESWT sessions (one session every six days); Group B, consisting of 15 patients who performed twenty sessions of therapeutic exercise and took daily a dietary supplement consisting of Hyaluronic Acid 200 mg, Collagen 5,000 mg, Vitamin C 250 mg and Manganese 10 mg for thirty days; and Group C, consisting of 15 patients, who received a combined treatment of therapeutic exercise, focal ESWT and nutraceutical supplementation The Numerical Rating Scale (NRS) and Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) were administered during the first physiatric examination (T0), at 15 days after the start of treatment (T1), and at a 30-day follow-up (T2). In addition, muscle strength (Handgrip strength) was analyzed by means of a dynamometer, and common extensor tendon thickness (CET Thickness) by ultrasound examination.
Data analysis showed that NRS scale scores decreased significantly only in group B at T1 ( < 0.05), and in the three groups at T2 ( < 0.05). Grip strength increased significantly after 30 days only in group C ( < 0.05), while PRTEE scores and CET Thickness decreased significantly at T2 in the three groups ( < 0.05). The comparison among the various groups also showed that the Group C showed statistically significant improvements of function and grip strength at T2, compared with the other groups ( < 0.05).
Our study demonstrated that the combination of focal ESWT, therapeutic exercise, and nutraceutical supplementation, represent a viable therapeutic option for the management of lateral epicondylitis; likewise, the proposed treatments resulted in a synergistic effect for pain relief and functional recovery in the short term, providing a decrease in the inflammatory state and an increase in muscle strength.
众多科学论文比较了外侧上髁炎治疗中的不同治疗方案。我们的研究评估了聚焦式体外冲击波治疗（ESWT）联合透明质酸、胶原蛋白、维生素C和锰的综合营养补充剂治疗，与单一治疗相比，对外侧上髁炎患者在疼痛改善、功能能力、肌肉力量以及超声图像上炎症减轻方面的疗效。
在一组外侧上髁炎患者中进行了一项单中心随机对照试验（RCT）。患者入组并随机分为3组：A组，由15名患者组成，接受20次治疗性锻炼和5次聚焦式ESWT治疗（每六天一次）；B组，由15名患者组成，进行20次治疗性锻炼，并每天服用一种膳食补充剂，其中含有200毫克透明质酸、5000毫克胶原蛋白、250毫克维生素C和10毫克锰，持续30天；C组，由15名患者组成，接受治疗性锻炼、聚焦式ESWT和营养补充剂的联合治疗。在首次物理治疗检查（T0）时、治疗开始后15天（T1）以及30天随访时（T2），使用数字评定量表（NRS）和患者自评网球肘评估量表（PRTEE）。此外，通过测力计分析肌肉力量（握力），并通过超声检查分析常见伸肌肌腱厚度（CET厚度）。
数据分析显示，仅B组在T1时NRS量表评分显著降低（<0.05），三组在T2时均显著降低（<0.05）。仅C组在30天后握力显著增加（<0.05），而三组在T2时PRTEE评分和CET厚度均显著降低（<0.05）。各组之间的比较还显示，与其他组相比，C组在T2时功能和握力有统计学显著改善（<0.05）。
我们的研究表明，聚焦式ESWT、治疗性锻炼和营养补充剂相结合，是外侧上髁炎治疗的一种可行治疗选择；同样，所提出的治疗方法在短期内对缓解疼痛和功能恢复产生了协同作用，减轻了炎症状态并增加了肌肉力量。
