王明杰網球肘的新認識

1、◆ 原有的認識,◆ 肌筋膜觸發(fā)點的認識。 1、病理認識。 2、網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）?！?網球肘的綜合治療。,原有的認識,網球肘，又稱肱骨外上髁炎。大多數病人主訴肱骨外上髁處的疼痛、前臂運動性疼痛和無力。過去僅注意到肱骨外上髁的病理變化，如：局部淋巴細胞浸潤、疤痕化等。因此，重點放在對肱骨外上髁的治療，治療時常對肱骨外上髁處疼痛的局部封閉、理療、針刺治療。這種療法早期治療尚可，但后期反復復發(fā)，嚴重影響了患者的工作

2、和生活質量。 Tennis elbow, also called the extenal humerus epicondylitis. Most patients complained of the external condyle humerus pain, their forearm is fatigue pain and weakness. In the Past， doctors only took no

3、tice of the external condyle humerus pathological changes, such as: partial lymphocytes infiltration, scariation, etc. Therefore, focuses on the external condyle humerus, the cure on the external condyle humerus often ar

4、e implementations of blockade, physiotherapy, acupuncture treatment at the local pain on condyle. This kind of therapy works as early treatment, but it would relapse in later period, and influence patients’ job and l

5、ife quality.,The original understanding,肘關節(jié)正側位片,L,◆,肌筋膜觸發(fā)點疼痛的認識,引入肌筋膜觸發(fā)點疼痛理論，改變了我們對肱骨外上髁炎的認識。肱骨外上髁疼痛不是原發(fā)疼痛，而是一個來自接近肱骨外上髁肘外側肌群（主要是伸肌群）的肌筋膜觸發(fā)點疼痛的牽涉痛。 Introduction of myofascial trigger points theory changed our understan

6、ding of external humeral epicondylitis. The external condyle humerus pain is not a primary pain, but referred pain to the myofascial trigger points around external condyle humerus on elbow musculus lateralis externi (mai

7、nly extensor muscles).,Understanding of Myofascial trigger points of pain,肌筋膜觸發(fā)點疼痛的認識,這種痛性綜合征常因為肘外側肌過渡疲勞或損傷，造成慢性持續(xù)肌節(jié)縮短，大大地增加局部能量的消耗和局部血循環(huán)的減少，從而引起異常的肌纖維運動終板處異常的放電，以致靜息狀態(tài)下肌肉持續(xù)痙攣，而產生疼痛 。Because of the elbow musculus latera

8、lis externi injury or fatigue, this kind of ache syndrome often result in continued chronic sarcomere shortening. The local energy consumption increases and local blood circulation decease greatly, thus causes the muscle

9、 fibers end plate discharge abnormally, so convulsion of muscles would last in the resting state, then causes the pain.,Understanding of Myofascial trigger points of pain,肌筋膜觸發(fā)點疼痛的認識,最近的微電極診斷證據證實異常肌運動終板神經末梢處的乙酰膽堿濃度在休息狀況下

10、存在著病理性增高，結果引起肌的后連接持續(xù)的去極化，從而產生持續(xù)性肌節(jié)縮短和肌纖維收縮，因此出現了運動終板處的收縮結節(jié)。Recent evidence to substantiate the microelectrode diagnosis, in the resting condition, there is pathological increase of acetylcholine concentration in abnorma

11、l muscle movement endplate nerve endings. The result causes depolarization of tendons, which to generate continued constant shortening of muscle fibers and sarcomere, and thus appeared the end plate contraction knots.,肌筋

12、膜觸發(fā)點疼痛的認識,這種慢性持續(xù)肌節(jié)縮短將大大地增加局部能量的消耗和局部血循環(huán)的減少；局部缺血和低氧可刺激神經血管反應物質的釋放，這些物質使傳入神經致敏而引起觸發(fā)點疼痛。這些物質又可以刺激異常的乙酰膽堿釋放，形成了一個正反饋環(huán)的惡性刺激，對短縮肌節(jié)的拉長可以打破這個環(huán)。This chronic continued shortening of sarcomere lead to great increase of local energ

13、y consumption and reduction of local blood circulation. Ischemia and low oxygen can stimulate the release of vessels and nerves reaction substances, these substances that afferent nerve sensitization triggers caused pain

14、. These substances also can stimulate the abnormal release of acetylcholine, formed a positive feedback loop of the malignant stimulation, spinning of the shortened sarcomere can break the loop.,肌筋膜觸發(fā)點疼痛的認識,,如果長期短縮肌節(jié)，還會產

15、生骨骼肌周圍筋膜的攣縮，而防礙肌肉牽張治療。當傷害性感受器被致敏時，由傳入神經將疼痛信號傳入脊髓，產生了中樞疼痛信號，再擴散到鄰近的脊髓節(jié)段引起牽涉痛。長期的中樞疼痛致敏可以增高神經元的興奮性和神經元受體池的擴大，造成頑固性牽涉痛。If there is a long-term sarcomere shortening, a contracture of aponeurosis around the skeletal muscles

16、can be produced, which would hinder muscles stretch treatment. While there is sensitization in harmful sensor, the pain signals are afferent into the spinal cord by the afferent nerve, producing the central pain signals

17、which spread to neighboring segmental spinal cord, thus referred pain caused. Long-term central pain sensitization can heighten excitability of neurons and expand the neurons receptor pool, then make referred pain stubbo

18、rn.,肌筋膜觸發(fā)點疼痛的認識,,網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）,肌肉名稱,musculus triceps brachii,musculus anconeus,musculus brachioradialis,extensor carpi radialis longus,digitus annularis musculus extensor,supinator,musculus subclavius,Associated skelet

19、al muscle of tennis elbow (trigger point),網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）,網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）,Associated skeletal muscle of tennis elbow (trigger point),網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）,網球肘關聯(lián)骨骼?。ㄓ|發(fā)點）,網球肘的綜合治療,針刺治療：針刺觸發(fā)點時，病人有酸脹感，并且有局部肌肉抽搐。針刺可以破壞肌肉的觸發(fā)點和刺破張力帶或強烈刺激觸發(fā)

20、點，引發(fā)了脊髓的強烈反射，而改變或破壞了脊髓中樞的感覺支配區(qū)，從而放松了張力帶達到止痛。 Acupuncture treatment: while trigger point is acupunctured, the patient has triggered acid bilges feeling, and a partial muscle twitching. Acupuncture may break the muscle tr

21、igger points, and prick tension band or intense stimulation trigger points, causing the strong reflection of spinal cord, then change or break down the central control of feeling in spinal cord, thereby relaxed tension b

22、and and kill the pain.,Comprehensive treatment of tennis elbow,操作A.MPG,操作B.MPG,牽張訓練：對前臂肌的牽張鍛煉，可以使肌肉保持一種松弛和有氧狀態(tài)，是減少復發(fā)的關鍵。 Stretch exercise: forearm muscles stretching can maintain a relaxed and aerobic condition of muscl

23、es, it is the key to reduce the recurrence.,網球肘的綜合治療,牽張鍛煉,肘外側肌的牽張鍛煉法：患臂的肘關節(jié)伸直，并用另一側手握住患側手，幫助過屈患側碗關節(jié)；然后，前臂盡量旋前。并每次鍛煉持續(xù)1－2分鐘。肘內側肌的牽張鍛煉法：患臂的肘關節(jié)伸直，并用另一側手握住患側手，幫助過伸患側碗關節(jié)；然后，前臂盡量旋后。并每次鍛煉持續(xù)1－2分鐘。Instruction of elbow musculus

24、lateralis externi stretch: from the sick elbow unbend arm, hand, and the healthy hand helps to hypercurve the bowl of joints (the palm faces the patient); then, the forearm does the pronation movement as far as possible.

25、 The exercise sustained for 1-2 minutes each time.Instruction of elbow musculus lateralis interni stretch: from the sick elbow unbend arm, hand, and the healthy hand helps to hyperextension the bowl of joints (the opist

26、henar faces the patient); then, the forearm does the supinatio movement as far as possible. The exercise sustained for 1-2 minutes each time.,Stretch exercise,網球肘的綜合治療,輔助治療：1.應當長期恰當的補給多種維生素藥物，有利于對治療的鞏固和減少復發(fā)。 2.改善微循環(huán)可以緩

27、解局部血管危像，也是協(xié)助減少觸發(fā)點疼痛的輔助因子。 Adjuvant therapy：1 A appropriate long-term vitamins supply is advantageous to consolidate the therapy and reduce the recurrence.2 Improvement of microcirculation can alleviate the local blood