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Tennis Elbow - Lateral Epicondylitis
Prior
to any Sonocur treatment, care must be taken to be certain that the
patient meets the treatment criteria, has no treatment contraindications,
has had the necessary pre-treatment imaging studies, and has read and
signed the proper informed consent.
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PROCEDURE
TECHNIQUE
- Place patient on
treatment table in the supine position with a pillow under the head.
- Position elbow
as shown over abdomen and support with wedge or pillow as illustrated.
- Identify trigger
point (sore area near or over lateral epicondyle) by palpation and mark
with pen if necessary.
- Apply transmission
gel over trigger point.
- Swing Sonocur
shock head into place and position over identified trigger point.
- Apply shock waves
initially at lowest energy level (level 1) at 4Hz.
- Move shock head
or elbow in small increments until patient reports maximal reproduction
of discomfort.
- Accomplish fine
adjustment of shock wave penetration depth by adjusting amount of fluid
in bellows, again with patient feedback to identify maximal trigger
point stimulation.
- Great care must
be taken to precisely identify the exact area of pain. It may require
the use of several shocks (eg.100) to identify this site.
- Depending upon
patient tolerance, gradually increase energy levels to the highest level
that can be maximally tolerated. In tennis elbow, this is generally
level two (2) or occasionally level three (3). Be certain that the patient
does no become too uncomfortable. It is more important to deliver all
the shock waves to the correct area at a lower energy level than miss
the mark with higher levels because the patient is too uncomfortable.
- Readjust the shock
head position after every 200-400 shocks to precisely treat the maximal
area of tenderness. This is necessary because of small positional movements
that occur during treatment.
- Deliver a total
of 2000 shocks to the affected site.
- Remove shock head
from elbow and observe the site of application.
- Wipe away the
gel.
- Supply patient
with post treatment instructions and return appointment for additional
treatment or physician visit.
HELPFUL HINTS
- If the patient
is exquisitely tender or has significant discomfort, it may be helpful
to initiate treatment more distally off of the condyle or slightly away
from the point of maximal tenderness. After 100-200 shocks, slowly readjust
the shock head so that the shock waves are focused more progressively
toward area of maximal tenderness. Slowly advance to the maximal trigger
point and complete the treatment.
- Inform the patient
that it is usual to have soreness after treatment and that often the
pain will be worse for a few days until healing begins. Explain that
if multiple treatments are necessary, that subsequent treatments can
sometimes be more uncomfortable than the initial treatment. In addition,
emphasize that healing may take several weeks to occur and that one
should not expect maximal improvement until 12 weeks after the last
treatment.
Sonorex Sonocur
Treatment Protocols are copyright protected.
© 2012 Sonorex. All rights reserved.
The Sonocur® Orthopedic Extracorporeal Shockwave system is available in Canada and other countries where regulatory approval has been obtained. The Sonocur® Basic is FDA approved in the United States for the treatment of chronic lateral epicondylitis (tennis elbow).
© 2012 Sonorex. All rights reserved. By using this service, you accept the terms of our Visitor Agreement. Please read it. The material sonorex.ca is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions. You should promptly seek professional medical care if you have any concern about your health, and you should always consult your physician before starting a fitness regimen.
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