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Objective: To describe and compare two ultrasonographic localization techniques for the treatment of lateral epicondylitis with extracorporeal shock wave therapy (ESWT). Design: Forty-one subjects selected through clinical examination were randomly assigned to two groups of treatment. Interventions: Each subject received a three-session ultrasound-guided ESWT (performed weekly). Lateral tangential focusing was used in group A, whereas back tangential focusing was used for group B. Main outcome measures: Total Elbow Scoring System (TESS) and a visual analogue scale (VAS) were used to evaluate each subject before the treatment and at six months follow-up. Results: TESS and VAS pretreatment scores were homogeneous between the groups (p/0.05). In both groups there was a significant (p B=0.05) increase in the TESS score and a decrease in the VAS score but there was no resolution of the pain. TESS and VAS follow-up scores were homogeneous between the two groups (p/0.05). Conclusions: There was no difference between the two techniques of using ESWT.

Objective: To generate data on optimal shoulder position comparing two ultrasound-guided extracorporeal shock wave therapy techniques for the treatment of calcifying tendinitis of the shoulder. Design: Random assignment to two groups of treatment with three months follow-up. Setting: The data were collected in outpatients. Subjects: Thirty-five subjects affected by calcifying tendinitis of the shoulder were examined. Interventions: Each subject received three sessions of ultrasound-guided extracorporeal shock wave therapy (performed weekly). Neutral position technique was used in group A (n = 17, mean age 53 ± 9.2 years) and the hyperextended internal rotation technique was used in group B (n = 18, mean age 52.2 ± 10.8 years). Main outcome measures: The Constant and Murley method and radiographs were used to evaluate each subject before the treatment and at three months follow-up. Results: There were no significant differences between changes in Constant total score and pain, activity of daily living and range of motion subscales of the two groups. Only the pain subscale showed a significant difference in favour of group B. Significant differences in the radiographic outcome were observed between the two groups: the percentage of total or subtotal resorption of the calcified deposits was 35.3% in group A (neutral position technique) versus 66.6% in group B (hyperextended internal rotation technique). The resorption of the calcific deposit positively influenced the clinical outcome. Conclusions: Positioning the shoulder in hyperextension and internal rotation during extracorporeal shock wave therapy seems to be a useful technique to achieve resorption of calcific deposits.

Objective: To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur.Design: Random assignment to two groups of treatment with two and eight months follow-up.Setting: The data were collected in outpatients.Subjects: Forty-five subjects with a history of at least six months of heel pain were studied.Interventions: Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 ± 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 ± 12.3 years).Main outcome measures: Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up.Results: Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 ±18.7; group B 53.5 ± 20; P>0.05). In both groups there was a significant (PConclusions: There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

Objective: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of painful subcalcaneal spurs and evaluate whether local steroid injections, body weight and the length of symptoms can affect the clinical results. Design: Subjects were selected through clinical examination and heel radiograms according to diagnosis of painful subcalcaneal spurs. Subjects: Sixty-four subjects were divided into two groups of treatment depending on their past history of previous local steroid injections. Interventions: Each subject received a three-session ESWT (performed weekly). A rehabilitative programme was instituted, consisting of self-assisted plantar fascia and plantar ‘exors stretching exercises. Main outcome measures: The Mayo Clinical Scoring System (MCSS) was utilized to evaluate each subject before the treatment and at two- and ten- month follow-ups. In addition, standard radiograms were done both before the treatment and at the ten-month follow-up. Results: Patients with no past treatment using steroids did not show any statistically significant improvement of the MCSS at the two-month follow-up. The statistical significance was obtained at the ten-month follow-up. Patients with past treatment using steroids did not show any statistically significant improvement of the MCSS at either follow-up. At the radiogram check, none of the subjects showed any modification of the heel spurs. Conclusions: According to the results of the present study ESWT should be considered as an effective treatment for painful subcalcaneal spurs. Previous local steroid injections may negatively affect the result of ESWT.