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Epicondylitis humeri radialis: konservativ – operativ

Lateral epicondylitis: conservative – operative

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Zusammenfassung

Hintergrund

Die Epicondylitis humeri radialis ist eine häufige Krankheit des humeralen Unterarmextensorenansatzes. Obwohl die Erkrankung häufig spontan ausheilt, kann es bei ausbleibender Heilung zu chronischen therapieresistenten Beschwerden mit erheblichen Funktionseinschränkungen des betroffenen Arms kommen.

Fragestellung

Die unterschiedlichen konservativen und operativen Therapieverfahren bei Epicondylitis humeri radialis werden dargestellt und untereinander auf ihre Vor- und Nachteile verglichen. Weiterhin erfolgt die Beschreibung gängiger Operationstechniken und ihrer Komplikationen. Anhand aktueller Literatur wird herausgearbeitet, inwieweit die einzelnen Therapieverfahren Anwendung finden.

Material und Methoden

Diese Übersichtsarbeit wurde basierend auf einer selektiven Literaturrecherche in u. a. der Datenbank PubMed zum Thema „konservative und operative Therapie der Epicondylitis humeri radialis“ und der klinischen Erfahrungen der Autoren erstellt.

Ergebnisse

Die konservative Therapie gilt als primäre Wahl zu Behandlung der lateralen Epicondylitis, wobei eine Begleitpathologie ausgeschlossen werden sollte. Sie sollte eine Kräftigung gegen Widerstand beinhalten, mit exzentrischen Dehnungsübungen der Extensorengruppe. Bei persistierenden Beschwerden ist die operative Therapie erforderlich. Dabei zeigt die Resektion des pathologisch veränderten Extensorensansatzes mit Anfrischung und Refixation gute Ergebnisse.

Schlussfolgerung

Die meisten Patienten mit Epicondylitis lateralis können mit konservativer Therapie erfolgreich behandelt werden. Bei therapierefraktärem Verlauf sollte eine weitere radiologische Bildgebung erfolgen. Bei höhergradigen Teil- oder Komplettrupturen des gemeinsamen Sehnenansatzes und einer fraglichen Mitbeteiligung des lateralen Kollateralbandkomplexes sollte eine Operation erwogen werden.

Abstract

Background

Lateral epicondylitis is a common disease of the common extensor origin at the lateral humerus. Despite its common self-limitation it can lead to chronic therapy-resistant pain with remarkable functional disability of the affected arm.

Objectives

Different conservative and operative treatment options of lateral epicondylitis are described and compared regarding benefits and risks. Additionally, recent surgical techniques and their complications are mentioned. Based on the current literature, it is shown which treatment option can be recommended.

Methods

This review was based on the literature analysis in PubMed regarding “conservative and operative therapy of lateral epicondylitis” as well as the clinical experience of the authors.

Results

Conservative treatment is the primary choice for the treatment of lateral epicondylitis if concomitant pathologies such as instability among others can be excluded. It should include strengthening against resistance with eccentric stretching of the extensor group. In persistent cases, operative treatment is warranted. Resection of the pathologic tissue at the extensor origin with debridement and refixation of the healthy tendinous tissue yields good results.

Conclusions

Most patients with lateral epicondylitis can be treated conservatively with success. Radiological evaluation should be performed in therapy-resistant cases. In the case of partial or complete rupture of the extensor origin, operative therapy is indicated.

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Authors and Affiliations

  1. Sporthopaedicum Regensburg, Hildegard-von-Bingen-Str. 1, 93053, Regensburg, Deutschland

    Burak Altintas &  Stefan Greiner

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  1. Burak Altintas
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  2. Stefan Greiner
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Correspondence to Stefan Greiner.

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B. Altintas und S. Greiner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Altintas, B., Greiner, S. Epicondylitis humeri radialis: konservativ – operativ. Orthopäde 45, 870–877 (2016). https://doi.org/10.1007/s00132-016-3327-9

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