Authors' objectives:

This study reviews the use of extracorporeal shock wave therapy (ESWT) for treating musculoskeletal conditions. It updates an earlier review on extracorporeal shock wave therapy in workers with lateral epicondylitis.

Authors' recommendations: ESWT has been applied to treat various musculoskeletal conditions, including lateral epicondylitis, plantar fasciitis, calcific and non calcific shoulder tendonitis, delayed fracture union and fracture non-union, stress fracture and avascular necrosis of the femoral head. Prior to 2000, published literature on these topics were appraised as low quality and experts stressed the importance of conducting proper controlled trials in order to assess the efficacy of ESWT in treating various musculoskeletal conditions. Based on published systematic reviews (level 1 evidence) and one RCT, currently the evidence on the effectiveness of ESWT in treating: - Lateral epicondylitis - inconclusive - Plantar fasciitis - no evidence or inconclusive at best for low energy ESWT. However, high energy ESWT probably is effective. - Shoulder tendonitis - moderate evidence that low energy ESWT does not have any effect. There is moderate evidence that high energy ESWT has effect. There is no information available on the status of the ESWT coverage on the websites of WCBs in Canada. The Washington State and Colorado State Department of Labor and Industries specifically state that ESWT is not covered therapy for various musculoskeletal conditions, including lateral epicondylitis, plantar fasciitis, calcific and non calcific shoulder tendonitis, delayed fracture union and fracture non-union. The US private health insurance companies, including Aetna, the Regence Group, Tufts and BlueCross of California, consider the application of ESWT in treating lateral epicondylitis, plantar fasciitis, calcific and non calcific shoulder tendonitis, delayed fracture union and fracture non-union, stress fracture and avascular necrosis of the femoral head to be investigational or not medically necessary. As such, to date, these companies did not provide coverage for ESWT. Wellmark BlueCross BlueShield of Iowa and South Dakota provide limited coverage of ESWT, as somewhat the last treatment resort prior to surgery, for patients with plantar fasciitis. The company did not mention whether the coverage involve high or low energy ESWT. The US Medicare - Medicaid provides limited coverage for ESWT for patients with plantar fasciitis and lateral epicondylitis. The coverage includes low and high energy ESWT. Both high-dose and low-dose protocols have been investigated. A high-dose protocol consists of a single treatment of high energy shock waves (1300mJ/mm2). This painful procedure requires anesthesia. A low-dose protocol consists of multiple treatments, spaced one week to one month apart, in which a lower dose of shock waves is applied (1405mJ/ mm2 over three sessions). This protocol does not require anesthesia.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.worksafebc.com/health_care_providers/related_information/evid ence_based_medicine/default.asp

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC