Comparison of efficacy and safety of extracorporeal shock wave therapy and local hormone injection for external humeral epicondylitis: a meta-analysis_West China Medical Journal

Authors：

 LIU Kai ¹ , ZHANG Huiwei ² , WANG Yongcai ¹

1. Department of Orthopedics, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;
2. Department of Anesthesia, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Extracorporeal shock wave; hormone injection; external humeral epicondylitis; tennis elbow

DOI：

10.7507/1002-0179.202505017

Video：

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Objective To compare the efficacy and safety of extracorporeal shock wave therapy and local hormone injection for external humeral epicondylitis. Methods China National Knowledge Infrastructure, VIP, Wanfang, PubMed, Embase, and Cochrane Library (with a search time range from the establishment of the databases to March 2026) were searched to collect all randomized controlled trials comparing extracorporeal shock wave therapy and local hormone injection for external humeral epicondylitis. RevMan 5.3 software was used for meta-analysis. Results A total of 8 randomized controlled trials were included. The meta-analysis results showed that compared with the hormone injection group, the extracorporeal shock wave group had lower grip strength [mean difference (MD)=?5.86 kg] after 1 month of treatment and lower pain scores (MD=?1.56) after 3 months of treatment (P<0.05). There was no significant difference in grip strength after 3 months of treatment and complication rate between the two groups (P>0.05). Conclusions Compared with local hormone injection for external humeral epicondylitis, extracorporeal shock wave therapy can better alleviate pain without affecting grip strength 3 months after treatment and without increasing complications.

Citation： LIU Kai, ZHANG Huiwei, WANG Yongcai. Comparison of efficacy and safety of extracorporeal shock wave therapy and local hormone injection for external humeral epicondylitis: a meta-analysis. West China Medical Journal, 2026, 41(4): 618-622. doi: 10.7507/1002-0179.202505017 Copy

1.	Shapiro LM, Welch JM, Zhuang T, et al. The use and downstream associations of magnetic resonance imaging for lateral epicondylitis. J Hand Surg Am, 2024, 49(12): 1269.e1-1269.e7.
2.	Yaka H, Ba?bu? V, Tekin AA, et al. Evaluation of the relationship between lateral epicondylitis and vitamin D. Jt Dis Relat Surg, 2022, 33(2): 414-418.
3.	Cakar A, Gozlu OD. Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial. J Orthop Traumatol, 2024, 25(1): 34.
4.	Crowther MA, Bannister GC, Huma H, et al. A prospective, randomised study to compare extracorporeal shock-wave therapy and injection of steroid for the treatment of tennis elbow. J Bone Joint Surg Br, 2002, 84(5): 678-679.
5.	Ozturan KE, Yucel I, Cakici H, et al. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics, 2010, 33(2): 84-91.
6.	Gündüz R, Malas Fü, Borman P, et al. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison. Clin Rheumatol, 2012, 31(5): 807-812.
7.	Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci, 2015, 27(12): 3755-3758.
8.	Ismael MMM, Arafa MM, El Zohiery A, et al. Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis. Egypt Rheumatol Reh, 2020, 47(1): 25-31.
9.	劉光華, 陳建新, 王平, 等. 局部封閉與體外沖擊波治療肱骨外上髁炎的療效對比. 上海醫學, 2020, 43(8): 490-494.
10.	Ibrahim NH, El Tanawy RM, Mostafa AFS, et al. Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation. Egypt Rheumatol Rehabil, 2021, 48: 1-14.
11.	?etin BV, Sepet?i ?, Yazar ?, et al. Comparison of local massage, steroid injection, and extracorporeal shock wave therapy efficacy in the treatment of lateral epicondylitis. Jt Dis Relat Surg, 2024, 35(2): 386-395.
12.	Murat S, Dogruoz Karatekin B, Zengin M. Clinical and sonographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with lateral epicondylitis. Medeni Med J, 2024, 39(2): 109-116.
13.	Yi R, Bratchenko WW, Tan V. Deep friction massage versus steroid injection in the treatment of lateral epicondylitis. Hand (N Y), 2018, 13(1): 56-59.
14.	Bayram K, Yesil H, Dogan E. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. North Clin Istanb, 2014, 1(1): 33-38.
15.	Yalva? B, Mesci N, Geler Külcü D, et al. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. Acta Orthop Traumatol Turc, 2018, 52(5): 357-362.
16.	Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg, 2005, 13(1): 37-46.
17.	Simplicio CL, Purita J, Murrell W, et al. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma, 2020, 11(Suppl 3): S309-S318.
18.	D Agostino MC, Frairia R, Romeo P, et al. Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice. J Biol Regul Homeost Agents, 2016, 30(2): 323-332.
19.	Bosch G, de Mos M, van Binsbergen R, et al. The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J, 2009, 41(4): 335-341.
20.	Wu PC, Liu DH, Cheng YS, et al. High-intensity laser therapy versus extracorporeal shockwave therapy for lateral elbow tendinopathy: a systematic review and meta-analysis. Bioengineering (Basel), 2026, 13(2): 155.

1. Shapiro LM, Welch JM, Zhuang T, et al. The use and downstream associations of magnetic resonance imaging for lateral epicondylitis. J Hand Surg Am, 2024, 49(12): 1269.e1-1269.e7.
2. Yaka H, Ba?bu? V, Tekin AA, et al. Evaluation of the relationship between lateral epicondylitis and vitamin D. Jt Dis Relat Surg, 2022, 33(2): 414-418.
3. Cakar A, Gozlu OD. Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial. J Orthop Traumatol, 2024, 25(1): 34.
4. Crowther MA, Bannister GC, Huma H, et al. A prospective, randomised study to compare extracorporeal shock-wave therapy and injection of steroid for the treatment of tennis elbow. J Bone Joint Surg Br, 2002, 84(5): 678-679.
5. Ozturan KE, Yucel I, Cakici H, et al. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics, 2010, 33(2): 84-91.
6. Gündüz R, Malas Fü, Borman P, et al. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison. Clin Rheumatol, 2012, 31(5): 807-812.
7. Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci, 2015, 27(12): 3755-3758.
8. Ismael MMM, Arafa MM, El Zohiery A, et al. Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis. Egypt Rheumatol Reh, 2020, 47(1): 25-31.
9. 劉光華, 陳建新, 王平, 等. 局部封閉與體外沖擊波治療肱骨外上髁炎的療效對比. 上海醫學, 2020, 43(8): 490-494.
10. Ibrahim NH, El Tanawy RM, Mostafa AFS, et al. Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation. Egypt Rheumatol Rehabil, 2021, 48: 1-14.
11. ?etin BV, Sepet?i ?, Yazar ?, et al. Comparison of local massage, steroid injection, and extracorporeal shock wave therapy efficacy in the treatment of lateral epicondylitis. Jt Dis Relat Surg, 2024, 35(2): 386-395.
12. Murat S, Dogruoz Karatekin B, Zengin M. Clinical and sonographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with lateral epicondylitis. Medeni Med J, 2024, 39(2): 109-116.
13. Yi R, Bratchenko WW, Tan V. Deep friction massage versus steroid injection in the treatment of lateral epicondylitis. Hand (N Y), 2018, 13(1): 56-59.
14. Bayram K, Yesil H, Dogan E. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. North Clin Istanb, 2014, 1(1): 33-38.
15. Yalva? B, Mesci N, Geler Külcü D, et al. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. Acta Orthop Traumatol Turc, 2018, 52(5): 357-362.
16. Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg, 2005, 13(1): 37-46.
17. Simplicio CL, Purita J, Murrell W, et al. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma, 2020, 11(Suppl 3): S309-S318.
18. D Agostino MC, Frairia R, Romeo P, et al. Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice. J Biol Regul Homeost Agents, 2016, 30(2): 323-332.
19. Bosch G, de Mos M, van Binsbergen R, et al. The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J, 2009, 41(4): 335-341.
20. Wu PC, Liu DH, Cheng YS, et al. High-intensity laser therapy versus extracorporeal shockwave therapy for lateral elbow tendinopathy: a systematic review and meta-analysis. Bioengineering (Basel), 2026, 13(2): 155.

West China Medical Journal

Comparison of efficacy and safety of extracorporeal shock wave therapy and local hormone injection for external humeral epicondylitis: a meta-analysis

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