The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on extracorporeal shockwave therapy for refractory tennis elbow.

Guidance has also been issued on Extracorporeal shockwave therapy for refractory Achilles tendinopathy and Extracorporeal shockwave therapy for refractory plantar fasciitis. It replaces the previous guidance on Extracorporeal shockwave therapy for refractory tendinopathies (plantar fasciitis and tennis elbow) (NICE interventional procedure guidance 139, November 2005).


Tennis elbow is a condition affecting the tendons of the elbow which connect the muscles of the forearm to the upper arm bone. It may be associated with tiny tears in the fibres of the tendon and is usually caused by overuse or injury. Symptoms include pain in the outer part of the elbow, weakness or stiffness. In extracorporeal shockwave therapy, a machine is used to deliver sound waves to the painful area. It is not known exactly how it works, but it is thought that it might stimulate healing of the tendons.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)