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Handchir Mikrochir Plast Chir 2018; 50(05): 348-352
DOI: 10.1055/a-0732-5556
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Image-guided versus palpation-guided injections for the treatment of chronic lateral epicondylopathy: a randomized controlled clinical trial

Ultraschall- versus palpationsgesteuerte Injektionen zur Behandlung der chronischen lateralen Epikondylopathie: eine randomisierte kontrollierte klinische Studie
Michael-Alexander Malahias
1   Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
,
Maria-Kyriaki Kaseta
1   Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
,
Sotirios-Tsambikos Kazas
1   Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
,
Panayiotis D Megaloikonomos
2   First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
,
Andreas F Mavrogenis
2   First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
,
George C Babis
1   Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
› Institutsangaben
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Publikationsverlauf

07/09/2018

08/31/2018

Publikationsdatum:
07. November 2018 (online)

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Abstract

Background There have been several studies published comparing the ultrasound-guided with the “blind” infiltrations in the shoulder’s area. On the contrary, there is only very limited data regarding the necessity of ultrasound guidance in lateral epicondylitis.

Materials and Methods A prospective, randomized, blinded at initial and follow-up evaluation, comparative clinical trial was conducted, involving 44 patients with a history of chronic persistent epicondylopathy. The patients were randomly divided into 2 groups of 22 people each. Group A patients underwent three ultrasound-guided betamethazone injections, while group B included those who underwent three “blind” injections, centered at the palpable point of maximum pain. The evaluation was done before and after (4 and 12 weeks) the injections using the Visual Analogue Scale for pain (VAS, 0–10) and the Roles & Maudsley score.

Results There was not any significant statistical difference between the two groups as for mean VAS at 4 weeks (p = 0.150, t-test) and mean VAS at 12 weeks (p = 0.286, t-test). Furthermore, the final success rate, as measured by the Roles & Maudsley score, was slightly superior in group B (67 % of the patients with excellent or good results) when compared with group A (46 % of the patients), but without any statistical difference (p = 0.161, chi-square).

Conclusion Our trial proved that an ultrasound-guided injection is not superior than a palpation-guided injection of corticosteroids in the treatment of lateral epicondylopathy.

Zusammenfassung

Hintergrund In mehreren Studien wurden ultraschallgesteuerte mit „blinden“ Infiltrationen im Schulterbereich verglichen. Im Gegensatz dazu gibt es nur sehr begrenzte Daten bezüglich der ultraschallkontrollierten Infiltrationstherapie bei einer Epikondylitis humeri lateralis.

Patienten und Methoden: In die prospektive, randomisierte, verblindete Studie wurden 44 Patienten mit chronischer, therapieresistenter Epikondylitis humeri lateralis eingeschlossen. Die Patienten wurden nach dem Zufallsprinzip in 2 Gruppen von jeweils 22 Patienten eingeteilt. Patienten der Gruppe A erhielten drei ultraschallgesteuerte Betamethazon-Injektionen, Patienten der Gruppe B drei „blinde“ (= palpationsgesteuerte) Injektionen am Ort ihrer maximalen Schmerzen. Vor sowie 4 und 12 Wochen nach der letzten Injektion wurden die Schmerzen mittels der Visuellen Analogskala (VAS, 0–10) und der Roles & Maudsley-Score erfasst.

Ergebnisse Weder 4 noch 12 Wochen nach Injektionsbehandlung fand sich ein statistisch signifikanter Unterschied punkto Schmerzen (p = 0,150; p = 0,286). Bzgl. der endgültiger Erfolgsrate (Roles & Maudsley-Score) zeigte sich Gruppe B mit 67 % exzellenten oder guten Ergebnissen der Gruppe A mit 46% exzellenten oder guten Ergebnissen leicht überlegen, ohne dass dies statistisch signifikant war.

Schlussfolgerung Die Studie zeigt, dass eine ultraschallgesteuerte Injektionsbehandlung der Epikondylitis humeri lateralis der palpationsgesteuerten nicht überlegen ist.

Key words

ultrasound-guided - palpation-guided - epicondylopathy - epicondylitis - corticosteroid injections

Schlüsselwörter

ultraschallgesteuert - palpationsgesteuert - Epikondylopathie - Epikondylitis - Kortikosteroidinjektionen
 

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