Image-guided versus palpation-guided injections for the
                    treatment of chronic lateral epicondylopathy: a randomized controlled clinical
                    trial

Michael-Alexander Malahias; Maria-Kyriaki Kaseta; Sotirios-Tsambikos Kazas; Panayiotis D Megaloikonomos; Andreas F Mavrogenis; George C Babis

doi:10.1055/a-0732-5556

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2018; 50(05): 348-352
DOI: 10.1055/a-0732-5556

Originalarbeit

Image-guided versus palpation-guided injections for the treatment of chronic lateral epicondylopathy: a randomized controlled clinical trial

Ultraschall- versus palpationsgesteuerte Injektionen zur Behandlung der chronischen lateralen Epikondylopathie: eine randomisierte kontrollierte klinische Studie

Authors

Michael-Alexander Malahias

¹Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Maria-Kyriaki Kaseta

¹Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Sotirios-Tsambikos Kazas

¹Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Panayiotis D Megaloikonomos

²First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Andreas F Mavrogenis

²First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
George C Babis

¹Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece

Abstract

Background There have been several studies published comparing the ultrasound-guided with the “blind” infiltrations in the shoulder’s area. On the contrary, there is only very limited data regarding the necessity of ultrasound guidance in lateral epicondylitis.

Materials and Methods A prospective, randomized, blinded at initial and follow-up evaluation, comparative clinical trial was conducted, involving 44 patients with a history of chronic persistent epicondylopathy. The patients were randomly divided into 2 groups of 22 people each. Group A patients underwent three ultrasound-guided betamethazone injections, while group B included those who underwent three “blind” injections, centered at the palpable point of maximum pain. The evaluation was done before and after (4 and 12 weeks) the injections using the Visual Analogue Scale for pain (VAS, 0–10) and the Roles & Maudsley score.

Results There was not any significant statistical difference between the two groups as for mean VAS at 4 weeks (p = 0.150, t-test) and mean VAS at 12 weeks (p = 0.286, t-test). Furthermore, the final success rate, as measured by the Roles & Maudsley score, was slightly superior in group B (67 % of the patients with excellent or good results) when compared with group A (46 % of the patients), but without any statistical difference (p = 0.161, chi-square).

Conclusion Our trial proved that an ultrasound-guided injection is not superior than a palpation-guided injection of corticosteroids in the treatment of lateral epicondylopathy.

Zusammenfassung

Hintergrund In mehreren Studien wurden ultraschallgesteuerte mit „blinden“ Infiltrationen im Schulterbereich verglichen. Im Gegensatz dazu gibt es nur sehr begrenzte Daten bezüglich der ultraschallkontrollierten Infiltrationstherapie bei einer Epikondylitis humeri lateralis.

Patienten und Methoden: In die prospektive, randomisierte, verblindete Studie wurden 44 Patienten mit chronischer, therapieresistenter Epikondylitis humeri lateralis eingeschlossen. Die Patienten wurden nach dem Zufallsprinzip in 2 Gruppen von jeweils 22 Patienten eingeteilt. Patienten der Gruppe A erhielten drei ultraschallgesteuerte Betamethazon-Injektionen, Patienten der Gruppe B drei „blinde“ (= palpationsgesteuerte) Injektionen am Ort ihrer maximalen Schmerzen. Vor sowie 4 und 12 Wochen nach der letzten Injektion wurden die Schmerzen mittels der Visuellen Analogskala (VAS, 0–10) und der Roles & Maudsley-Score erfasst.

Ergebnisse Weder 4 noch 12 Wochen nach Injektionsbehandlung fand sich ein statistisch signifikanter Unterschied punkto Schmerzen (p = 0,150; p = 0,286). Bzgl. der endgültiger Erfolgsrate (Roles & Maudsley-Score) zeigte sich Gruppe B mit 67 % exzellenten oder guten Ergebnissen der Gruppe A mit 46% exzellenten oder guten Ergebnissen leicht überlegen, ohne dass dies statistisch signifikant war.

Schlussfolgerung Die Studie zeigt, dass eine ultraschallgesteuerte Injektionsbehandlung der Epikondylitis humeri lateralis der palpationsgesteuerten nicht überlegen ist.

Key words

ultrasound-guided - palpation-guided - epicondylopathy - epicondylitis - corticosteroid injections

Schlüsselwörter

ultraschallgesteuert - palpationsgesteuert - Epikondylopathie - Epikondylitis - Kortikosteroidinjektionen

Full Text

References

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