Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are common overuse injuries affecting the tendons of the forearm. These conditions are characterized by tendon degeneration, microtears, and poor vascularization, leading to chronic pain and functional impairment. Standard treatment approaches include rest, NSAIDs, corticosteroid injections, and physical therapy; however, for patients with persistent symptoms, medical devices provide targeted, evidence-based treatment solutions.
Top Medical Devices for Tennis and Golfer’s Elbow Treatment
1. SoftWave Therapy: A Broad-Focused ESWT for Tendon Healing
Extracorporeal shockwave therapy (ESWT) is an evidence-based intervention for treating chronic tendinopathies, including lateral and medial epicondylitis. Studies indicate that ESWT enhances tendon healing by inducing mechanotransduction, stimulating angiogenesis, and modulating inflammatory processes (D’Agostino et al., 2017). This non-invasive modality is particularly valuable for patients who do not respond to NSAIDs, corticosteroid injections, or physical therapy.
Among ESWT devices, SoftWave Therapy (SoftWave Gold Li-Series) stands out due to its broad-focused shockwave technology. Unlike radial or focused ESWT, which concentrate energy on a localized area, SoftWave Therapy disperses energy over a larger treatment zone, maximizing tissue penetration without inducing microtrauma. This makes it an ideal regenerative therapy for chronic tendon injuries, musculoskeletal disorders, and soft tissue pathologies.
Mechanism of Action
- Stimulates angiogenesis, enhancing blood supply to support tissue regeneration.
- Modulates inflammation, balancing cytokine activity to promote healing.
- Activates mechanotransduction pathways, triggering the proliferation of smooth muscle cells for improved tissue elasticity and remodeling.
- Promotes Type I collagen production, reinforcing long-term tendon remodeling and tensile strength.
- Activates resident stem cells, supporting natural tissue repair and regeneration.
- Stimulates endogenous growth factors, enhancing cellular healing responses.
Clinical Findings
Research by D’Agostino et al. (2017) demonstrated that ESWT significantly improves pain scores and functional outcomes in epicondylitis patients. Additionally, Schroeder et al. (2021) found that ESWT-treated patients showed faster return-to-function rates and reduced reliance on analgesics compared to conservative therapies.
Indications Beyond Epicondylitis
SoftWave Therapy is also clinically applied for:
- Orthopedic and musculoskeletal conditions (e.g., tendinopathies, ligament injuries).
- Diabetic foot ulcers, chronic wounds, burns (improving tissue healing and reducing infection risks).
- Urological and pelvic health applications (Health Canada Licensed, not FDA-cleared for these indications)
Discover SoftWave Therapy for your practice
2. High-Intensity Laser Therapy for Tendon Rehabilitation
High-intensity laser therapy (HILT) has been proposed as a non-invasive modality for reducing pain and enhancing tissue repair in tendinopathies. This modality relies on photobiomodulation, a process where light energy stimulates cellular activity, enhancing ATP production, reducing oxidative stress, and modulating inflammatory pathways.
HILT differs from low-level laser therapy (LLLT) in that it penetrates deeper into musculoskeletal tissues, allowing for greater metabolic activation of tenocytes, fibroblasts, and endothelial cells. The primary therapeutic goal is to reduce oxidative stress and modulate inflammatory mediators, which can help restore tendon function and minimize pain.
Mechanism of Action
- Photobiomodulation enhances ATP production, fueling cellular repair processes.
- Reduces oxidative stress, helping to prevent further degenerative changes in the tendon matrix.
- Modulates pro-inflammatory cytokines, limiting excessive immune responses while supporting tissue remodeling.
Clinical Findings
A meta-analysis by ElMeligie et al. (2023) evaluated six randomized controlled trials involving 344 patients with lateral epicondylitis. The findings showed that HILT reduced pain intensity, but improvements in grip strength and functional recovery were inconsistent. Additionally, while HILT enhanced short-term quality of life scores, long-term benefits remain unclear.
Limitations
- Limited evidence supporting long-term structural improvements in tendons.
- Most studies show only modest short-term pain relief, making it inferior to ESWT for chronic epicondylitis.
- Grip strength and functional mobility improvements remain inconsistent
3. Therapeutic Ultrasound for Deep Tendon Penetration
Therapeutic ultrasound is often used to increase circulation, improve tendon elasticity, and reduce stiffness. It works by delivering high-frequency sound waves that generate localized heat, thereby enhancing tissue perfusion and collagen remodeling.
The primary advantage of ultrasound therapy is its ability to generate localized heating, which enhances blood flow and metabolic exchange in chronic tendon injuries. However, it does not directly induce cellular regeneration the way ESWT or HILT does.
Mechanism of Action
- Increases circulation and oxygenation, improving nutrient delivery to degenerative tendons.
- Generates deep heat, reducing stiffness and improving tendon elasticity.
- Enhances cell permeability, facilitating metabolic activity and promoting extracellular matrix remodeling.
Clinical Findings
- A systematic review by Sun et al. (2022) compared therapeutic ultrasound with ESWT and found that while ultrasound produced comparable functional outcomes at eight weeks, ESWT provided superior short-term pain relief.
- More effective as an adjunct therapy rather than a standalone treatment.
5. Percutaneous Ultrasonic Tenotomy: A Minimally Invasive Alternative
Percutaneous ultrasonic tenotomy is a minimally invasive procedure designed to treat recalcitrant cases of lateral and medial epicondylitis by mechanically breaking down fibrotic tissue. This technique utilizes an ultrasound-guided needle device that emits ultrasonic energy to fragment scar tissue and degenerative tendinopathic changes.
The procedure is often performed in conjunction with platelet-rich plasma (PRP) injections to further promote tendon healing. PRP contains concentrated growth factors that enhance the proliferation of tenocytes and fibroblasts, accelerating tissue regeneration.
Mechanism of Action
- Ultrasound-guided debridement selectively targets and removes fibrotic and degenerative tendon tissue, reducing mechanical irritation.
- Stimulates healing responses by triggering localized inflammation, which initiates collagen remodeling and tendon repair.
- Often paired with PRP therapy, which enhances growth factor activity and tissue regeneration.
Clinical Findings
A long-term follow-up study by Ang et al. (2021) found that ultrasonic percutaneous tenotomy provided sustained pain relief and functional improvement for patients with chronic lateral epicondylitis. The study followed patients for 90 months and found no recurrence of symptoms, with significant improvements in tendon thickness and vascularity observed on ultrasound imaging.
Limitations
- More invasive than ESWT, requiring local anesthesia and a short recovery period.
- Potential for mild post-procedure discomfort due to induced inflammatory healing response.
- Typically reserved for severe or refractory cases where non-invasive treatments have failed.
6. Kinesiology Taping & Orthoses for Temporary Symptom Relief
Kinesiology taping and orthotic braces provide external mechanical support to alleviate stress on the common extensor and flexor tendons in epicondylitis cases. These interventions are primarily used for temporary pain relief and functional support rather than promoting intrinsic tendon healing.
Kinesiology taping aims to reduce mechanical load, improve proprioception, and enhance local circulation, while orthotic braces, such as counterforce braces or wrist splints, work by redistributing tension across the forearm muscles, thereby reducing strain on the injured tendons.
Mechanism of Action
- Taping provides external support, limiting excessive wrist extension and flexion movements that aggravate the tendon.
- Wrist braces offload mechanical stress from overused forearm flexor and extensor tendons, reducing repetitive microtrauma.
- Improves neuromuscular function, potentially decreasing compensatory movement patterns that may contribute to chronic overload.
Clinical Findings
A systematic review by Landesa-Piñeiro & Leirós-Rodríguez (2022) found that kinesiology taping can provide short-term improvements in pain and function, though its effects are not sustained beyond a few weeks. Similarly, forearm braces have been shown to reduce pain during activity, but do not address the underlying degenerative changes in chronic tendinopathies.
Limitations
- Short-term efficacy, requiring continuous reapplication for symptom relief.
- Does not induce tendon regeneration, making it an adjunct rather than a primary treatment.
- Best used in combination with ESWT or eccentric strengthening programs for long-term management.
Become a SoftWave Provider and Enhance Patient Outcomes
SoftWave Therapy offers a superior, non-invasive approach for managing tennis elbow and golfer’s elbow. Compared to traditional focused or radial ESWT, SoftWave’s broad-focused shockwaves provide a larger treatment area, enhancing tissue penetration and cellular response without inducing excessive microtrauma. This makes SoftWave ideal for musculoskeletal conditions that require a regenerative stimulus with minimal recovery time.
SoftWave Gold Li-Series: A Next-Generation ESWT Device
The SoftWave TRT patented parabolic reflector applicator distinguishes it from conventional shockwave devices by generating both a primary and secondary wave, optimizing therapeutic outcomes. This unique dual-wave approach enables:
- Broad energy dispersion, treating larger tissue volumes efficiently.
- Minimal discomfort, as the therapy does not induce localized microtrauma.
- Superior regenerative effects, making it a top choice for clinics managing chronic tendinopathies.
Interested in offering a clinically proven treatment for lateral and medial epicondylitis? Become a SoftWave provider today.
