Transcutaneous electrical nerve stimulation (TENS) and extracorporeal shockwave therapy (ESWT) in lateral epicondylitis: a systematic review and meta-analysis

BACKGROUND: Consensus has not yet been reached regarding the optimal nonoperative treatment of lateral epicondylitis. Physiotherapy is often utilized, yet the specific modalities used can vary significantly, making this treatment arm quite broad. The role and efficacy of passive physiotherapy by way of transcutaneous electrical nerve stimulation (TENS) and extracorporeal shockwave therapy (ESWT) are not well understood. The purpose of this systematic review and meta-analysis was to compare transcutaneous electrical nerve stimulation (TENS) and extracorporeal shockwave therapy (ESWT) with no active treatment. METHODS: MEDLINE, Embase, and Cochrane were searched through till September 20, 2021. All English-language randomized trials comparing passive electrophysiotherapy treatments compared with no active treatment/placebo of patients >18 years of age with lateral epicondylitis with minimum 6-month follow-up were included. RESULTS: In the pooled analysis of 2 trials, ESWT provided no benefit compared to no active treatment for pain (−7.063, 95% confidence interval [CI]: −19.16 to 3.89) or function (standardized mean difference [SMD]: 0.03, 95% CI: −0.31 to 0.38, I(2) = 0%). TENS showed no improvement in function compared with control with a mean difference in PRTEE scores of 2.93 points (95% CI −8.30 to 2.43) at 12 months, nor were differences seen in pain scores at 12 months (P = .139). DISCUSSION: The available evidence does not support the use of passive electrophysiotherapy modalities, TENS or ESWT in the treatment of lateral epicondylitis.