Lateral Epicondylitis or Fibromyalgia Tender Point? Diagnostic Pitfalls and the Risk of Unnecessary ESWT

Authors : Gülseren Demir Karakılıç, Sefa Gümrük Aslan, Ferda Surel

Pages : 430-437

Doi:10.16919/bozoktip.1789587

View : 54 | Download : 116

Publication Date : 2025-12-15

Article Type : Research Paper

Abstract :Objective: The aim of this study is to determine the frequency of fibromyalgia syndrome in patients with lateral epicondylitis receiving Extracorporeal Shock Wave Therapy (ESWT) treatment. Material and Methods: The study was a retrospective study. All patients who received ESWT treatment in City Hospital Physical Therapy Unit between January 2017 and December 2023 were retrospectively screened and patients with a diagnosis of lateral epicondylitis were included in study. Demographic information of patients such as age and gender; epicondylitis side, number of ESWT sessions, invoice amount, cost and whether have diagnosis of fibromyalgia syndrome were recorded. Results: A total of 2810 patients who received ESWT treatment with the diagnosis of lateral epicondylitis were included in study. While 1851 patients were diagnosed with unilateral epicondylitis, 959 patients were treated with the diagnosis of bilateral epicondylitis. While 1319 (71.3%) of the patients with unilateral epicondylitis were women, 761 (79.4%) of the patients with bilateral epicondylitis were women and there was a significant gender difference between groups, and female gender was more common in bilateral epicondylitis (p: 0.000). The mean age of patients with unilateral epicondylitis was 46.30±12.73 years, while the mean age of patients with bilateral epicondylitis was 46.54±11.83 years, and there was no significant difference between groups in terms of mean age (p:0.626). While 11(0.6) of unilateral epicondylitis patients had fibromyalgia syndrome, 184(19.2%) of bilateral epicondylitis patients had fibromyalgia syndrome and there was a significant difference between groups in terms of fibromyalgia syndrome frequency, and fibromyalgia syndrome was more common in bilateral epicondylitis (p: 0.000). We found both lateral epicondylitis and fibromyalgia syndrome more common in women and middle age. Conclusion: Our study is the first to investigate the fibromyalgia syndrome in lateral epicondylitis. It was observed that frequency of fibromyalgia syndrome increased in bilateral epicondylitis compared to normal population studies. The lateral epicondyle region, one of the common pain areas included in the Fibromyalgia Syndrome Diagnostic Criteria, can lead to diagnostic confusion and patients may have been mistakenly diagnosed with lateral epicondylitis despite actually having fibromyalgia syndrome and may have received unnecessary ESWT treatment. It should be kept in mind that fibromyalgia syndrome may accompany patients with bilateral lateral epicondylitis in particular, and patients should first be given fibromyalgia treatment, which is a multidisciplinary treatment such as medication, exercise, lifestyle changes, alternative and supportive therapies, and awareness should be raised about not using the costly ESWT treatment unnecessarily.
Keywords : Lateral Epikondilit, Ekstrakorporeal Şok Dalga Tedavisi, Fibromiyalji Sendromu, Prevalans

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