Generally, exercises to strengthen the wrist flexor pronators are also recommended. With healing, exercises to strengthen the wrist extensors can be started. Any activity that hurts on extending or pronating the wrist should be avoided. This overuse syndrome is caused by continued stress on the grasping muscles (extensor carpi radialis brevis and longus) and supination muscles (supinator longus and brevis) of the forearm, which originate on the lateral epicondyle of the elbow.Ĭonservative treatment involves rest, ice, stretching, strengthening, and lower intensity to allow for maladaptive change.
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Symptoms often persist for 18 months to 2 years and a small proportion of patients eventually undergo surgery.
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Lateral elbow pain (tennis elbow, lateral epicondylitis, rowing elbow) is one of the most commonly encountered repetitive motion injuries the prevalence of lateral elbow pain in the population has been estimated to be 1 to 3 %. It is purported to be an alternative to focused ESWT and can address larger treatment areas. ESWT is intended as a noninvasive alternative to surgical treatment in selected patients who have failed conventional medical therapy.Įxtracorporeal pulse activation therapy or radial wave therapy is another type of ESWT that uses waves of pressure to transform kinetic energy into radially expanding shock waves. ESWT is performed on an outpatient basis and may utilize local anesthesia to numb the area targeted for treatment. Shock waves are theorized to reduce inflammation, break up scar tissue and stimulate tissue healing. BackgroundĮxtracorporeal shock wave therapy (ESWT) is a nonsurgical treatment that involves the delivery of shock waves to musculoskeletal areas of the body (commonly the epicondyle, shoulder or heel) with the goal of reducing pain and promoting healing of the affected soft tissue.
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See also CPB 0235 - Plantar Fasciitis Treatments. Other musculoskeletal indications (e.g., calcaneal spur, Hammer toe, tenosynovitis of the foot or ankle, and tibialis tendinitis).Īetna considers pre-operative ESWT for reduction of scar formation following abdominoplasty surgery experimental and investigational because the effectiveness of this approach has not been established.Wound healing (including burn wounds and soft tissue wounds).Subacromial impingement syndrome/subacromial shoulder pain.Spasticity associated with brain injury/stroke, or cerebral palsy.Snapping scapula (scapula-thoracic bursitis).Rotator cuff tendonitis (shoulder pain).Neurogenic heterotopic ossification following traumatic brain injury.Myofascial pain syndrome of the trapezius.Lower limb ulceration (e.g., venous leg ulcers).Lower limb conditions (e.g., Achilles tendinopathy, greater trochanteric pain syndrome, knee tendinopathy, medial tibial stress syndrome, patellar tendinopathy and proximal hamstring tendinopathy).Hypertrophic scars of the hand caused by burn injury.Chronic kidney disease (other than kidney stones).
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Aetna considers extracorporeal shock-wave therapy (ESWT) medically necessary for calcific tendinopathy of the shoulder of at least 6 months’ duration with calcium deposit of 1 cm or greater, and who have failed to respond to appropriate conservative therapies (e.g., rest, ice application, and medications).Īetna considers extracorporeal shock-wave therapy (ESWT), extracorporeal pulse activation therapy (EPAT) (also known as extracorporeal acoustic wave therapy) experimental and investigational for the following indications (not an all-inclusive list) because there is insufficient evidence of effectiveness of ESWT for these indications in the medical literature: