Epicondylopathia humeri (EPH) and peritendinitis humeroscapularis (PHS): evaluation of radiation therapy long-term results and literature review.
BACKGROUND
The effectiveness of radiotherapy (RT) for degenerative inflammatory disorders has been clinically documented in historical studies, but long-term follow-up and assessment with objective criteria are still not available.


METHODS
From 1986 to 1991, 200 consecutive patients with symptomatic epicondylopathia humeri (EPH, n = 104) and peritendinitis humeroscapularis (PHS, n = 96) were referred to our clinic. All patients were refractory to conventional therapy prior to irradiation. One hundred fifty-six patients with 192 sites (due to bilateral symptoms) received a full treatment course and were available for long-term follow-up, i.e. 83 patients with 93 elbows and 73 patients with 89 shoulders. The treatment response was evaluated with regard to pain symptoms grouped into five categories (pain at strain, pain at night, persistent pain during daytime, pain at rest and morning stiffness) and four grades (none, mild, moderate and severe) and with regard to established orthopedic scores (Morrey score and Constant and Murley score). The analysis was performed before and 6 weeks after RT and at last follow-up. All joints received two RT series applied in three weekly fractions (EPH, 6 x 1 Gy (total 12 Gy); PHS, 6 x 0.5 Gy (total 6 Gy)). The second RT series started 6 weeks after the first RT series. The minimum follow-up was 1 year for both groups and the mean follow-up reached 4 years (range 1-8 years).


RESULTS
Fifty elbows (43 patients) and 44 shoulders (39 patients) achieved complete pain relief in all pain categories; 24 elbows and 28 shoulders substantially improved, i.e. had only minor symptoms. Thus, 74 elbows and 72 shoulders responded to RT. Nineteen elbows (17 patients) had surgery after RT due to persisting symptoms or subjective dissatisfaction; 17 shoulders (12 patients) were non-responders and five of those were operated on; seven elbows and one shoulder were completely free of pain after surgery. The mean Morrey score improved by 18 points (from 78 to 96) and the mean Constant and Murley score improved by 48 points (from 18 to 66). Two cases worsened according to the Morrey score and one case worsened according to the Constant and Murley score. Bi- and multivariate analysis revealed two factors with negative prognostic value on treatment outcome, i.e. EPH, long symptom interval prior to RT and long-term immobilization with plaster (P < 0.05) and PHS, long symptom interval prior to RT and lack of pain intensification during the first RT course (P < 0.05) were poor prognostic factors.


CONCLUSIONS
RT is highly effective for refractory EPH and PHS. Structured pain scores and quantitative orthopedic scores are important for evaluation. Prognostic factors for outcome can be established. Due to minimal side effects and low costs, RT represents an excellent treatment compared to conventional methods of treatment and surgery in the chronic disease.
Seegenschmiedt
M H
MH
Department of Radiotherapy, University of Erlangen-Nuremberg, Erlangen, Germany.
Keilholz
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011829:Radiation Dosage; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D012540:Scapula; D012785:Shoulder Joint; D052256:Tendinopathy / Q000503:physiopathology / Q000532:radiotherapy*; D013716:Tennis Elbow / Q000503:physiopathology / Q000532:radiotherapy*; D016896:Treatment Outcome