Wie sinnvoll ist die Zweipunktdiskrimination als diagnostisches Mittel bei der Epicondylopathia humeri radialis?

ZusammenfassungDie diagnostische Aussagekraft der Zweipunktdiskrimination (ZPD) als Indikator für chronische Krankheitsprozesse (z. B. Complex Regional Pain Syndrome, Chronic Low Back Pain) ist mehrfach untersucht und gilt als belegt. Das Ziel der vorliegenden Arbeit war es, die ZPD als diagnostisches Mittel in der Ellenbogenregion zu untersuchen.Mithilfe eines Ästhesiometers (Schieblehre) wurde die ZPD im Bereich des lateralen Ellenbogens bei einer Patientengruppe (N = 21) mit der Diagnose Epicondylopathia humeri radialis sowie einer gesunden Kontrollgruppe (N = 40) mit folgender primärer Fragestellung untersucht: Kann die ZPD am Ellenbogen gesunde Proband(inn)en von Proband(inn)en mit Epicondylopathia humeri radialis unterscheiden? Als Basis wurden ZPD-Normwerte anhand der Kontrollgruppe am lateralen Ellenbogen erstellt. In einer vertiefenden Datenanalyse der Patientenpopulation wurden die Daten der Patient(inn)en mit einem akuten (N = 13) mit den Daten der Patient(inn)en mit einem chronischen (N = 8) Zustand verglichen.Im Ergebnis scheint die ZPD kein geeignetes Diagnostikinstrument zur Differenzierung der Fall- von der Kontrollgruppe sowie von akuten und chronischen Verläufen in der lateralen Ellenbogenregion zu sein.

Epicondylopathia humeri radialis

Background Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options – with varying levels of evidence. Method The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 – 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process. Outcomes Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure. Conclusion This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.

Therapeutic Effects of Manual Therapy, Transcutaneous Electric Nerve Stimulation, and Forearm Brace on Lateral Epicondylitis: A Randomized Controlled Trial

Background: Epicondylopathia humeri radialis is often diagnosed by general practitioners. Usually, the therapy comprises transcutaneous electrical nerve stimulation and the application of a forearm brace. Manual therapy is prescribed beyond transcutaneous electrical nerve stimulation and forearm brace, and it is performed by specialized physiotherapists. However, data comparing the effectiveness of all methods are scarce. In this study, the therapeutic effects of manual therapy were compared to those of transcutaneous electrical nerve stimulation and forearm brace along with a combination of all three. Methods: Fifty-two patients diagnosed with epicondylopathia humeri radialis by a general practitioner were randomized into three treatment arms: 19 patients received a combination of manual therapy, transcutaneous nerve stimulation, and forearm brace; 18 patients received manual therapy only; and 15 patients wore a forearm brace and received transcutaneous nerve stimulation. The primary outcomes included the range of motion and pain intensity. The secondary outcomes were elbow function and psychological well-being. Primary and secondary outcomes were measured before treatment (0), and 4- and 8-weeks post-treatment using the Patient Rated Tennis Elbow Evaluation Questionnaire and the Short Form Health Survey Questionnaire. Results: The range of motion and pain intensity did not differ between the intervention groups.Conclusions: Manual therapy alone is as effective as combination therapy with transcutaneous nerve stimulation and the use of a forearm brace for epicondylopathia humeri radialis. Hence, there is evidence supporting the inclusion of manual therapy in the guidelines for treating patients with epicondylopathia humeri radialis. Trial registration: German Clinical Trial Register: DRKS, trial registration number: 00021137, date of registration: 24/03/2020 (retrospectively registered)