Skip to main content

Advertisement

SpringerLink
Log in

Stoßwellentherapie bei Tendinopathien der oberen Extremität

Tennisellenbogen

Shock wave treatment for lateral elbow tendinopathy

  • VARIA
  • Published:
Obere Extremität Aims and scope Submit manuscript

Summary

In a current Cochrane review based upon systematic review of nine placebo-controlled trials “Platinum” level evidence was found that shock wave therapy provided little or no benefit in terms of pain and function in lateral elbow pain. With the relevant data of those studies statistically and clinically too heterogeneous, the conclusion of this pooled meta-analysis was considered misleading, and a qualitative analysis was performed.

Ten relevant trials were retrieved (948 participants and evaluated following Chalmers' criteria. Conflicting results of those studies were probably due to variations in treatment regimen (use of local anaesthesia) and patient selection (chronic vs. acute cases). Three high-quality randomised controlled trials (255 participants) homogenously reported the following requirements for successful shock wave treatment: Strict selection of chronic patients (symptoms > 6 months, recalcitrant to conventional treatment); application of 1500–2000 shocks of low-energy flux density (0.08–0.15 mJ/mm2); application to the site of maximal discomfort (clinical focusing); weekly intervals (3–4 applications); no local anaesthesia; at least 3 months follow-up after the last application.

Shock wave treatment for tennis elbow is effective only under well-defined conditions. These conditions, together with a uniformly used outcome measurement, must be made the central and obligatory part of guidelines for shock wave treatment of tennis elbow immediately.

Zusammenfassung

Eine aktuelle Cochrane Meta-Analyse von 9 plazebokontrollierten Studien ergab nach dem Pooling „Platin“-Evidenz für eine Unwirksamkeit der Stoßwellentherapie (SWT) bezüglich Schmerz und Funktion bei Patienten mit einer Ansatztendinopathie des lateralen Ellenbogens. Durch die Vermischung klinisch und statistisch vollkommen inhomogener Untersuchungen wurde diese Schlussfolgerung jedoch als missverständlich angesehen und daher eine qualitative Analyse angestrebt.

10 Studien (11 Publikationen, 1 Doppelpublikation) mit 948 Teilnehmern wurden identifiziert und qualitativ anhand der Chalmers- Kriterien von 0–100 Punkten eingestuft.

Als Ursache gegensätzlicher klinischer Ergebnisse wurden Unterschiede der methodischen Qualität, des Behandlungsregimes, der Patientenselektion und der Nachuntersuchungszeitpunkte gefunden. Nur 6 Studien wiesen eine hochwertige Methodik auf (Chalmers-Score >70 Pkt). Drei unabhängig durchgeführte Studien identifizierten folgende Kriterien für eine erfolgreiche Durchführung einer SWT bei lateraler Epikondylopathie: Auswahl chronisch-therapieresistenter Patienten; Applikation von 1500–2000 niedrig-energetischen Impulsen (0.08–0.15 mJ/mm2); Klinisches Fokussieren; Wöchentliche Intervalle (3–4 Applikationen); Keine Lokalanästhesie; Mindestens 3-monatiges Follow-up.

Eine SWT war nur unter ganz bestimmten Voraussetzungen wirksam. Es ist erforderlich, dass diese definierten Voraussetzungen endlich durch die Stoßwellengesellschaften implementiert werden. Entsprechend der Datenlage ist die SWT bei lateraler Epikondylopathie weiterhin als vorletzte Therapiestufe zu sehen, unmittelbar vor Indikationsstellung zur operativen Intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Ashe MC et al. (2004) Tendinopathies of the upper extremity. A Paradigm shift. J Hand Ther 17:329–334

    PubMed  Google Scholar 

  2. Boyer MI, Hastings H (1999) Lateral tennis elbow: Is there any science out there? J Shoulder Elbow Surg 8:481–491

    Article  PubMed  CAS  Google Scholar 

  3. Buchbinder R et al. (2005) Shock wave therapy for lateral elbow pain (Review). Cochrane Database Syst Rev

  4. Buchbinder R et al. (2002) Surgery for lateral elbow pain (Cochrane Review). Cochrane Database Syst Rev. CD003525

  5. Chalmers TC et al. (1981) A method for assessing the quality of a randomized control trial. Control Clin Trials 2:31–49

    Article  PubMed  CAS  Google Scholar 

  6. Chen YJ et al. (2004) Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. J Orthop Res 22:854–861

    Article  PubMed  CAS  Google Scholar 

  7. Chung B, Wiley JP (2004) Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial. Am J Sports Med 32:1660–1667

    Article  PubMed  Google Scholar 

  8. Chung B et al. (2005) Long-Term effectiveness of extracorporeal shockwave therapy in the treatment of previously untreated lateral epicondylitis. Clin J Sport Med 15:305–312

    Article  PubMed  CAS  Google Scholar 

  9. Cole BJ, Schumacher HR (2005) Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13:37–46

    PubMed  Google Scholar 

  10. Crowther A et al. (2002) A prospective study to compare extracorporeal shock wave therapy and injection of steroid for the treatment of tennis elbow. J Bone Joint Surg 84:B678–B679

    Article  Google Scholar 

  11. Erak S et al. (2004) The role of supinator in the pathogenesis of chronic lateral elbow pain: a biomechanical study. J Hand Surg [Br] 29:461–464

    Article  CAS  Google Scholar 

  12. Fink M et al. (2002) Acupuncture in chronic epicondylitis: a randomized controlled trial. Rheumatology (Oxford) 41:205–209

    Article  PubMed  CAS  Google Scholar 

  13. Green S et al. (2002) Acupuncture for lateral elbow pain (Cochrane Review). Cochrane Database Syst Rev. CD003527

  14. Green S et al. (2002) Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. CD003686

  15. Haahr JP, Andersen JH (2003) 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 42:1–10

    Article  Google Scholar 

  16. Haake M et al. (2002) Extracorporeal shock wave therapy in the treatment of lateral epicondylitis. J Bone Joint Surg 84:A1982–A1991

    Google Scholar 

  17. Kraushaar BS, Nirschl RP (1999) Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. JBJS 81:A259–A278

    Google Scholar 

  18. Labek G et al. (2005) Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis. Z Orthop Ihre Grenzgeb 143:240–246

    Article  PubMed  CAS  Google Scholar 

  19. Macdermid J (2005) Update: The Patient-rated Forearm Evaluation Questionnaire Is now the Patient-rated Tennis Elbow Evaluation. J Hand Ther 18:407–410

    PubMed  Google Scholar 

  20. Mehra A et al. (2003) The use of a Mobile Lithotripter in the treatment of Tennis Elbow and Plantar Fasciitis. Surg J R Coll Surg Edinb Irel 1:290–292

    CAS  Google Scholar 

  21. Melegati G et al. (2004) Comparison of two ultrasonographic localization techniques for the treatment of lateral epicondylitis with extracorporeal shock wave therapy: a randomized study. Clinical Rehabilitation 18:366–370

    Article  PubMed  Google Scholar 

  22. Melikyan EY et al. (2003) Extracorporeal shock wave therapy for tennis elbow. A randomized double blind study. J Bone Joint Surg 85:B852–B855

    Google Scholar 

  23. David Moher et al. (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement Lancet 354:1896–1900

    Article  PubMed  CAS  Google Scholar 

  24. Newcomer KL et al. (2005) Sensitivity of the Patient-rated Forearm Evaluation Questionnaire in Lateral Epicondylitis. J Hand Ther 8:400–406

    Google Scholar 

  25. Nirschl RP et al. (2003) Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. Am J Sports Med 31:189–194

    PubMed  Google Scholar 

  26. Nirschl RP, Ashman ES (2004) Tennis elbow tendinosis (epicondylitis). Instr Course Lect 53:587–598

    PubMed  Google Scholar 

  27. Ohtori S. et al. (2001) Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres. Neurosci Lett 315:57–60

    Article  PubMed  CAS  Google Scholar 

  28. Overend TJ et al. (1999) Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther 12:31–37

    PubMed  CAS  Google Scholar 

  29. Pettrone F, McCall B (2005) Extracorporeal shock wave therapy without local anaesthesia for chronic lateral epicondylitis. J Bone Joint Surg 87:1297–1304

    Article  PubMed  Google Scholar 

  30. Rompe J et al. (1996) Analgesic effects of extracorporeal shock wave therapy on chronic tennis elbow. J Bone Joint Surg 78:B233–B237

    Google Scholar 

  31. Rompe J et al. (2004) Repetitive low energy shock wave treatment for chronic lateral epicondylitis in tennis players. Am J Sports Med 32:734–743

    Article  PubMed  Google Scholar 

  32. Rompe J et al. (2005) Repetitive lowenergy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res 23:931–941

    PubMed  Google Scholar 

  33. Scott A et al. (2004) What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. Br J Sports Med 38:372–380

    Article  PubMed  CAS  Google Scholar 

  34. Sems A, Dimeff R, Ianotti JP. (2006) Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 14:195–204

    PubMed  Google Scholar 

  35. Sharma P, Maffulli N (2005) Tendon injury and tendinopathy: Healing and repair. J Bone Joint Surg 87:A187–A202

    Article  Google Scholar 

  36. Smidt N et al. (2002) Corticosteroid injections for lateral epicondylitis: a systematic review. Pain 96:23–40

    Article  PubMed  CAS  Google Scholar 

  37. Smidt N et al. (2002) Corticosteroid injections, physiotherapy, or a wait-andsee policy for lateral epicondylitis: a randomised controlled trial. Lancet 359:657–662

    Article  PubMed  CAS  Google Scholar 

  38. Spacca G et al. (2005) Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Eur Med Phys 41:17–25

    CAS  Google Scholar 

  39. Speed C et al. (2002) Extracorporeal shock wave therapy for lateral epicondylitis: a double blind randomized controlled trial. J Orthop Res 20:895–898

    Article  PubMed  CAS  Google Scholar 

  40. Stasinopoulos D, Johnson MI (2005) Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). Br J Sports Med 39:132–136

    Article  PubMed  CAS  Google Scholar 

  41. Struijs PA et al. (2002) Orthotic devices for the treatment of tennis elbow (Cochrane Review). Cochrane Database Syst Rev. CD001821

  42. Takahashi N et al.: Second application of low-energy shock waves has a cumulative effect on free nerve endings. Clin Orthop 443:315–319

  43. Teitz CC et al. (1997) Tendon problems in athletic individuals. JBJS 79:A138–A152

    Google Scholar 

  44. Theis C et al. (2004) Evidence-based evaluation of present guidelines for the treatment of tennis elbow – a review. Zentralbl Chir 129:252–260

    Article  PubMed  CAS  Google Scholar 

  45. Van de Streek MD et al. (2004) The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis. Prosthet Orthot Int 28:183–189

    PubMed  CAS  Google Scholar 

  46. Van Tulder MW et al. (1997) Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for spinal disorders. Spine 22:2323–2330

    Article  PubMed  CAS  Google Scholar 

  47. Walker-Bone K et al. (2004) Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 51:642–651

    Article  PubMed  Google Scholar 

  48. Wang CJ et al. (2003) Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 21:984–989

    Article  PubMed  Google Scholar 

  49. Wang CJ et al. (2005) The effect of shock wave treatment at the tendon–bone interface – an histomorphological and biomechanical study in rabbits. Jl Orthop Res 23:274–280

    Article  Google Scholar 

  50. Whaley AL, Baker CL (2004) Lateral epicondylitis. Clin Sports Med 23:677–691

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. OrthoTrauma Clinic, Kirchheimer Straße 60, 67269, Grünstadt, Germany

    J.-D. Rompe

Authors
  1. J.-D. Rompe
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rompe, JD. Stoßwellentherapie bei Tendinopathien der oberen Extremität. Obere Extremität 1, 98–104 (2006). https://doi.org/10.1007/s11678-006-0018-x

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-006-0018-x

Key words

Schlüsselwörter

Search

Navigation