Skip to main content

Advertisement

SpringerLink
Log in

Epicondylopathia humeri radialis et ulnaris

Gibt es neue Therapieoptionen?

Epicondylopathia humeri radialis and ulnaris

New therapeutic options

  • Leitthema: Übersicht
  • Published:
Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Die Epicondylopathia humeri radialis und ulnaris ist eine schmerzhafte Erkrankung des Sehnenansatzgewebes der Extensoren- bzw. Flexorengruppe, die ätiologisch auf eine sportliche oder berufliche Überlastung der Handgelenkextensoren bzw. -flexoren zurückzuführen ist. Pathomorphologisch imponiert ein ödematös verändertes Gewebe im Bereich des M. extensor carpi radialis brevis, der zudem partiell oder komplett rupturiert sein kann. Nichtoperative Verfahren stellen noch immer den therapeutischen Kernbereich der Epikondylopathien dar. Neuere Verfahren wie die Injektion von Botulinumtoxin (hohe Evidenz), Applikation von „platelet-rich plasma“ (mäßige Evidenz) und die extrakorporale Stoßwellentherapie (geringe Evidenz) sind mit unterschiedlichem klinischem Erfolg in die therapeutischen Algorithmen aufgenommen worden. Bestehende chirurgische Verfahren werden erst nach Ausschöpfung der konservativen Therapieverfahren empfohlen. Im Zuge der Entwicklungen arthroskopischer Techniken hat sich die Ellenbogengelenkarthroskopie etabliert, da sie die simultane Diagnostik und ggf. auch Therapie intraartikulärer Begleitpathologien ermöglicht.

Abstract

Tennis or golfer elbow (epicondylopathia humeri radialis et ulnaris) are painful disorders of the tendon insertion tissues of the extensor or flexor groups that can be attributed to an overload due to sports or labour activity of the wrist extensor or flexor muscles. Pathomorphologically the tendon of the musculus extensor carpi radialis brevis is characterized by edematous changes and even partial or complete ruptures. 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 (moderate level of evidence) and the extracorporal shock wave therapy (low level of evidence) have been included in the therapeutic algorithms with varying degrees of clinical success. Established surgical procedures are recommended after failed conservative treatment. Operative techniques have been expanded to arthroscopic techniques with the advantage of improved diagnostics and therapy of intraarticular pathologies.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Ajimsha MS, Chithra S, Thulasyammal RP (2012) Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch Phys Med Rehabil 93:604–609

    Article  PubMed  CAS  Google Scholar 

  2. Baker CL Jr, Baker CL 3rd (2008) Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med 36:254–260

    Article  PubMed  Google Scholar 

  3. Baker CL Jr, Murphy KP, Gottlob CA et al (2000) Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg 9:475–482

    Article  PubMed  Google Scholar 

  4. Brosseau L, Casimiro L, Milne S et al (2002) Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev:CD003528

  5. Buchbinder R, Johnston RV, Barnsley L et al (2011) Surgery for lateral elbow pain. Cochrane Database Syst Rev:CD003525

  6. Edwards SG, Calandruccio JH (2003) Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 28:272–278

    Article  PubMed  Google Scholar 

  7. Gardner RC (1970) Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstructive operation. Clin Orthop Relat Res 72:248–253

    PubMed  CAS  Google Scholar 

  8. Gosens T, Peerbooms JC, Van Laar W et al (2011) 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 39:1200–1208

    Article  PubMed  Google Scholar 

  9. Kalichman L, Bannuru RR, Severin M et al (2011) Injection of botulinum toxin for treatment of chronic lateral epicondylitis: systematic review and meta-analysis. Semin Arthritis Rheum 40:532–538

    Article  PubMed  CAS  Google Scholar 

  10. Keizer SB, Rutten HP, Pilot P et al (2002) Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res 401:125–131

    Article  PubMed  Google Scholar 

  11. Knobloch K, Stadermann S, Vogt PM (2012) Innovative multimodale Therapie der chronischen lateralen Epikondylitis. Obere Extremität 7:158–165

    Article  Google Scholar 

  12. Kraushaar BS, Nirschl RP (1999) Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am 81:259–278

    Article  PubMed  CAS  Google Scholar 

  13. Major H (1883) Lawn-tennis elbow (letter). Br Med J 2:557

    Google Scholar 

  14. Mittelmeier H (1975) Surgical management of insertion-tendon diseases resistant to therapy. Beitr Orthop Traumatol 22:61–63

    PubMed  CAS  Google Scholar 

  15. Nirschl RP (1992) Elbow tendinosis/tennis elbow. Clin Sports Med 11:851–870

    PubMed  CAS  Google Scholar 

  16. Nirschl RP, Pettrone FA (1979) Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 61:832–839

    PubMed  CAS  Google Scholar 

  17. Overend TJ, Wuori-Fearn JL, Kramer JF et al (1999) Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther 12:31–37

    Article  PubMed  CAS  Google Scholar 

  18. Peerbooms JC, Sluimer J, Bruijn DJ et al (2010) 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 38:255–262

    Article  PubMed  Google Scholar 

  19. Placzek R, Drescher W, Deuretzbacher G et al (2007) Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am 89:255–260

    Article  PubMed  Google Scholar 

  20. Placzek R, Lang M, Perka C et al (2006) Insertional tendinopathies of te elbow. Z Orthop Ihre Grenzgeb 144:R1–13; R14–15

    Google Scholar 

  21. Placzek R, unter Mitarbeit von Jerosch JR A, Söhling M (2006) Botulinumtoxin in Orthopädie und Sportmedizin. UNI – MED SCIENCE, Bremen

  22. Rajeev A, Pooley J (2009) Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg 75:37–40

    PubMed  Google Scholar 

  23. Regan W, Wold LE, Coonrad R et al (1992) Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 20:746–749

    Article  PubMed  CAS  Google Scholar 

  24. Rompe JD, Hopf C, Kullmer K et al (1996) Low-energy extracorporal shock wave therapy for persistent tennis elbow. Int Orthop 20:23–27

    Article  PubMed  CAS  Google Scholar 

  25. Runge F (1873) Zur Genese und Behandlung des Schreibkrampfes. Berliner Klin Wochenschr 10:245–248

    Google Scholar 

  26. Savnik A, Jensen B, Norregaard J et al (2004) Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol 14:964–969

    Article  PubMed  Google Scholar 

  27. Staples MP, Forbes A, Ptasznik R et al (2008) A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol 35:2038–2046

    PubMed  Google Scholar 

  28. Struijs PA, Smidt N, Arola H et al (2001) Orthotic devices for tennis elbow. Cochrane Database Syst Rev:CD001821

  29. Wild C, Khene M, Wanke S (2000) Extracorporeal shock wave therapy in orthopedics. Assessment of an emerging health technology. Int J Technol Assess Health Care 16:199–209

    Article  PubMed  CAS  Google Scholar 

  30. Wilhelm A (1999) Treatment of therapy refractory epicondylitis lateralis humeri by denervation. On the pathogenesis. Handchir Mikrochir Plast Chir 31:291–302

    Article  PubMed  CAS  Google Scholar 

  31. Wolf JM, Ozer K, Scott F et al (2011) Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am 36:1269–1272

    Article  PubMed  Google Scholar 

  32. Wong SM, Hui AC, Tong PY et al (2005) Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 143:793–797

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. CMSC, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Kathi Thiele, Carsten Perka &  Stefan Greiner

Authors
  1. Kathi Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carsten Perka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Greiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Greiner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thiele, K., Perka, C. & Greiner, S. Epicondylopathia humeri radialis et ulnaris. Obere Extremität 8, 9–15 (2013). https://doi.org/10.1007/s11678-013-0202-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-013-0202-8

Schlüsselwörter

Keywords

Search

Navigation