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Stadiengerechte Behandlung der lateralen Epikondylopathie des Ellenbogens – ein Update

Stage-appropriate lateral epicondylitis treatment—an update

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Zusammenfassung

Hintergrund

Die laterale Epikondylopathie (LE) ist eine der häufigsten Pathologien am Ellenbogen, die Möglichkeiten der konservativen und operativen Therapie sind manigfaltig.

Material und Methode

Dargestellt wird eine kursorische Zusammenstellung der aktuellen Datenlage der konservativen und operativen Therapie der LE und eines möglichen Diagnosealgorithmus und den hieraus resultierenden Therapieempfehlungen.

Ergebnisse

Die verschiedenen Therapiemaßnahmen (konservativ wie operativ) zeigen in der Studienlage durchweg gute Ergebnisse. Keine Einzelmaßnahme ist der anderen signifikant überlegen oder in der Langfrist signifikant besser als der per se gutmütige Spontanverlauf. Die operativen Maßnahmen sind erst nach frustraner Therapie indiziert und sollten anhand der sehr genauen Diagnostik einem klaren, der Pathologie angepassten Therapieplan folgen.

Schlussfolgerung

Die LE ist eine der häufigsten Enthesopathien. Eine saubere Anamnese und klinische Untersuchung reichen normalerweise aus, um die Diagnose zu stellen. Die Verwendung nichtoperativer Behandlungsmodalitäten bei der Behandlung der LE ist der Goldstandard. Eine operative Maßnahme kommt nach frustraner konservativer Therapie und entsprechender Pathologieabklärung (MRT, Ultraschall) in Frage. Wichtig ist es, eine posterolaterale Rotationsinstabilität (PLRI) nicht zu übersehen und diese ggf. zu stabilisieren.

Abstract

Background

Lateral epicondylitis (LE), “tennis elbow”, is one of the most common pathologies of the elbow; its conservative and operative therapy options are manifold.

Materials and methods

Compilation of the current data situation of conservative and surgical therapy for lateral epicondylopathy and presentation of a diagnostic algorithm and the resulting therapy recommendations.

Results

There are many therapeutic options for epicondylopathy. The conservative as well as the operative treatments show consistently good results in literature, but none is significantly better than the good-natured spontaneous disease course. Surgical treatment is indicated only after frustrating therapy and should follow a clear therapy plan adapted to the pathology based on the very precise diagnosis.

Conclusion

Lateral epicondylitis is one of the most common enthesopathies. A medical history and clinical examination are usually sufficient to make a diagnosis. The use of nonsurgical treatment modalities in the management of LE is the gold standard. Surgical measures come into question after failed conservative therapy and appropriate diagnostic (magnetic resonance imaging [MRI], ultrasonography [US]). It is important not to miss posterolateral rotational instability (PLRI), which “mimics” LE, and therefore to stabilize it if necessary.

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Literatur

  1. Arrigoni P, Cucchi D, D’Ambrosi R (2017) Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE). KSSTA 2255-2263. https://doi.org/10.1007/s00167-017-4530-x

    Book  Google Scholar 

  2. Ahmed A et al (2021) Comparing the effectiveness of Mulligan mobilization versus Cyriax approach in the management of patients with subacute lateral epicondylitis. J Pak Med Assoc 71(1(A)):12–15. https://doi.org/10.47391/JPMA.186

    Article  PubMed  Google Scholar 

  3. Baker CL, Murphy KP, Gottlob CA et al (2000) Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg 9(6):475–482

    Article  PubMed  Google Scholar 

  4. Balk ML, Hagberg WC, Buterbaugh GA et al (2005) Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker’s compensation. Am J Orthop 34(3):122–126

    PubMed  Google Scholar 

  5. Barth J, Mahieu P, Hollevoet N (2013) Extensor tendon and fascia sectioning of extensors at the musculotendinous unit in lateral epicondylitis. Acta Orthop Belg 79(3):266–270

    PubMed  Google Scholar 

  6. Ben-Nafa W, Munro W (2018) The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review. SICOT J 4(7):11

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bisset L, Beller E, Jull G et al (2006) Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 333(7575):939

    Article  PubMed  PubMed Central  Google Scholar 

  8. Boyer MI, Hastings H 2nd (1999) Lateral tennis elbow: ‘Is there any science out there? J Shoulder Elbow Surg 8(5):481–491. https://doi.org/10.1016/s1058-2746(99)90081-2

    Article  CAS  PubMed  Google Scholar 

  9. Calandruccio JH, Steiner MM (2017) Autologous blood and platelet-rich plasma injections for treatment of lateral epicondylitis. Orthop Clin North Am 48(3):351–357

    Article  PubMed  Google Scholar 

  10. Chen X, Jones IA, Park C, Vangsness CT Jr (2018) The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med 46(8):2020–2032. https://doi.org/10.1177/0363546517743746

    Article  PubMed  Google Scholar 

  11. Chung B, Wiley JP, Rose MS (2005) Long-term effectiveness of extracorporeal shockwave therapy in the treatment of previously untreated lateral epicondylitis. Clin J Sport Med 15(5):305–312

    Article  CAS  PubMed  Google Scholar 

  12. Connell D, Datir A, Alyas F et al (2009) Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. Br J Sports Med 43(4):293–298

    Article  CAS  PubMed  Google Scholar 

  13. Coombes BK, Bisset L, Brooks P et al (2013) Effect of Cor-ticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral Epicondylalgia. JAMA 309(5):461

    Article  CAS  PubMed  Google Scholar 

  14. Creaney L, Wallace A, Curtis M et al (2011) Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med 45(12):966–971

    Article  PubMed  Google Scholar 

  15. de Vos R‑J, Windt J, Weir A (2014) Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med 48(12):952–956

    Article  PubMed  Google Scholar 

  16. Degen RM et al (2017) Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: an analysis of 3863 patients. J Shoulder Elbow Surg 26(4):704–709. https://doi.org/10.1016/j.jse.2016.10.022

    Article  PubMed  Google Scholar 

  17. Dunkow PD, Jatti M, Muddu BN (2004) A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br 86(5):701–704

    Article  CAS  PubMed  Google Scholar 

  18. Dunn JH, Kim JJ, Davis L, Nirschl RP (2008) Ten- to 14-year follow-up of the Nirschl surgical technique for lateral Epicondylitis. Am J Sports Med 36(2):261–266

    Article  PubMed  Google Scholar 

  19. Dwyer AJ, Govindaswamy R, Elbouni T et al (2010) Are “knife and fork” good enough for day case surgery of resistant tennis elbow? Int Orthop 34(1):57–61

    Article  PubMed  Google Scholar 

  20. Galatz LM, Gerstenfeld L, Heber-Katz E et al (2015) Tendon regeneration and scar formation: the concept of scarless healing. J Orthop Res 33(6):823–831

    Article  PubMed  PubMed Central  Google Scholar 

  21. Galván Ruiz A et al (2019) Effects of ultrasound-guided administration of Botulinum toxin (IncobotulinumtoxinA) in patients with lateral Epicondylitis. Toxins 11(1):46–15. https://doi.org/10.3390/toxins11010046

    Article  CAS  PubMed Central  Google Scholar 

  22. Geyer M, Schoch C, Harnoß T (2013) Therapiemöglichkeiten der chronischen ligamentären Ellenbogeninstabilität. Arthroskopie 26:197–206. https://doi.org/10.1007/s00142-012-0730-z

    Article  Google Scholar 

  23. Gosens T, Peerbooms JC, van Laar W (2011) Ongoing positive effect of platelet-rich plasma versus Corticosteroid injection in lateral Epicondylitis. Am J Sports Med 39(6):1200–1208

    Article  PubMed  Google Scholar 

  24. Grundberg AB, Dobson JF (2000) Percutaneous release of the common extensor origin for tennis elbow. Clin Orthop Relat Res 376:137–140

    Article  Google Scholar 

  25. 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(10):1216–1225

    Article  CAS  PubMed  Google Scholar 

  26. Haake M, König IR, Decker T et al (2002) Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am 84-A(11):1982–1991

    Article  Google Scholar 

  27. Hay EM, Paterson SM, Lewis M et al (1999) Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ 319(7215):964–968

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Herquelot E, Bodin J, Roquelaure Y et al (2013) Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population. Am J Ind Med 56(4):400–409

    Article  PubMed  Google Scholar 

  29. Kahlenberg CA, Knesek M, Terry MA (2015) New developments in the use of biologics and other modalities in the management of lateral epicondylitis. Biomed Res Int 2015(5):439309

    PubMed  PubMed Central  Google Scholar 

  30. Karkhanis S, Frost A, Maffulli N (2008) Operative management of tennis elbow: a quantitative review. Br Med Bull 88(1):171–188

    Article  PubMed  Google Scholar 

  31. Kaux JF et al (2011) Current opinions on tendinopathy.”. J Sports Sci Med 10(2):238–253

    PubMed  PubMed Central  Google Scholar 

  32. Keijsers R, van den Bekerom MPJ, Koenraadt KLM et al (2017) Elbow study collaborative. Injection of tennis elbow: hit and miss? A cadaveric study of injection accuracy. Knee Surg Sports Traumatol Arthrosc 25(7):2289–2292. https://doi.org/10.1007/s00167-016-4212-0

    Article  PubMed  Google Scholar 

  33. Krogh TP, Bartels EM, Ellingsen T et al (2013) Comparative effectiveness of injection therapies in lateral Epicondylitis. Am J Sports Med 41(6):1435–1446

    Article  PubMed  Google Scholar 

  34. Kroslak M, Murrell GAC (2017) Surgical treatment of lateral Epicondylitis. Orthop J Sports Med 5(Suppl 3):2325967117S0012

    Article  Google Scholar 

  35. Kwon BC, Kim JY, Park KT (2017) The Nirschl procedure versus arthroscopic extensor carpi radialis brevis débridement for lateral epicondylitis. J Shoulder Elbow Surg 26(1):118–124

    Article  PubMed  Google Scholar 

  36. Lee SY, Kim W, Lim C et al (2015) Treatment of lateral epicondylosis by using allogeneic adipose-derived mesenchymal stem cells: a pilot study. stem Cells 33(10):2995–3005

    Article  CAS  PubMed  Google Scholar 

  37. Lindenhovius A, Henket M, Gilligan BP et al (2008) Injection of dexamethasone versus placebo for lateral elbow pain: a prospective, double-blind, randomized clinical trial. J Hand Surg Am 33(6):909–919

    Article  PubMed  Google Scholar 

  38. Luginbühl R, Brunner F, Schneeberger AG (2008) No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study. Chir Organi Mov 91(1):35–40

    Article  PubMed  Google Scholar 

  39. Melikyan EY, Shahin E, Miles J et al (2003) Extracorporeal shock-wave treatment for tennis elbow. A randomised double-blind study. j Bone Joint Surg Br 85(6):852–855

    Article  CAS  PubMed  Google Scholar 

  40. Merolla G, Dellabiancia F, Ricci A et al (2017) Arthroscopic debridement versus platelet-rich plasma injection: a prospective, randomized, comparative study of chronic lateral Epicondylitis with a nearly 2‑year follow-up. Arthroscopy 33(7):1320–1329

    Article  PubMed  Google Scholar 

  41. Mills GP (1928) The treatment of tennis elbow. Br Med J 1(3496):12–13. https://doi.org/10.1136/bmj.1.3496.12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Morris H (1883) Lawn-tennis elbow. BMJ 15:557

    Article  Google Scholar 

  43. Newcomer KL, Laskowski ER, Idank DM et al (2010) Corticosteroid injection in early treatment of lateral epicondylitis. Clin J Sport Med 11(4):214–222

    Article  Google Scholar 

  44. Nirschl RP, Pettrone FA, Elbow T (1979) The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 61(6A):832–839

    Article  CAS  PubMed  Google Scholar 

  45. Nirschl RP, Ashman ES (2003) Elbow tendinopathy: tennis elbow. Clin Sports Med 22(4):813–836. https://doi.org/10.1016/s0278-5919(03)00051-6

    Article  PubMed  Google Scholar 

  46. Osborne H (2010) Stop injecting corticosteroid into patients with tennis elbow, they are much more likely to get better by themselves! J Sci Med Sport 13(4):380–381

    Article  PubMed  Google Scholar 

  47. Othman AMA (2011) Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg 31(3):383–388

    Article  Google Scholar 

  48. Park J‑Y, Park HK, Choi JH et al (2010) Prospective evaluation of the effectiveness of a home-based program of isometric strengthening exercises: 12-month follow-up. Clin Orthop Surg 2(3):173–178

    Article  PubMed  PubMed Central  Google Scholar 

  49. Pattanittum P, Turner T, Green S, Buchbinder R (2013) Non-steroidal anti- inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003686.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  50. Peart RE, Strickler SS, Schweitzer KM (2004) Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop 33(11):565–567

    PubMed  Google Scholar 

  51. Peterson M, Butler S, Eriksson M et al (2011) A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci 116(4):269–279

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pettrone FA, Mccall BR (2005) Extracorporeal Shock Wave Therapy without Local Anesthesia for Chronic Lateral Epicondylitis. J Bone Jt Surg 87(6):1297

    Google Scholar 

  53. 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 

  54. Qi L, Zhu Z‑F, Li F, Wang R‑F (2013) MR imaging of patients with lateral Epicondylitis of the elbow: is the common extensor tendon an isolated lesion? Plos One 8(11):e79498. https://doi.org/10.1371/journal.pone.0079498

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Raeissadat SA, Rayegani SM, Hassanabadi H (2014) Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil 6(1):12

    Article  PubMed  PubMed Central  Google Scholar 

  56. Richer N, Marchand A‑A, Descarreaux M (2017) Management of chronic lateral Epicondylitis with manual therapy and local Cryostimulation: a pilot study. J Chiropr Med 16(4):279–288

    Article  PubMed  PubMed Central  Google Scholar 

  57. Rubenthaler F, Wiese M, Senge A et al (2005) Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis. Arthroscopy 21(6):684–690

    Article  PubMed  Google Scholar 

  58. Runge F (1873) Zur Genese und Behandlung des Schreibekrampfs. Berlin Klin Wochenschr 10:245–248

    Google Scholar 

  59. Schoch C, Geyer M (2019) Symptom Epikondylitis. Arthroskopie 32:236–242. https://doi.org/10.1007/s00142-019-0286-2

    Article  Google Scholar 

  60. Scott A, Khan KM (2010) Corticosteroids: short-term gain for long-term pain? Lancet 376(9754):1714–1715

    Article  PubMed  Google Scholar 

  61. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 164(11):1065–1074. https://doi.org/10.1093/aje/kwj325

    Article  PubMed  Google Scholar 

  62. Sims SEG, Miller K, Elfar JC, Hammert WC (2014) Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand 9(4):419–446

    Article  PubMed  PubMed Central  Google Scholar 

  63. Singh A, Gangwar DS, Singh S (2014) Bone marrow injection: a novel treatment for tennis elbow. J Nat Sci Biol Med 5(2):389–391

    Article  PubMed  PubMed Central  Google Scholar 

  64. Smidt N, Assendelft WJ, Arola H et al (2003) Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med 35(1):51–62

    Article  PubMed  Google Scholar 

  65. Smidt N, van der Windt DA, Assendelft WJ et al (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359:657–662

    Article  CAS  PubMed  Google Scholar 

  66. Solheim E, Hegna J, Øyen J (2013) Arthroscopic versus open tennis elbow release: 3‑ to 6‑year results of a case-control series of 305 elbows. Arthroscopy 29(5):854–859

    Article  PubMed  Google Scholar 

  67. Speed CA, Nichols D, Richards C et al (2002) Extracorporeal shock wave therapy for lateral epicondylitis—a double blind randomised controlled trial. J Orthop Res 20(5):895–898

    Article  CAS  PubMed  Google Scholar 

  68. 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(10):2038–2046

    PubMed  Google Scholar 

  69. Struijs PAA, Kerkhoffs GMMJ, Assendelft WJJ, van Dijk CN (2004) Conservative treatment of lateral Epicondylitis. Am J Sports Med 32(2):462–469

    Article  CAS  PubMed  Google Scholar 

  70. Szabo SJ, Savoie FH, Field LD et al (2006) Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elbow Surg 15(6):721–727

    Article  PubMed  Google Scholar 

  71. Thanasas C, Papadimitriou G, Charalambidis C (2011) A. Platelet-rich plasma versus Autologous whole blood for the treatment of chronic lateral elbow Epicondylitis. am J Sports Med 39(10):2130–2134

    Article  PubMed  Google Scholar 

  72. Thornton SJ, Rogers JR, Prickett WD et al (2005) Treatment of recalcitrant lateral Epicondylitis with suture Anchor repair. Am J Sports Med 33(10):1558–1564

    Article  PubMed  Google Scholar 

  73. Titchener AG, Fakis A, Tambe AA et al (2013) Risk factors in lateral epicondylitis (tennis elbow): a case-control study. J Hand Surg Eur 38(2):159–164

    Article  CAS  Google Scholar 

  74. Verhaar JA, Walenkamp GH, van Mameren H et al (1996) AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. j Bone Joint Surg Br 78(1):128–132

    Article  CAS  PubMed  Google Scholar 

  75. Vicenzino B, Coombes BK (2010) A single botulinum toxin injection at a precise anatomic point on the forearm reduces pain at rest, compared to placebo injection in patients with chronic refractory lateral epicondylitis. Evid Based Med 15:149–150

    Article  PubMed  Google Scholar 

  76. Walz DM, Newman JS, Konin GP et al (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30(1):167–184. https://doi.org/10.1148/rg.301095078

    Article  PubMed  Google Scholar 

  77. Wang A, Breidahl W, Mackie KE et al (2013) Autologous Tenocyte injection for the treatment of severe, chronic resistant lateral Epicondylitis. Am J Sports Med 41(12):2925–2932

    Article  PubMed  Google Scholar 

  78. Wang D, Degen RM, Camp CL (2017) Trends in surgical practices for lateral Epicondylitis among newly trained orthopaedic surgeons. Orthop J Sports Med 5(10):2325967117730570

    Article  PubMed  PubMed Central  Google Scholar 

  79. AWMF Leitlinie zur Epicondylopathia radialis humeri Registernummer 033-019

  80. Schoch C, Harnoß T, Geyer M (2014) Tendopathien der oberen Extremität. Teil 3: Ellbogen. Orthopäd Unfallchir Up2date 9:107–130

    Google Scholar 

  81. Loew LM, Brosseau L, Tugwell P, Wells GA, Welch V, Shea B, Poitras S, De Angelis G, Rahman P (2014) Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev 8(11):CD003528. https://doi.org/10.1002/14651858.CD003528.pub2

    Article  Google Scholar 

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  1. Schulter- und Ellbogenchirurgie, St. Vinzenz-Klinik Pfronten, Kirchweg 15, 87459, Pfronten, Deutschland

    C. Schoch, M. Dittrich & M. Geyer

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Schoch, C., Dittrich, M. & Geyer, M. Stadiengerechte Behandlung der lateralen Epikondylopathie des Ellenbogens – ein Update. Obere Extremität 16, 182–191 (2021). https://doi.org/10.1007/s11678-021-00639-8

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