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.