Treatment of Medial Epicondylitis and Calcific Tendinosis with Radial Shockwave Therapy: A Case Report

Case Diagnosis: Medial Epicondylitis with Calcific Tendinosis

Case Description or Program Description: A 45-year-old male weightlifter presented to the clinic with 10 years of sharp, aching, non-radiating pain over the medial aspect of the right elbow. His pain was exacerbated by weightlifting and relieved by rest. He had 2 steroid injections in the past (at least 8 years prior) with temporary relief, and he failed numerous therapeutic exercise programs. Physical exam of the right upper extremity was significant for tenderness to palpation over the medial epicondyle and flexor tendon mass, pain with resisted wrist flexion, mild pain with varus stress, and slightly decreased pronation. No motor or sensory deficits were present, and no swelling was seen. Ultrasound and x-ray findings were consistent with medial epicondylitis with calcific component. Patient received physical therapy along with radial shockwave therapy once weekly for 6 weeks, with an average of 6,000 strikes, max bar of 4.0, and 15 Hz delivered per session targeting the common flexor tendon and muscles of the forearm.

Setting: Outpatient Rehabilitation Clinic

Assessment/Results: At 8-week follow-up, the patient reported 85% improvement in pain and function. Physical exam revealed decreased tenderness to palpation over the affected area and improved range of motion.

Discussion (relevance): Currently, conservative management and steroid injections are the most well-described treatment options for medial epicondylitis and calcific tendinosis in the literature, with limited research on the utility of shockwave therapy. Increased awareness and exploration of shockwave therapy as a treatment alternative may lead to greater pain relief and functional ability, ultimately improving quality of life for these patients.

Conclusions: The patient’s remarkable response suggests that shockwave therapy may offer therapeutic and functional benefit for medial epicondylitis with calcific tendinosis. Concurrent treatment with physical therapy appears to maximize benefits. Further research is warranted to determine the therapeutic duration and long-term effects.