Sportverletz Sportschaden 2010; 24(4): 218-224
DOI: 10.1055/s-0029-1245441
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Die Therapie der Epicondylitis – eine aktuelle Übersicht

Treatment of Epicondylitis – a Current ReviewI. Schleicher1 , G. Szalay1 , J. Kordelle2
  • 1Klinik für Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH in Gießen
  • 2Klinik für Orthopädie, Universitätsklinikum Gießen und Marburg GmbH in Gießen
Further Information

Publication History

Publication Date:
14 December 2010 (online)

Zusammenfassung

Die Epicondylitis radialis humeri oder auch Tennisellbogen ist eine sehr häufige Erkrankung, die nicht nur bei Tennisspielern, sondern im Zusammenhang mit vielerlei Aktivitäten auftritt und ein Überlastungssyndrom der Unterarmextensoren darstellt. Bereits bei der Differenzialdiagnose sind dennoch viele andere Erkrankungen abzugrenzen. Die Auswahl an Therapieoptionen ist unüberschaubar und es existieren nur wenige gute klinische Studien, die ein Therapiekonzept evidenzbasiert hinsichtlich Wirksamkeit unterstützen. Im akuten Stadium erweist sich die lokale Anwendung von NSAIR, Steroidinjektionen, Ultraschall oder Akupunktur als hilfreich. Hinsichtlich der Wirksamkeit von Krankengymnastik, Orthesen, Lasertherapie, Elektrotherapie oder Botulinumtoxininjektion besteht zurzeit kein Konsens. Im chronischen Stadium der Erkrankung erweist sich gemäß Evidenzkriterien bisher keine Therapie als wirksam. Ob Patienten in dieser Phase von Krankengymnastik, Orthesen, Stoßwellentherapie oder einer Operation profitieren, ist nicht bewiesen. Ob in Zukunft orthobiologische Verfahren eine Rolle spielen werden, ist gegenwärtig noch ungewiss.

Abstract

Lateral epicondylitis or tennis elbow is a common injury, which affects not only people who play tennis but occurs with many different activities. It reflects overuse of the extensor muscles of the forearm. There are some other pathologies which have to be separated from epicondylitis. The choice of different treatments is hard to overlook and there are only a few good clinical trials which support one treatment option by means of evidence based medicine. During the acute phase topical NSAIR, steroid injections, ultrasound and acupuncture are helpful. There is no consensus about the effectiveness of physiotherapy, orthoses, laser, electrotherapy or botulinumtoxininjections. During the chronic phase none of the different treatment modalities is effective according to criterias of evidence based medicine. By now, it has not been proven whether patients profit during that time of physiotherapy, orthoses, extracorporeal shock wave therapy or an operation. Whether orthobiological treatment options may play a role in the future is presently uncertain.

Literatur

  • 1 Antuna S A, O’Driscoll S W. Snapping plicae associated with radiocapitellar chondromalacia.  Arthroscopy. 2001;  17 491-495
  • 2 Barr S, Cerisola F L, Blanchard V. Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: a systematic review.  Physiotherapy. 2009;  95 251-265
  • 3 Bosworth D M. Surgical treatment of tennis elbow, a follow-up study.  J Bone Joint Surg Am. 1965;  47 1533-1536
  • 4 Bouter L M. Insufficient scientific evidence for efficacy of widely used electrotherapy, laser therapy, and ultrasound treatment in physiotherapy.  Ned Tijdschr Geneeskd. 2000;  144 502-505
  • 5 Brosseau L, Casimiro L, Milne S et al. Deep transverse friction massage for treating tendinitis.  Cochrane Database Syst Rev. 2002;  4 CD003528
  • 6 Buchbinder R, Green S, Bell S et al. Surgery for lateral elbow pain.  Cochrane Database Syst Rev. 2002;  1 CD003525
  • 7 Buchbinder R, Green S E, Youd J M et al. Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain.  J Rheumatol. 2006;  33 1351-1363
  • 8 Bunata R E, Brown D S, Capelo R. Anatomic factors related to the cause of tennis elbow.  J Bone Joint Surg Am. 2007;  89 1955-1963
  • 9 Chang W D, Wu J H, Yang W J et al. Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: Systematic Review.  Photomed Laser Surg. 2009;  [Epub ahead of print]
  • 10 Coenen W. A diagnostic sign in so-called epicondylitis humeri radialis.  Z Orthop Ihre Grenzgeb. 1986;  124 323-326
  • 11 Dahmen G, Best S, Siebert W. et al .Epicondylopathia radialis humeri. In (Hrsg) Leitlinien der Orthopädie.. Köln: Deutscher Ärzte Verlag; 2002: 27-29
  • 12 Förster K K, Schmid K, Reichelt A. Sports-induced acute epicondylitis of the elbow and conservative therapy].  Sportverletz Sportschad. 1997;  11 16-20
  • 13 Goodfellow J W, Bullough P G. The pattern of ageing of the articular cartilage of the elbow joint.  J Bone Joint Surg Br. 1967;  49 175-181
  • 14 Green S, Buchbinder R, Barnsley L et al. Acupuncture for lateral elbow pain.  Cochrane Database Syst Rev. 2002;  1 CD003527
  • 15 Green S, Buchbinder R, Barnsley L et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults.  Cochrane Database Syst Rev. 2009;  2 CD003686
  • 16 Haahr J P, Andersen J H. Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice.  Rheumatology. 2003;  42 1216-1225
  • 17 Hay E M, Paterson S M, Lewis M et al. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care.  BMJ. 1999;  319 964-968
  • 18 Karkhanis S, Frost A, Maffulli N. Operative management of tennis elbow: a quantitative review.  Br Med Bull. 2008;  88 171-188
  • 19 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
  • 20 Kivi P. Rheumatic disorders of the upper limbs associated with repetitive occupational tasks in Finland in 1975 – 1979.  Scand J Rheumatol. 1984;  13 101-107
  • 21 Korthals-Bos I B, Smidt de N, Tulder M W et al. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care.  Pharmacoeconomics. 2004;  22 185-195
  • 22 Krahl van H, Langhoff J. Degenerative tendon changes following local application of corticoids.  Z Orthop Ihre Grenzgeb. 1971;  109 501-511
  • 23 Maier M, Milz S, Wirtz D C et al. Basic research of applying extracorporeal shockwaves on the musculoskeletal system. An assessment of current status.  Orthopade. 2002;  31 667-677
  • 24 Miller T T, Shapiro M A, Schultz E et al. Comparison of sonography and MRI for diagnosing epicondylitis.  J Clin Ultrasound. 2002;  30 193-202
  • 25 Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.  Am J Sports Med. 2006;  34 1774-1778
  • 26 Nirschl R P, Pettrone F A. Tennis elbow. The surgical treatment of lateral epicondylitis.  J Bone Joint Surg Am. 1979;  61 832-839
  • 27 Paoloni J A, Appleyard R C, Nelson J et al. Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blinded, placebo-controlled clinical trial.  Am J Sports Med. 2005;  33 806-813
  • 28 Perlick L, Gassel F, Zander D et al. Comparison of results of results of medium energy ESWT and Mittelmeier surgical therapy in therapy refractory epicondylitis humeri radialis.  Z Orthop Ihre Grenzgeb. 1999;  137 316-321
  • 29 Pfandl S, Wetzel R, Hackspacher J et al. Supinator tunnel syndrome – a differential diagnosis of so-called tennis elbow.  Sportverletz Sportschad. 1992;  6 71-76
  • 30 Roetert E P, Brody H, Dillman C J et al. The biomechanics of tennis elbow. An integrated approach.  Clin Sports Med. 1995;  14 47-57
  • 31 Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review.  Curr Rev Musculoskelet Med. 2008;  1 165-174
  • 32 Seegenschmiedt M H, Katalinic A, Makoski H et al. Radiation therapy for benign diseases: patterns of care study in Germany.  Int J Radiat Oncol Biol Phys. 2000;  47 195-202
  • 33 Shiri R, Viikari-Juntura E, Varonen H et al. Prevalence andeterminants of lateral and medial epicondylitis: a population study.  Am Jpidemiol. 2006;  164 1065-1074
  • 34 Silverstein B, Welp E, Nelson N et al. Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.  Am J Public Health. 1998;  88 1827-1833
  • 35 Smidt N, Windt D A, Assendelft W J et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.  Lancet. 2002;  359 657-662
  • 36 Smidt van der N, Assendelft W J, Windt D A et al. Corticosteroid injections for lateral epicondylitis: a systematic review.  Pain. 2002;  96 23-40
  • 37 Smola van der C. About the problem of radial tunnel syndrome or „where does the tennis elbow end and where does the radial tunnel syndrome begin?.  Handchir Mikrochir Plast Chir. 2004;  36 241-245
  • 38 Struijs P A, Smidt N, Arola H et al. Orthotic devices for the treatment of tennis elbow.  Cochrane Database Syst Rev. 2002;  1 CD001821
  • 39 Struijs P A, Kerkhoffs G M, Assendelft W J et al. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both – a randomized clinical trial.  Am J Sports Med. 2004;  32 462-469
  • 40 Tomaino M M, Towers J D. Clinical presentation and radiographic findings of distal biceps tendon degeneration: a potentially forgotten cause of proximal radial forearm pain.  Am J Orthop. 2004;  33 31-34
  • 41 Trinh K V, Phillips S D, Ho E et al. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review.  Rheumatology. 2004;  43 1085-1090
  • 42 Tumilty S, Munn J, McDonough S et al. Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis.  Photomed Laser Surg. 2010;  28 3-16
  • 43 Windt D A, Heijden van der G J, Berg van den S G et al. Ultrasound therapy for musculoskeletal disorders: a systematic review.  Pain. 1999;  81 257-271
  • 44 Rijn van R M, Huisstede B M, Koes B W et al. Associations between work-related factors and specific disorders at the elbow: a systematic literature review.  Rheumatology. 2009;  48 528-536
  • 45 Walker-Bone van der K, Palmer K T, Reading I et al. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population.  Arthritis Rheum. 2004;  51 642-651
  • 46 Wanivenhaus A. Differential diagnosis of epicondylitis humeri radialis.  Z Orthop Ihre Grenzgeb. 1986;  124 775-779
  • 47 Wilhelm A. Treatment of therapy refractory epicondylitis lateralis humeri by denervation. On the pathogenesis.  Handchir Mikrochir Plast Chir. 1999;  31 291-302
  • 48 Woodley B L, Newsham-West R J, Baxter G D. Chronic tendinopathy: effectiveness of eccentric exercise.  Br J Sports Med. 2007;  41 188-198
  • 49 Wong S M, Hui A C, Tong P Y et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial.  Ann Intern Med. 2005;  143 793-797

Dr. Iris Schleicher

Klinik für Unfallchirurgie, Universitätsklinikum Gießen und Marburg in Gießen

Rudolf-Buchheim-Str. 7

35385 Gießen

Email: iris.schleicher@ortho.med.uni-giessen.de

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