Download PDF
OP-Journal 2012; 28(1): 72-80
DOI: 10.1055/s-0031-1298587
Georg Thieme Verlag KG Stuttgart · New York

Epikondylitis – Ätiologie, Diagnostik und therapeutische Optionen

Epicondylitis – Aetiology, Diagnostics and Therapeutic Options
Stefan Greiner
,
Carsten Perka
,
Kathi Thiele
Further Information

Publication History

Publication Date:
26 July 2012 (online)

   Permissions and Reprints

Zusammenfassung

Die Epicondylopathia humeri radialis et ulnaris ist eine schmerzhafte Erkrankung des Sehnenansatzgewebes der Extensoren- bzw. Flexorengruppe, welche ätiologisch auf eine sportliche oder berufliche Überlastung der Handgelenksextensoren bzw. -flexoren zurückzuführen ist. Die vorliegende Arbeit fasst derzeitig bestehende konservative und operative Therapiekonzepte nach Einsicht der gängigen Fachliteratur zusammen. Nicht operative Verfahren stellen noch immer den therapeutischen Kernbereich der Epikondylitiden dar. Neuere Verfahren wie die Injektion von Botulinumtoxin (gute Evidenz), Applikation von Platelet-Rich-Plasma (mäßige Evidenz) und die extrakorporale Stoßwellentherapie (geringe Evidenz) sind in die therapeutischen Algorithmen mit unterschiedlichem klinischem Erfolg aufgenommen worden. Bestehende chirurgische Verfahren als alternative Option bei frustraner konservativer Therapie zeigen ebenfalls ein geringes Evidenzlevel. Im Zuge der Entwicklungen arthroskopischer bzw. endoskopischer Techniken hat sich dieser Zugangsweg auch in der Behandlung der Epikondylopathie etabliert. Neuere konservative Therapieverfahren zeigen nur anteilig vielversprechende Ergebnisse bei z. T. nur mäßiger wissenschaftlicher Evidenzlage. Operative Verfahren sind um die arthroskopischen Techniken mit dem Vorteil der gleichzeitigen Diagnostik von intraartikulären Begleitpathologien erweitert worden.

Epicondylitis – Aetiology, Diagnostics and Therapeutic Options

Tennis elbow (epicondylopathia humeri radialis et ulnaris) is a painful disorder of the tendon insertion tissues of the extensor or, respectively, flexor groups that can be attributed to an overload due to sport or industrial activity of the wrist extensors or flexors. The present article gives a summary of the currently available conservative and surgical treatment concepts as described in the literature. Non-surgical procedures are still the therapeutic mainstay for all forms of epicondylitis. Recently presented methods such as the injection of botulinum toxin (good evidence), administration of platelet-rich plasma (moderat level of evidence) and the extracorporeal shock wave therapy (low level of evidence) have been included in the therapeutic algorithm with varying degrees of clinical success. Established surgical procedures as alternatives to failed conservative therapy also exhibit a low level of evidence. In the course of the development of arthroscopic and endoscopic techniques, these approaches have also become established in the treatment of epicondylopathies. Only few of the recent conservative therapeutic modalities show promising results albeit with only moderate levels of scientific evidence. Operative techniques have been expanded to include arthroscopic techniques with the added advantage of obtaining concomitant diagnostic information about accompanying intraarticular pathologies.

 

  • Literatur

  • 1 Runge F. Zur Genese und Behandlung des Schreibkrampfes. · Berliner Klin Wochenschr 1873; 10: 245-248
    PubMedGoogle Scholar
  • 2 Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979; 61: 832-839
    PubMedGoogle Scholar
  • 3 Regan W, Wold LE, Coonrad R, Morrey BF. Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 1992; 20: 746-749
    CrossrefPubMedGoogle Scholar
  • 4 Nirschl RP. Tennis elbow. Orthop Clin North Am 1973; 4: 787-800
    PubMedGoogle Scholar
  • 5 Morrey BF. Surgical treatment of extraarticular elbow contracture. Clin Orthop Relat Res 2000; 370: 57-64
    CrossrefPubMedGoogle Scholar
  • 6 Nirschl RP. Mesenchymal syndrome. Va Med Mon (1918) 1969; 96: 659-662
    PubMedGoogle Scholar
  • 7 Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am 1999; 81: 259-278
    CrossrefPubMedGoogle Scholar
  • 8 Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992; 11: 851-870
    PubMedGoogle Scholar
  • 9 Overend TJ, Wuori-Fearn JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther 1999; 12: 31-37
    CrossrefPubMedGoogle Scholar
  • 10 Placzek R, Lang M, Perka C, Rompe JD. [Insertional tendinopathies of te elbow]. Z Orthop Ihre Grenzgeb 2006; 144: R1-13 R4–5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol 2004; 33: 685-697
    CrossrefPubMedGoogle Scholar
  • 12 Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005; 34: 1-18
    CrossrefPubMedGoogle Scholar
  • 13 Savnik A, Jensen B, Norregaard J et al. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol 2004; 14: 964-969
    CrossrefPubMedGoogle Scholar
  • 14 Green GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone 2001; 3: 50-60
    CrossrefPubMedGoogle Scholar
  • 15 Struijs PA, Smidt N, Arola H et al. Orthotic devices for tennis elbow. Cochrane Database Syst Rev 2001; (2) CD001821
    PubMedGoogle Scholar
  • 16 Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005; 39: 411-422 discussion − 22
    CrossrefPubMedGoogle Scholar
  • 17 Bisset L, Smidt N, Van der Windt DA et al. Conservative treatments for tennis elbow do subgroups of patients respond differently?. Rheumatology (Oxford) 2007; 46: 1601-1605
    CrossrefPubMedGoogle Scholar
  • 18 Brosseau L, Casimiro L, Milne S et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev 2002; (4) CD003528
    PubMedGoogle Scholar
  • 19 Reza Nourbakhsh M, Fearon FJ. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study. Clin Rehabil 2008; 22: 601-609
    CrossrefPubMedGoogle Scholar
  • 20 Bisset L, Beller E, Jull G et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333: 939
    CrossrefPubMedGoogle Scholar
  • 21 Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med 2011; 39: 1200-1208
    CrossrefPubMedGoogle Scholar
  • 22 Smidt N, Assendelft WJ, van der Windt DA et al. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain 2002; 96: 23-40
    CrossrefPubMedGoogle Scholar
  • 23 Green S, Buchbinder R, Barnsley L et al. Acupuncture for lateral elbow pain. Cochrane Database Syst Rev 2002; (1) CD003527
    PubMedGoogle Scholar
  • 24 Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 2003; 28: 272-278
    CrossrefPubMedGoogle Scholar
  • 25 Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008; 1: 165-174
    CrossrefPubMedGoogle Scholar
  • 26 Foster TE, Puskas BL, Mandelbaum BR et al. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 2009; 37: 2259-2272
    CrossrefPubMedGoogle Scholar
  • 27 Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006; 34: 1774-1778
    CrossrefPubMedGoogle Scholar
  • 28 Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010; 38: 255-262
    CrossrefPubMedGoogle Scholar
  • 29 Peerbooms JC, van Laar W, Faber F et al. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial. BMC Musculoskelet Disord 2010; 11: 69
    CrossrefPubMedGoogle Scholar
  • 30 Connell DA, Ali KE, Ahmad M et al. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol 2006; 35: 371-377
    CrossrefPubMedGoogle Scholar
  • 31 Wolf JM, Ozer K, Scott F et al. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am 2011; 36: 1269-1272
    CrossrefPubMedGoogle Scholar
  • 32 Thanasas C, Papadimitriou G, Charalambidis C et al. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med 2011; 39: 2130-2134
    CrossrefPubMedGoogle Scholar
  • 33 Keizer SB, Rutten HP, Pilot P et al. Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res 2002; 401: 125-131
    CrossrefPubMedGoogle Scholar
  • 34 Wong SM, Hui AC, Tong PY et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2005; 143: 793-797
    CrossrefPubMedGoogle Scholar
  • 35 Placzek R, Drescher W, Deuretzbacher G et al. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am 2007; 89: 255-260
    CrossrefPubMedGoogle Scholar
  • 36 Espandar R, Heidari P, Rasouli MR et al. Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial. CMAJ 2010; 182: 768-773
    CrossrefPubMedGoogle Scholar
  • 37 Hayton MJ, Santini AJ, Hughes PJ et al. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am 2005; 87: 503-507
    CrossrefPubMedGoogle Scholar
  • 38 Jabbari B, Machado D. Treatment of refractory pain with botulinum toxins – an evidence-based review. Pain Med 2011; 12: 1594-1606
    CrossrefPubMedGoogle Scholar
  • 39 Kalichman L, Bannuru RR, Severin M, Harvey W. Injection of botulinum toxin for treatment of chronic lateral epicondylitis: systematic review and meta-analysis. Semin Arthritis Rheum 2011; 40: 532-538
    CrossrefPubMedGoogle Scholar
  • 40 Placzek R, Jerosch J, Reißig A, Söhling M. Botulinumtoxin in Orthopädie und Sportmedizin. Bremen: UNI – MED SCIENCE; 2006
    Google Scholar
  • 41 http://www.digest-ev.de
    PubMed
  • 42 Rompe JD, Hopf C, Kullmer K et al. Low-energy extracorporal shock wave therapy for persistent tennis elbow. Int Orthop 1996; 20: 23-27
    CrossrefPubMedGoogle Scholar
  • 43 Haake M, Konig IR, Decker T et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am 2002; 84: 1982-1991
    PubMedGoogle Scholar
  • 44 Wild C, Khene M, Wanke S. Extracorporeal shock wave therapy in orthopedics. Assessment of an emerging health technology. Int J Technol Assess Health Care 2000; 16: 199-209
    CrossrefPubMedGoogle Scholar
  • 45 Buchbinder R, Green SE, Youd JM et al. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev 2005; (4) CD003524
    PubMedGoogle Scholar
  • 46 Buchbinder R, Green SE, Youd JM et al. Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain. J Rheumatol 2006; 33: 1351-1363
    PubMedGoogle Scholar
  • 47 Ramsey ML, Getz CL, Parsons BO. Whatʼs new in shoulder and elbow surgery. J Bone Joint Surg Am 2010; 92: 1047-1061
    CrossrefPubMedGoogle Scholar
  • 48 Staples MP, Forbes A, Ptasznik R et al. A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol 2008; 35: 2038-2046
    PubMedGoogle Scholar
  • 49 Smidt N, van der Windt DA, Assendelft WJ et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 2002; 359: 657-662
    CrossrefPubMedGoogle Scholar
  • 50 Kalainov DM, Cohen MS. Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Joint Surg Am 2005; 87: 1120-1125
    CrossrefPubMedGoogle Scholar
  • 51 Buchbinder R, Johnston RV, Barnsley L et al. Surgery for lateral elbow pain. Cochrane Database Syst Rev 2011; (3) CD003525
    PubMedGoogle Scholar
  • 52 Mittelmeier H. [Surgical management of insertion-tendon diseases resistant to therapy]. Beitr Orthop Traumatol 1975; 22: 61-63
    PubMedGoogle Scholar
  • 53 Bankes MJ, Jessop JH. Day-case simple extensor origin release for tennis elbow. Arch Orthop Trauma Surg 1998; 117: 250-251
    CrossrefPubMedGoogle Scholar
  • 54 Rayan GM, Coray SA. V–Y slide of the common extensor origin for lateral elbow tendonopathy. J Hand Surg Am 2001; 26: 1138-1145
    CrossrefPubMedGoogle Scholar
  • 55 Wilhelm A. [Treatment of therapy refractory epicondylitis lateralis humeri by denervation. On the pathogenesis]. Handchir Mikrochir Plast Chir 1999; 31: 291-302
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstructive operation. Clin Orthop Relat Res 1970; 72: 248-253
    PubMedGoogle Scholar
  • 57 Coonrad RW, Hooper WR. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am 1973; 55: 1177-1182
    PubMedGoogle Scholar
  • 58 Rajeev A, Pooley J. Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg 2009; 75: 37-40
    PubMedGoogle Scholar
  • 59 Baker Jr. CL, Murphy KP, Gottlob CA, Curd DT. Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg 2000; 9: 475-482
    CrossrefPubMedGoogle Scholar
  • 60 Baker Jr. CL, Baker 3rd CL. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med 2008; 36: 254-260
    CrossrefPubMedGoogle Scholar
  • 61 Baker Jr. CL, Jones GL. Arthroscopy of the elbow. Am J Sports Med 1999; 27: 251-264
    PubMedGoogle Scholar
  • 62 Savoie 3rd FH, Field LD, Gurley DJ. Arthroscopic and open radial ulnohumeral ligament reconstruction for posterolateral rotatory instability of the elbow. Hand Clin 2009; 25: 323-329
    CrossrefPubMedGoogle Scholar