Botulinum Toxin for Chronic Lateral Epicondylitis (LE).

Abstract:

:Lateral epicondylitis is a common disease in orthopaedic practice. Although the majority of cases do not become chronic, patients who do not respond to the initial treatment may suffer from pain in the long term and effective treatment is challenging. The off-label use of botulinum toxin is one of the common potential indications for the substance in orthopaedics and traumatology. In a literature review of 2000 - 2019, eight EBM ≥ level 3 studies evaluating the use of botulinum toxin in lateral epicondylitis were found. Five of these studies evaluated botulinum toxin versus placebo in chronic cases; two other studies compared botulinum toxin with corticosteroids in acute cases and classic Hohmann surgery in chronic cases; the eighth study compared botulinum toxin in two different injection sites and corticosteroids by classic injection. Our findings suggest that the use of this substance may be a treatment option in refractory chronic cases before surgery is indicated. The working group on botulinum toxin in O & T of the International Musculoskeletal Pain Society (IMPS/IGOST) introduced an alternative injection schedule, which combines findings from the recent clinical literature with practical experience in order to reduce the risk of side effects while ensuring treatment effectiveness. Using 2 simple tests of function and, if necessary, sonographic verification, 2 separate injection sites in the extensor carpi radialis or the extensor digitorum can be identified by palpation. The tendon level on the lateral epicondyle acts as the third injection site. With optimal use of the ampoule content, the 3 injection sites can be infiltrated individually, depending on the muscle status. On the one hand, this enables treatment to take place after a dual therapy approach and, on the other hand, the risk of overdose in a muscle with subsequent unnecessary muscle weakening can be reduced. :Die Epicondylitis humeroradialis ist eine häufige Erkrankung in der orthopädischen Praxis. Obwohl die Mehrzahl der Fälle nicht chronifiziert, stellen längere Verläufe bei Therapierefraktärität oft ein Behandlungsproblem dar. Der Einsatz von Botulinumtoxin als Off-Label-Use ist eine der häufiger genannten und klinisch untersuchten Indikationen für die Substanz in O & U. In einer Literaturrecherche 2000 – 2019 konnten 8 klinische Studien ≥ EBM-Level 3 (EBM: evidenzbasierte Medizin) zum Einsatz von Botulinumtoxin bei Epicondylitis humeroradialis gefunden werden. Fünf dieser Studien waren Vergleichsarbeiten mit Verum vs. Placebo bei chronischen Verläufen, in 2 weiteren Arbeiten wurde Botulinumtoxin mit Kortikosteroiden bei akuten Fällen bzw. mit einer klassischen Hohmann-Operation bei chronischen Fällen verglichen, die 8. Arbeit verglich Botulinumtoxin mit 2 verschiedenen Injektionsorten und Kortikosteroiden in klassischer Injektion. Die vorliegenden Arbeiten deuten darauf hin, dass der gezielte Einsatz dieser Substanz eine Therapieoption bei therapierefraktären chronischen Fällen vor der Indikationsstellung zur Operation darstellen kann. Ausgehend von den Erkenntnissen der vorliegenden Arbeiten stellt der Arbeitskreis Botulinumtoxin in O & U der IGOST ein alternatives Injektionsschema vor, welches die bisherigen Verfahren in den positiven Aspekten bündeln und in den Nebenwirkungen minimieren könnte. Unter Nutzung von 2 einfachen Funktionstests und ggf. sonografischer Überprüfung können 2 separate Injektionsstellen in den M. extensor carpi radialis bzw. den M. extensor digitorum palpatorisch identifiziert werden. Als 3. Injektionsstelle fungiert der Sehnenspiegel am Epicondylus humeroradialis. Unter optimaler Ausnutzung des Ampulleninhalts können individuell angepasst je nach Muskelstatus die 3 Injektionsstellen infiltriert werden. Damit kann einerseits nach einem dualen Therapieansatz die Behandlung erfolgen und andererseits das Risiko einer Überdosierung in einen Muskel mit nachfolgender unnötiger Muskelabschwächung reduziert werden.

journal_name

Z Orthop Unfall

authors

Grüner S,Schulz A,Schlüter-Brust K,Lippert-Grüner M

doi

10.1055/a-1202-6220

subject

Has Abstract

pub_date

2020-08-03 00:00:00

eissn

1864-6697

issn

1864-6743

pub_type

杂志文章
  • [Clinical and Radiological Results after Anterior Cervical Corpectomy with Cage Fusion - a Retrospective Comparison of PEEK vs. Titanium Cages].

    abstract::Background Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. Beside the fusion technique using autogenous bone grafts, synthetic cages have been increasingly used in recent years. Published infor...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0042-118717

    authors: Schulz C,Mauer UM,Mathieu R

    更新日期:2017-04-01 00:00:00

  • [Minimally invasive treatment of tumours and metastases in the spine by plasma field therapy (cavity coblation) and vertebro-/kyphoplasty with and without additional dorsal percutaneous instrumentation].

    abstract:BACKGROUND:Realisation of a major operation of tumours/metastases in the backbone is in many cases not possible, above all in older multimorbid patients with higher OP risks. So it is important to proceed here so minimally invasive as possible, but at least actually to reduce above all pain for the patient and the dang...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0034-1382936

    authors: Dabravolski D,Lahm A,Kasch R,Merk H

    更新日期:2014-10-01 00:00:00

  • [Significance of bone mineral density and modern cementing technique for in vitro cement penetration in total shoulder arthroplasty].

    abstract:AIM:Loosening of the glenoid component is one of the major causes of failure in total shoulder arthroplasty. Possible risk factors for loosening of cemented components include an eccentric loading, poor bone quality, inadequate cementing technique and insufficient cement penetration. The application of a modern cementi...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0030-1249986

    authors: Pape G,Raiss P,Kleinschmidt K,Schuld C,Mohr G,Loew M,Rickert M

    更新日期:2010-12-01 00:00:00

  • Clinical Relevance of Cement Leakage after Radiofrequency Kyphoplasty vs. Balloon Kyphoplasty: A Prospective Randomised Study.

    abstract:BACKGROUND:Cement leakage is regarded as a typical complication of cement-based augmentation of vertebral fractures. The gold standard is balloon kyphoplasty (BK). Recent methods, such as radiofrequency kyphoplasty (RFK), must be compared with BK in terms of therapeutic success and complication rates. It is unclear whe...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章,随机对照试验

    doi:10.1055/s-0042-104069

    authors: Riesner HJ,Kiupel K,Lang P,Stuby F,Friemert B,Palm HG

    更新日期:2016-08-01 00:00:00

  • [The Foot in Language, Symbols, and Myths].

    abstract::In the history of evolution, the human foot is the youngest part of our skeleton and allows plane bipedal walking due to development of a longitudinal and transverse arch of the foot, with a stable, parallel first ray, but sacrificing the ability to grasp. Due to the loss of grasping, the hominoid mothers had to lay d...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/a-0661-6250

    authors: Zwipp H

    更新日期:2019-02-01 00:00:00

  • [Ceramic-on-ceramic bearings in total hip arthroplasty (THA)].

    abstract::The main reason for total hip arthroplasty (THA) revision is the wear-related aseptic loosening. Younger and active patients after total joint replacement create high demands, in particular, on the bearings. The progress, especially for alumina ceramic-on-ceramic bearings and mixed ceramics have solved many problems o...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0035-1545802

    authors: Sentürk U,Perka C

    更新日期:2015-04-01 00:00:00

  • [Partial physeal growth arrest with increasing genu varum deformity caused by a cortical enchondroma--a case report].

    abstract:INTRODUCTION:Trauma or infectious diseases can cause destruction of the epiphyseal region of the knee with premature partial bridging of the physis and deviation of length and axis. There is only little information about tumorous lesions as pathogenetic factor for these deviations. We have been searching for an approac...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-2008-1038999

    authors: Niethard M,Rogalski M,Deja M,Zacher J

    更新日期:2008-11-01 00:00:00

  • [The articular fracture of the lower limb].

    abstract:AIMS:The combination of a distal tibia fracture with an additional upper ankle joint injury is a challenge. Apart from various implants the intraoperative problem is the handling of these two injuries with appropriate reduction and retention. The existing and further developing soft tissue damage has to be taken into c...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-2008-1039265

    authors: Weber O,Müller MC,Goost H,Burger C,Kabir K,Wirtz D

    更新日期:2009-05-01 00:00:00

  • [Evaluation of image quality of two different three-dimensional cone-beam-scanners used for orthopedic surgery in the bony structures of the pelvis in comparison with standard CT scans].

    abstract:AIM:This study evaluated the image quality of two different cone beam CT scanners used in the operation theatre in pelvic trauma surgery in relation to their radiation dosage. Furthermore, the assumption that a higher dosage would result in better image quality was analysed by using the different acquisition scanner mo...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0030-1271136

    authors: Stuby F,Seethaler AC,Shiozawa T,Weise K,Mroue A,Badke A,Buchgeister M,Ochs BG

    更新日期:2011-12-01 00:00:00

  • [Ultrasound-based treatment of proximal humerus fractures in children].

    abstract:INTRODUCTION:The treatment of juvenile proximal humerus fractures is based on the extent of the deformity. The standard diagnosis with X-ray images in 2 directions is error-prone and can lead to a suboptimal treatment. The aim of this study was to evaluate if ultrasound imaging can improve the measurement of the deform...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1055/s-0032-1328193

    authors: Ackermann O,Eckert K,Rülander C,Endres S,von Schulze Pellengahr C

    更新日期:2013-02-01 00:00:00

  • [Non-operative treatment for severe forms of infantile idiopathic scoliosis].

    abstract:INTRODUCTION:Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatme...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0031-1280330

    authors: Trobisch PD,Samdani A,O'Neil C,Betz R,Cahill P

    更新日期:2012-02-01 00:00:00

  • [S3 guideline. Part 2: Non-Traumatic Avascular Femoral Head Necrosis in Adults - Untreated Course and Conservative Treatment].

    abstract:BACKGROUND:In Germany there are 5000 to 7000 new cases of atraumatic avascular necrosis of the femoral head in adults per year. It occurs mostly in middle age. An increased frequency of idiopathic cases can be observed. Chemotherapy, corticoids and kidney transplants are frequently associated with the disease. In most ...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0035-1545903

    authors: Roth A,Beckmann J,Smolenski U,Fischer A,Jäger M,Tingart M,Rader C,Peters KM,Reppenhagen S,Nöth U,Heiss C,Maus U

    更新日期:2015-10-01 00:00:00

  • [Diagnostic and Treatment Strategies in Morel-Lavallee Lesions in the Spinal Column and Pelvis].

    abstract:BACKGROUND:The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment optio...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章,评审

    doi:10.1055/a-0596-8018

    authors: Becker CA,Kammerlander C,Greiner A,Sommer F,Linhart C,Böcker W,Rubenbauer B,Weidert S

    更新日期:2018-10-01 00:00:00

  • Systemic Effects of Metals Released from Arthroplasty Implants - a Brief Summary.

    abstract::In recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/a-1187-1751

    authors: Rakow A,Schoon J

    更新日期:2020-10-01 00:00:00

  • [Prophylaxis of venous thromboembolism in orthopaedic surgery--trivial option, huge potential].

    abstract::Venous thromboembolism (VTE) is a common, sometimes even fatal though preventable complication after surgical interventions, especially in orthopaedic surgery. The risk can be reduced by more than 50 % by mechanical means and different anticoagulant drugs. However, only few patients receive adequate treatment. Medicam...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0029-1186018

    authors: Saxer F,Dick W

    更新日期:2010-01-01 00:00:00

  • [Elastic stable intramedullary nailing (ESIN) in pediatric forearm shaft fractures: intraoperative image intensifier times].

    abstract:AIM:Elastic stable intramedullary nailing (ESIN)is the therapy of choice in pediatric forearm shaft fractures. It requires increased intraoperative image intensifier times and radiation load. METHOD:We performed a retrospective analysis of 78 operative procedures from a five-year period. In 16 cases the image intensif...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 临床试验,杂志文章

    doi:10.1055/s-2007-965171

    authors: Kraus R,Pavlidis T,Szalay G,Meyer C,Schnettler R

    更新日期:2007-03-01 00:00:00

  • [Malpractice in the treatment of supracondylar humeral fractures in children - experience of the arbitration office of the Northern German Medical Boards].

    abstract:INTRODUCTION:Arbitration offices ("Schlichtungsstellen") in Germany are expert panels for the extrajudicial resolution of malpractice claims. The performance of arbitration panel proceedings ("Schlichtungsverfahren") is based on the German medical and insurance jurisdiction. In Germany, and in the United States likewis...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0030-1250487

    authors: Vinz H,Neu J,Festge OA

    更新日期:2010-12-01 00:00:00

  • [Therapy of Periprosthetic Shoulder Infection].

    abstract::There are several therapeutic options for the treatment of periprosthetic joint infections of shoulder arthroplasties. In acute infections, the implant can remain in place with open debridement, septic lavage with antibacterial solutions such as octinedine or polyhexanide solution and exchange of all mobile components...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章,评审

    doi:10.1055/s-0043-116942

    authors: Fink B,Sevelda F

    更新日期:2018-02-01 00:00:00

  • [The Postero-Lateral Approach--An Alternative to Closed Anterior-Posterior Screw Fixation of a Dislocated Postero-Lateral Fragment of the Distal Tibia in Complex Ankle Fractures].

    abstract:BACKGROUND:The dislocated posterolateral fragment of the distal tibia is considered as a key fragment for the successful reduction of comminuted ankle fractures. The reduction of this fragment can either be achieved indirectly by joint reduction using the technique of closed anterior-posterior screw fixation, or direct...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0035-1545706

    authors: von Rüden C,Hackl S,Woltmann A,Friederichs J,Bühren V,Hierholzer C

    更新日期:2015-06-01 00:00:00

  • [Association between Hindfoot Alignment and Localisation of Osteochondral Lesions of the Talus].

    abstract:BACKGROUND:Osteochondral lesions (OCL) of the talus show a distinct distribution pattern. Vascular, metabolic, idiopathic, and biomechanical factors have been proposed as influencing factors. However, the association of hindfoot alignment and the location of talar OCL is not known. MATERIALS AND METHODS:In 22 patients...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0034-1368604

    authors: Paul J,Hinterwimmer S,Vavken P,Wörtler K,Imhoff AB

    更新日期:2014-08-01 00:00:00

  • [Evidence-based therapy for cartilage lesions in the knee - regenerative treatment options].

    abstract:BACKGROUND:The treatment of cartilage defects has seen a shift from replacement to regeneration in the last few years. The rationale behind this development is the improvement in the quality-of-care for the growing segment of young patients who are prone to arthroplasty complications because of their specific character...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章,meta分析,评审

    doi:10.1055/s-0031-1298387

    authors: Proffen B,von Keudell A,Vavken P

    更新日期:2012-06-01 00:00:00

  • [Current concepts for treatment of massive rotator cuff tears].

    abstract::The ideal treatment for massive rotator cuff tears is influenced by the morphology and chronicity of the tear, tissue quality, the degree of concomitant osteoarthritis, and patient-specific factors. Traditionally, massive rotator cuff tears have wrongly been equated with irreparable tears. A variety of improvements in...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章,评审

    doi:10.1055/s-0035-1558056

    authors: Euler SA,Spiegl UJ,Millett PJ,Petri M

    更新日期:2016-02-01 00:00:00

  • Bilateral Tibial Tubercle Avulsion Fractures in Children - Clinical Results of a Rare Fracture.

    abstract:BACKGROUND:Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compa...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/a-0979-2384

    authors: Fernandez Fernandez F,Eberhardt O,Schröter S,Wirth T,Ihle C

    更新日期:2020-10-01 00:00:00

  • [Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology].

    abstract:BACKGROUND:The developments towards a combined specialty of orthopaedic and trauma surgery requires not only the consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new spe...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-2008-1038899

    authors: Dreinhöfer KE,Walcher F,Obertacke U,Waydhas C,Josten C,Rüsseler M,Venbrocks RA,Liener U,Marzi I,Nast-Kolb D,Forst R

    更新日期:2008-07-01 00:00:00

  • [Introduction of a new intervertebral spacer for cervical fusion: results of a controlled animal study].

    abstract:AIM:This study investigated the fusion properties of a new intervertebral spacer that is directly fixed to the adjacent vertebrae by screws. The new spacer was compared with an identical spacer without direct fixation but with an additional plate and with an autologous bone graft. METHODS:A single-level, cervical fusi...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-2007-965798

    authors: Schreiner U,Scheller G,Chen C,Schwarz M

    更新日期:2007-11-01 00:00:00

  • [Chances and risks of a new residency program for orthopedics and trauma surgery].

    abstract:BACKGROUND:The residency program for a specialist in orthopedics and trauma surgery is facing fundamental changes based on an initiative originating from the working group "medical training" of the German Medical Association (GMA). A survey indicated that 50 % of all trainees are dissatisfied with their current situati...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0033-1345672

    authors:

    更新日期:2013-04-01 00:00:00

  • [Mid-term outcome after implantation of a pyrocarbon endoprosthesis in patients with degenerative arthritis].

    abstract:AIM:The aim of this study was to make a mid-term evaluation of an unconstrained pyrocarbon prosthesis (Ascension®) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHOD:13 implants (10 patients) were clinically and radiologically studied after a follow-up perio...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 临床试验,杂志文章

    doi:10.1055/s-0031-1298389

    authors: Heers G,Telisselis P,Winkler F,Grifka J,Borisch N

    更新日期:2012-06-01 00:00:00

  • [Clinical cost analysis of balloon kyphoplasty--is there a possibility of cost-covering treatment?].

    abstract::Financial pressure on hospitals has been a major issue in the health care system of the past years and the financial situation is often what decides about the future of the hospitals. Therefore today the economic feasibility of patient treatment in hospitals is more important than ever before. After the degradation of...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-0034-1368472

    authors: Chmielnicki M,McDougall AM,Prokop A

    更新日期:2014-06-01 00:00:00

  • [A new anatomical wing plate for osteoporotic acetabular fractures: biomechanical testing and first clinical experience].

    abstract:BACKGROUND:Acetabular fractures are rare injuries, but there is an increasing number of elderly people with ventral medial instability in cases of central subluxation of the femoral head in osteoporotic acetabular fractures. Common plate osteosynthesis cannot enable medial support of the quadrilateral surface. The new ...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 临床试验,杂志文章

    doi:10.1055/s-0033-1360351

    authors: Schäffler A,Döbele S,Stuby F,Maucher M,Schröter S,Stöckle U,König B

    更新日期:2014-02-01 00:00:00

  • [Optical coherence tomography (OCT) to evaluate cartilage tissue engineering].

    abstract:AIM:The aim of this study was to investigate hyaline cartilage defects treated with cell-seeded artificial matrix systems (two different collagen type I gels) with the method of optical coherence tomography (OCT) and to correlate the results with conventional histological and immunocytochemical staining. METHOD:Osteoc...

    journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie

    pub_type: 杂志文章

    doi:10.1055/s-2008-1038948

    authors: Gavenis K,Schmitt R,Eder K,Mumme T,Andereya S,Schneider U,Müller-Rath R

    更新日期:2008-11-01 00:00:00