Kuumbwa uye kurapwa kwe tennis elbow

Tsanangudzo ye lateral epicondylitis yehumerus

Iyo inozivikanwawo se tennis elbow, tendon strain ye extensor carpi radialis muscle, kana sprain yeattachment point ye extensor carpi tendon, brachioradial bursitis, inozivikanwawo se lateral epicondyle syndrome. Kushungurudza aseptic kuzvimba kwezvinyoro zvinyoro zvakatenderedza lateral epicondyle yehumerus nekuda kwekukuvara kwakanyanya, kusingaperi..

Pathogenesis

Yakanyatsoenderana nebasa, kunyanya muvashandi vanowanzotenderedza ruoko uye kutambanudza uye kuchinjisa gokora uye wrist majoini. Vazhinji vavo madzimai epamba, vavezi, vanovaka zvidhinha, vanogadzira pombi, uye vatambi.

Dchikamu

Izvo zvinozivikanwa kumativi ose maviri emucheto wezasi wehumerus ndeyepakati uye lateral epicondyles, iyo medial epicondyle ndiyo yakanamatira tendon yakajairika ye flexor muscles ye forearm, uye lateral epicondyle ndiyo yakasungirirwa yetendon yakajairika ye extensor muscles ye forearm. Nzvimbo yekutanga yebrachioradialis tsandanyama, shandura ruoko uye zvishoma pronate. Nzvimbo yekutanga ye extensor carpi radialis longus, extensor carpi radialis brevis muscle, extensor digitorum majoris, extensor digitorum propria yemunwe muduku, extensor carpi ulnaris, supinator muscle.

Pathogen

Kutanga kwekondiyo kunokonzerwa nekuputika kwakanyanya uye kutambanudza, asi varwere vakawanda vane zvishoma nezvishoma uye kazhinji havana nhoroondo yakajeka yekutambudzika, uye inowanzoonekwa kune vanhu vakuru vanoda kudzokorodza kutenderera mberi uye kuwedzera ruoko nesimba. Inogonawo kudzvinyirirwa kana kuvharwa nekuda kwekudzokorora dorsal kuwedzera kwekubatana kwemaoko uye kunyanya kutambanudza kwetendon ye wrist pakubatanidzwa kwe lateral epicondyle yehumerus apo ruoko rwuri munzvimbo yekutaura.

Pathology

1.Nekuda kwekukuvara kwakadzokororwa, iyo lateral epicondyle yemuscle fiber yakabvaruka uye inobuda ropa, ichigadzira subperiosteal hematoma, uyezve kuronga uye ossifying, zvichiita kuti periosteitis uye bone hyperplasia ye lateral epicondyle yehumerus (kunyanya muchimiro chechidimbu chinopinza). Pathological tissue biopsy kuongorora ndeye hyaline degeneration ischemia, saka inonziwo ischemic kuzvimba. Dzimwe nguva inoperekedzwa nekubvarura kwesaga rekubatana, uye synovial membrane yejojo ​​inowedzera uye yakakora nekuda kwekukurudzira kwenguva refu nemusuru.
2.Kubvarura pane extensor tendon attachment point. 
3.kushungurudza kuzvimba kana fibrohistolitis ye annular ligament. 
4. bursitis ye brachioradial joint uye extensor common tendon.
5.Kuputika kwe synovium yehumerus uye radial joint inokonzerwa nekupindirana kwehumerus uye musoro muduku wepakati.
6. Kusununguka kwehumerioradial ligament uye kupatsanurwa kwakadzikama kweproximal radial-ulnar joint inogonawo kuitika, zvichiita kuti kuputika kwemusoro we cephalic musoro. Idzi shanduko dzepathological dzinogona kukonzera tsandanyama spasms, kurwadza kwenzvimbo, marwadzo anopenya kubva kune yakatambanudzwa mhasuru dzechanza kusvika paruoko.

Clinical presentation

1.Marwadzo ari kunze kwejojo ​​yegorofu anowedzera kana kududzirwa, kunyanya kana uchitenderedza kumashure kwekuwedzera, kusimudza, kudhonza, kuguma, kusundira uye zvimwe zviito, uye kupenya pasi pamwe nemutsara we wrist extensor. Pakutanga, ndinowanzonzwa kurwadziwa uye kushaya simba mumakumbo ekukuvadzwa, uye zvishoma nezvishoma ndinotanga kurwadziwa kunze kwegokora, izvo zvinonyanya kuwedzera nekuwedzera kwekurovedza muviri. (The nature of the pain is soreness or tingling)
2.Inowedzerwa mushure mekushanda nesimba uye kusunungurwa mushure mekuzorora.
3.Forearm kutenderera uye kushaya simba mukubata zvinhu, uye kunyange kudonha nezvinhu.

Signs

1.Lateral humeral epicondyle The posterolateral aspect of the lateral epicondyle of the humerus, nzvimbo yehumeral-radial joint, cephalic cephalic uye lateral edge ye radial neck condyle inogona kuvharwa, uye musculosis uye nyama yenyama padivi reradial repamusoro pepamusoro pepamusoro-soro, kunyorova kwepamusoro-soro kunogonawo kunyorova. Dzimwe nguva micheto yakapinza ye hyperostosis inogona kunzwika kune lateral epicondyle yehumerus, uye inyoro kwazvo.
2.The Mills bvunzo yakanaka. Pembera ruoko rwako zvishoma uye gadzira hafu-chibhakera, chinjisa chanza chako zvakanyanya sezvinobvira, wobva wanyatsoburitsa ruoko rwako wotwasanudza gokora rako. Kana kurwadziwa kuchiitika kune lateral side yebrachioradial joint kana gokora ratwasanudzwa, zvakanaka.
3.Positive extensor resistance test: murwere akabata chibhakera chake ndokuchinjanisa ruoko rwake, uye muongorori akadzvanya kumashure kweruoko rwemurwere neruoko rwake kuita kuti murwere arambe kuramba uye awedzere ruoko, sekurwadziwa kunze kwegokora kwakanaka.
4.X-ray kuongorora dzimwe nguva inogona kuratidza periosteal irregularity, kana nhamba shoma ye calcification points kunze kwe periosteum.

Kurapa

Conservative treatment:

1. Rega kudzidziswa kwemunharaunda kwekukurudzira kare, uye vamwe varwere vanogona kusunungurwa nekuzorora kana yemunharaunda plaster immobilization condyle.
2.Massage therapy, shandisa nzira dzekusunda uye kukanya kuti ubvise spasm uye marwadzo e extensor tsandanyama dze forearm, uye ipapo shandisa point pressure uye kukanya nzira pa lateral epicondyle yehumerus uye marwadzo ari pedyo.
3. Tuina therapy, murwere anogara. Chiremba anoshandisa kuumburuka zvinyoro nyoro uye kukanyaira kuita kumusana nekunze kwegokora uye kudzokerana nechepaseri peruoko. Chiremba anoshandisa chigunwe chechigunwe kuti atsikidze uye achikwiza Ah Shi (lateral epicondyle), Qi Ze, Quchi, Hand Sanli, Waiguan, Hegu acupoint, etc. Murwere agere, uye chiremba anochera kutanga kwemurwere we extensor carpi uye extensor carpi longus uye brevis radialis. Dhonza uye tambanudza, rarama magokora. Pakupedzisira, shandisa iyo thenar rubbing method yekukwesha lateral epicondyle yegokora uye extensor muscles ye forearm, uye kupisa kwenzvimbo kunoshandiswa kusvika padhigirii.
4. Kurapa kwezvinodhaka, oral non-steroidal anti-inflammatory drugs in the acute stage.
5. Occlusive treatment: glucocorticoids (yakadai sejojo ​​ye betamethasone) inopinza mumutsara wenyoro uye injected munzvimbo yekuisa tendon uye subaponeurosis nzvimbo (isingasviki kana yakaenzana ne3 nguva), iyo inogona kutamba anti-inflammatory uye analgesic effect, uye betamethasone yakasanganiswa uye ropivacaine neropivacaine kana levopivacaine kana kuti compivacaine inokurumidza kuona. refu-inobata, yakakwira anti-kuzvimba titer, uye yakachengeteka, yakarebesa kuvharira nguva, ine muchetura kuita uye kuderera kwemarwadzo kudzoreredzwa kwezvinodhaka kugarisana kwenzvimbo.
6. Kurapa kweAcupuncture, iyo incision iri pedyo nepamusoro pebhonzo kuti ibvise kunamatira zvinyoro zvinyoro zvakapoteredza bone process, dredge the extensor wrist muscle, extensor finger muscle common tendon uye supinator tendon, uye kuvhomora banga nekunzwa kwekusunungura. Kuvhiya kurapwa: kwakakodzera kune varwere vasingapindure kurapwa kwekuchengetedza.

1. Muviri & Meleod nzira, kushanda kunosanganisira zvinenge zvese zvinyama zvechironda, kusanganisira kubviswa kwe2mm lateral epicondyle, kusunungurwa kwekutanga kwechigamba chinonzi extensor common tendon, chikamu chechikamu chechikamu chekupedzisira kweannular ligament, kuiswa kwehumeroradial joint mu synovium ye-bundu kana kuti kubviswa kwe granovium, uye kubviswa kwe granovium munzvimbo.

2. Nischl nzira, iyo yakajairika extensor tendon uye extensor carpi longus radialis tendon inoparadzaniswa kwenguva refu, yakadzika extensor carpi radialis brevis tendon inoratidzirwa, nzvimbo yekuisa inobviswa kubva pakati pe lateral epicondyle, iyo yakasvibiswa tendon tissue inocheneswa, chikamu chepfupa chepfupa chinobviswa, tendon inobviswa pamberi, uye tendon iri mberi. sutured kana kugadzirwazve pabhonzo. Intra-articular kubatanidzwa hakukurudzirwe.

Prognosis

Chirwere chechirwere chakareba uye chinowanzodzoka zvakare.

Note

1.Kuchenjerera kuti ugare uchidziya uye urege kutonhora;
2.Reduce pathogenic factors;
3.Kushanda basa;
4. Muchikamu chakaoma, nzira yacho inofanira kuva yakapfava, uye nzira yekurapa inofanira kuwedzera zvishoma nezvishoma kune avo vave vachirwara kwenguva yakareba, kureva kuti, nzira yacho inofanira kuva yakapfava nekuoma, kuoma nekunyorova, uye kuoma uye kunyorova kunofanira kusanganiswa.