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DOI: 10.1055/s-0031-1298587
Epikondylitis – Ätiologie, Diagnostik und therapeutische Optionen
Epicondylitis – Aetiology, Diagnostics and Therapeutic OptionsPublication History
Publication Date:
26 July 2012 (online)
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Zusammenfassung
Die Epicondylopathia humeri radialis et ulnaris ist eine schmerzhafte Erkrankung des Sehnenansatzgewebes der Extensoren- bzw. Flexorengruppe, welche ätiologisch auf eine sportliche oder berufliche Überlastung der Handgelenksextensoren bzw. -flexoren zurückzuführen ist. Die vorliegende Arbeit fasst derzeitig bestehende konservative und operative Therapiekonzepte nach Einsicht der gängigen Fachliteratur zusammen. Nicht operative Verfahren stellen noch immer den therapeutischen Kernbereich der Epikondylitiden dar. Neuere Verfahren wie die Injektion von Botulinumtoxin (gute Evidenz), Applikation von Platelet-Rich-Plasma (mäßige Evidenz) und die extrakorporale Stoßwellentherapie (geringe Evidenz) sind in die therapeutischen Algorithmen mit unterschiedlichem klinischem Erfolg aufgenommen worden. Bestehende chirurgische Verfahren als alternative Option bei frustraner konservativer Therapie zeigen ebenfalls ein geringes Evidenzlevel. Im Zuge der Entwicklungen arthroskopischer bzw. endoskopischer Techniken hat sich dieser Zugangsweg auch in der Behandlung der Epikondylopathie etabliert. Neuere konservative Therapieverfahren zeigen nur anteilig vielversprechende Ergebnisse bei z. T. nur mäßiger wissenschaftlicher Evidenzlage. Operative Verfahren sind um die arthroskopischen Techniken mit dem Vorteil der gleichzeitigen Diagnostik von intraartikulären Begleitpathologien erweitert worden.
Epicondylitis – Aetiology, Diagnostics and Therapeutic Options
Tennis elbow (epicondylopathia humeri radialis et ulnaris) is a painful disorder of the tendon insertion tissues of the extensor or, respectively, flexor groups that can be attributed to an overload due to sport or industrial activity of the wrist extensors or flexors. The present article gives a summary of the currently available conservative and surgical treatment concepts as described in the literature. 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 (moderat level of evidence) and the extracorporeal shock wave therapy (low level of evidence) have been included in the therapeutic algorithm with varying degrees of clinical success. Established surgical procedures as alternatives to failed conservative therapy also exhibit a low level of evidence. In the course of the development of arthroscopic and endoscopic techniques, these approaches have also become established in the treatment of epicondylopathies. Only few of the recent conservative therapeutic modalities show promising results albeit with only moderate levels of scientific evidence. Operative techniques have been expanded to include arthroscopic techniques with the added advantage of obtaining concomitant diagnostic information about accompanying intraarticular pathologies.
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