This study aims to evaluate the effectiveness of magnetotherapy in the treatment of lateral epicondylitis (tennis elbow). Lateral epicondylitis is a common musculoskeletal condition characterized by pain and tenderness over the outer part of the elbow, often associated with repetitive wrist extension and gripping activities. It may cause reduced grip strength, functional limitations, and decreased quality of life.
In this prospective, randomized, double-blind, sham-controlled clinical trial, 40 patients aged 18-65 years diagnosed with lateral epicondylitis will be enrolled. Participants will be randomly assigned into two groups using the sealed envelope method.
The experimental group will receive active magnetotherapy in addition to standard treatment (local application and supervised exercise therapy). The control group will receive sham magnetotherapy (inactive device without magnetic field) plus the same standard treatment. Treatments will be administered five days per week for three weeks.
Magnetotherapy will be applied at a frequency of 50 Hz and intensity of 85 Gauss for 30 minutes per session. All participants will also receive 15 minutes of local application and 15 minutes of supervised exercises including eccentric wrist extensor exercises, isotonic strengthening, stretching, and isometric exercises.
Outcomes will be evaluated at baseline (week 0), at the end of treatment (week 3), and at follow-up (week 12). Primary and secondary outcome measures include pain intensity (Visual Analog Scale), pressure pain threshold (algometer), grip strength (hand dynamometer), functional status (PRTEE and QuickDASH questionnaires), quality of life (SF-36), clinical provocation tests (Cozen, Mill's, and Maudsley's tests), and patient satisfaction (Likert scale).
The study hypothesis is that adding magnetotherapy to standard treatment will provide additional benefit in reducing pain and improving function compared to standard treatment alone.
Age between 18 and 65 years
Clinical diagnosis of lateral epicondylitis
Tenderness over the lateral epicondyle on palpation
Tenderness over the common extensor tendon
Acute infection
Elbow surgery within the past 12 months
Presence of electronic implants (e.g., pacemaker, cochlear implant)
Pregnancy
Parallel
Pulsed Electromagnetic Field Therapy (Magnetotherapy)
DeviceActive pulsed electromagnetic field (PEMF) therapy applied to the lateral epicondyle region using a device delivering 50 Hz frequency and 85 Gauss intensity for 30 minutes per session. Treatment is administered five days per week for three consecutive weeks. The device generates an active magnetic field. All participants additionally receive 15 minutes of local application and 15 minutes of supervised therapeutic exercise including eccentric wrist extensor exercises, isotonic strengthening, stretching, and isometric exercises.
Sham Pulsed Electromagnetic Field Therapy
DeviceSham pulsed electromagnetic field therapy applied to the lateral epicondyle region using an identical device that does not emit a magnetic field. The procedure duration (30 minutes per session), frequency (five days per week), and total treatment period (three weeks) are identical to the active intervention to maintain blinding. Participants additionally receive 15 minutes of local application and 15 minutes of supervised therapeutic exercise including eccentric wrist extensor exercises, isotonic strengthening, stretching, and isometric exercises.
Change in Pain Intensity Measured by Visual Analog Scale (VAS)
Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10-cm scale ranging from 0 (no pain) to 10 (worst imaginable pain). Pain will be evaluated both at rest and during activity. The primary endpoint is the change in VAS score from baseline to post-treatment and follow-up. Lower scores indicate reduced pain severity.
Change in Pressure Pain Threshold Measured by Algometer
Pressure pain threshold over the lateral epicondyle will be measured using a standardized digital algometer (kg/cm²). Controlled pressure will be applied to the most tender point, and the value at which pain is first perceived will be recorded. Higher values indicate improved pain tolerance. The primary endpoint is the change from baseline.
Change in Grip Strength Measured by Hand Dynamometer
Grip strength will be assessed using a JAMAR® hand dynamometer with the patient seated, shoulder adducted, elbow flexed at 90°, and forearm in neutral position. Both affected and unaffected sides will be measured. The primary endpoint is the change in grip strength of the affected side from baseline. Higher values indicate improvement.
Change in Functional Status Measured by PRTEE Score
Functional disability will be evaluated using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. The PRTEE consists of 15 items assessing pain and functional limitations, with total scores ranging from 0 to 100. Higher scores indicate greater pain and disability. The primary endpoint is the change in total PRTEE score from baseline.
Change in Upper Extremity Disability Measured by QuickDASH
Upper extremity functional disability will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. The instrument consists of 11 items evaluating physical function and symptoms related to the upper limb. Scores range from 0 to 100, with higher scores indicating greater disability. The outcome measure is the change in total score from baseline.
Change in Health-Related Quality of Life Measured by SF-36
Quality of life will be evaluated using the Short Form-36 (SF-36) questionnaire, which includes eight subdomains assessing physical and mental health status. Scores range from 0 to 100 for each domain, with higher scores indicating better health-related quality of life. The outcome measure is the change in domain scores from baseline.
Change in Clinical Provocation Test Results (Cozen, Mill's, Maudsley's Tests)
Clinical provocation tests specific to lateral epicondylitis (Cozen, Mill's, and Maudsley's tests) will be performed to evaluate pain provocation. A reduction in pain response during these tests will be considered clinical improvement. Results will be recorded as positive or negative findings.
Patient Satisfaction Measured by 5-Point Likert Scale
Patient satisfaction with treatment will be assessed using a 5-point Likert scale ranging from 1 (not satisfied at all) to 5 (completely satisfied). Higher scores indicate greater satisfaction with the intervention.
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