Effect of Scapular Stabilization Exercises and ESWT in Patients With Lateral Epicondylitis

Investigation of the Effect of Scapular Stabilization Exercises Applied in Addition to Extracorporeal Shock Wave Therapy on Pain, Muscle Strength, Functional Status, and Quality of Life in Patients With Lateral Epicondylitis

We aim to investigate the effects of adding scapular stabilization exercises to the extracorporeal shock wave therapy (ESWT) protocol in the treatment of lateral epicondylitis on pain, muscle strength, functional status, and quality of life.

Study Overview

• Status: Recruiting
• Conditions: Lateral Epicondylitis; Tennis Elbow
• Intervention / Treatment: Other: ESWT + Scapular stabilization exercise program

Detailed Description

Forty eight volunteer participants with lateral epycondilitis aged 18 to 65 years were included in the study. Participants were randomly divided into two groups as study and control group. In the control group, a protocol including ESWT, stretching of the ECRB muscle and wrist extensor muscles, and isometric, eccentric, and concentric strengthening exercises for the wrist extensors will be applied.

In the study group, the same protocol will be administered (ESWT, stretching of the ECRB and wrist extensor muscles, and strengthening exercises), with the addition of scapular stabilization exercises.

The exercise program will be conducted twice a week for 8 weeks. At the beginning of the treatment and at the end of the eighth week, pain, muscle strength, functional status, and Quality of Life were evaluated between groups

• Study Type: Interventional
• Enrollment (Estimated): 48
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: büşra yalçın, MSc; Phone Number: +905075157949; Email: busracakmakyalcin@gmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Recruiting
    • Büşra Yalçın
    • Contact: büsra yalçın Student, MSc; Phone Number: +90 507 515 79 49; Email: busracakmakyalcin@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged between 18 and 65 years.

  • Diagnosed with lateral epicondylitis by a physician, with positive Mill's, Cozen's, or Thomsen tests.
  • Experiencing pain and tenderness over and around the lateral epicondyle for at least 3 months, with symptoms exacerbated by resisted elbow extension, wrist extension, gripping, and supination.
  • Willing to voluntarily participate in the study.

Exclusion Criteria:

• • Individuals with serious systemic or cardiovascular diseases that contraindicate exercise of the hand and upper extremity.

  • Those diagnosed with upper extremity entrapment neuropathies.
  • Patients with a diagnosis of malignancy.
  • Individuals with open wounds on the hand or upper extremity.
  • Pregnant women or those suspected of being pregnant.
  • Patients who have received physiotherapy and/or injection treatments within the last 6 weeks.
  • Patients with diabetes mellitus, rheumatologic diseases, or neurological disorders.
  • Individuals who have undergone upper extremity surgery or had an upper extremity fracture within the last 6 months.
  • Patients with coagulation disorders or those receiving anticoagulant therapy.
  • Individuals with conditions causing degenerative changes in the hand and upper extremity.
  • Patients diagnosed with carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, medial epicondylitis, radiohumeral bursitis, or cervical disc pathology.
  • Patients using analgesic or anti-inflammatory medications other than acetaminophen (paracetamol).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: control group; Participants in the control group will receive a protocol consisting of extracorporeal shock wave therapy (ESWT), stretching exercises for the extensor carpi radialis brevis (ECRB) muscle and wrist extensor muscles, as well as isometric, eccentric, and concentric strengthening exercises targeting the wrist extensors. The ESWT will be applied once a week, for a total of 5 sessions	Other: ESWT + Scapular stabilization exercise program; Participants in the study group will follow a treatment protocol consisting of extracorporeal shock wave therapy (ESWT) - 5 sessions, once per week - combined with stretching exercises for the extensor carpi radialis brevis (ECRB) and wrist extensor muscles, strengthening exercises for the wrist extensors, and an additional scapular stabilization exercise program. This combined program will be performed twice per week for a duration of 8 weeks. The scapular stabilization component will include strengthening exercises targeting the lower and middle trapezius and serratus anterior muscles. The program will consist of scapular clock exercises, wall push-up exercises, and wall slide or ball slide exercises performed on a wall.
Experimental: Study group; Participants in the study group will follow a treatment protocol consisting of extracorporeal shock wave therapy (ESWT) - 5 sessions, once per week - combined with stretching exercises for the extensor carpi radialis brevis (ECRB) and wrist extensor muscles, strengthening exercises for the wrist extensors, and an additional scapular stabilization exercise program. This combined program will be performed twice per week for a duration of 8 weeks. The scapular stabilization component will include strengthening exercises targeting the lower and middle trapezius and serratus anterior muscles. The program will consist of scapular clock exercises, wall push-up exercises, and wall slide or ball slide exercises performed on a wall.	Other: ESWT + Scapular stabilization exercise program; Participants in the study group will follow a treatment protocol consisting of extracorporeal shock wave therapy (ESWT) - 5 sessions, once per week - combined with stretching exercises for the extensor carpi radialis brevis (ECRB) and wrist extensor muscles, strengthening exercises for the wrist extensors, and an additional scapular stabilization exercise program. This combined program will be performed twice per week for a duration of 8 weeks. The scapular stabilization component will include strengthening exercises targeting the lower and middle trapezius and serratus anterior muscles. The program will consist of scapular clock exercises, wall push-up exercises, and wall slide or ball slide exercises performed on a wall.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Assessment: Visual Analog Scale (VAS)	Pain will be assessed using the Visual Analog Scale (VAS). On this scale, a score of 0 indicates "no pain" and a score of 10 represents "the worst possible pain." Participants will be asked to mark their perceived pain level on a 10 cm horizontal line, anchored at 0 and 10. The distance from the left end of the line to the participant's mark will be measured in centimeters and recorded. The VAS is a valid and reliable tool for pain assessment. Pain will be evaluated separately at rest, during activity, and at night.	From baseline assesment to the end of treatment at 8 weeks
Scapular Position Assessment: (Lateral Scapular Slide Test)	The distance between the inferior angle of each scapula and the nearest spinous process will be measured in three different test positions on both sides using a measuring tape. A side-to-side difference of 1.5 cm or more is considered a positive result and indicates scapular asymmetry.	From enrollment to the end of treatment at 8 weeks
Pressure Pain Threshold Measurement	Measurements will be performed with a digital algometer while the participant is seated, with the shoulder abducted at 30°, the elbow flexed at 90°, and the forearm, wrist, and hand supported. Pressure pain threshold will be measured over the lateral epicondyle. Three measurements will be taken at each point using the 1 cm² tip of the algometer, and the average of these three measurements will be recorded.	From enrollment to the end of treatment at 8 weeks
Grip Strength	Patients' grip strength will be assessed using a Jamar hand dynamometer, following the protocol recommended by the American Society of Hand Therapists.	From enrollment to the end of treatment at 8 weeks
Muscle Strength	Muscle strength of the lower and middle trapezius, serratus anterior, and wrist extensor muscles will be measured using a handheld dynamometer before and after the treatment.	0 and 8 week
Functional Status	PRTEE (Patient-Rated Tennis Elbow Evaluation): The PRTEE is designed specifically for lateral epicondylitis and consists of 15 items divided into 3 subscales. Each item is scored from 0 to 10. Higher scores on the scale indicate worse functional status. (The subscales assess pain, specific activities, and general daily activities.) JHand: JHand evaluates the functional status of the upper extremity and consists of 25 items. Each item is scored on a scale from 0 (no difficulty) to 4 (unable to perform). Higher scores on this scale also indicate worse functional status.	From enrollment to the end of treatment at 8 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-Related Quality of Life	Short Form-12 Health Survey (SF-12) is a validated and reliable questionnaire used to assess health-related quality of life. It includes 12 items covering both physical and mental health domains, and provides two summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Higher scores indicate better perceived health status.	baseline and at the end of the 8-week intervention period.

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi
• Collaborators: Marmara University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): February 1, 2026

Study Registration Dates

• First Submitted: September 28, 2025
• First Submitted That Met QC Criteria: November 15, 2025
• First Posted (Estimated): November 20, 2025

Study Record Updates

• Last Update Posted (Estimated): December 4, 2025
• Last Update Submitted That Met QC Criteria: December 3, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Pain; functional status; tennis elbow; ESWT; Scapular muscle training
• Additional Relevant MeSH Terms: Elbow Tendinopathy; Elbow Injuries; Neurologic Manifestations; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Tendon Injuries; Arm Injuries; Tendinopathy; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Tennis Elbow
• Other Study ID Numbers: TR ISTANBU60

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No