Lateral epicondylitis
Introduction
Introduction of external humeral epicondylitis External humeral epicondylitis (externalhumeralepicondylitis) is also known as tennis elbow or sacral tendon muscle tendon injury. This disease is related to occupation. It is more common in adults who need to repeatedly exercise their wrists, especially those who frequently rotate their forearms frequently. Such as tennis, golfers, violinists, tile woodworkers, etc. The disease belongs to the category of Chinese medicine. basic knowledge The proportion of illness: 1.3% Susceptible people: more common in adults who need to repeatedly exercise their wrists Mode of infection: non-infectious Complications: bursitis, periostitis
Cause
Causes of external humeral epicondylitis
Occupational factors (30%):
In the forearm excessive pronation or supination, passive traction muscles (hand fist, wrist) and active contraction extensor (extension) will produce greater tension on the origin of the extensor tendon at the lateral epicondyle of the humerus, such as long-term Repeat this action to cause chronic damage. Therefore, occupational and life movements that require repeated active movements of the wrist can cause such injuries, such as tennis, badminton, table tennis players, fitters, cooks and housewives.
Age factor (15%)
With the aging of the body as the body grows, in a few cases, the middle-aged and elderly civil servants who do not perform stylistic activities usually suffer from weak muscles. Even short-term lifting can cause epicondylitis of the tibia, such as a business trip. Luggage, assist with handling a large number of books, furniture, etc.
Pathological mechanism:
The basic pathological change of the external humeral epicondylitis is chronic injurious inflammation. Although the inflammation is more limited, the range of inflammation varies from patient to patient: some are only in the apex of the humerus, mainly fascia and periostitis; some are between the upper humerus and the humeral head. Is mainly fasciitis or ankle synovitis. In addition, it has been found that there is a small vascular bundle in the deep part of the extensor muscle, which is compressed when passing through the tendon and fascia, surrounded by inflammatory cell infiltration and scar tissue formation, which becomes the pathological basis for the symptoms.
1. In the forearm excessive pronation or supination position, passive traction muscles (hand fist, wrist) and active contraction extensor (extension wrist) will produce greater tension on the origin of the extensor tendon at the external iliac crest. If this action is repeated for a long time, it can cause chronic damage. Therefore, occupational and life movements that require repeated active movements of the wrist can cause such injuries, such as tennis, badminton, table tennis players, fitters, cooks and housewives. In a few cases, middle-aged and elderly civil servants who do not perform stylistic activities often suffer from weak muscles. Even short-term weight lifting can cause epicondylitis of the humerus. For example, it is necessary to carry heavy suitcases, assist in handling a large number of books, furniture, etc. .
2, the basic pathological changes of the external humeral epicondylitis is chronic injury inflammation. Although the inflammation is more limited, the range of inflammation varies from patient to patient: some are only in the apex of the humerus, mainly fascia and periostitis; some are between the upper humerus and the humeral head. Is mainly fasciitis or ankle synovitis. In addition, it has been found that there is a small vascular bundle in the deep part of the extensor muscle, which is compressed when passing through the tendon and fascia, surrounded by inflammatory cell infiltration and scar tissue formation, which becomes the pathological basis for the symptoms. Wait.
Prevention
External humeral epicondylitis prevention
1. The onset of humeral epicondylitis is related to chronic injury. Middle-aged and elderly people are often caused by fatigue. Therefore, the labor intensity should not be too large. Do not walk heavy objects for a long time. It is not appropriate to wash clothes once.
2, to prevent the temporomandibular fascia strain on the external humerus, usually pay attention to exercise, active upper limb joints, enhance muscle strength, help prevent the occurrence of this disease.
3. Before the work, prepare for functional exercise, take the initiative to make fists every day, bend the elbows, pre-rotate, and force out the punches and other exercises. Do not wash cold water frequently to avoid trauma.
Complication
Complications of external humeral epicondylitis Complications bursitis periostitis
Can be complicated by extensor tendon sacral bursitis, humeral epicondylitis, osteitis, ring ligament degeneration and ankle synovial fold hyperplasia, hypertrophy, nerve, blood vessel incarceration.
Symptom
Symptoms of humeral epicondylitis Common symptoms Elbow pain and swelling of the elbow and dysfunction Elbow swelling and tenderness
Symptoms often appear gradually. Initially, the pain on the lateral side of the elbow is relieved after a certain action. After the break, the pain is sustained. The lighter does not dare to twist the towel. When the heavy one extracts, there is a sudden disability phenomenon, usually outside the humerus. There is a limited tenderness point in the upper palate. The tenderness can spread to the sacral tendon of the temporal extensor. There is no redness and swelling in the local area. The flexion and extension of the elbow joint is generally unaffected, but sometimes the local forearm is prone or pronation. There is stiffness in the joints. Because the affected limbs are flexing elbows and the forearms are often relieved when they are in the posterior position, the patient takes this position. Some patients are tired at the elbows, and the pain is aggravated in rainy days.
Mills test positive: elbow, wrist, finger flexion, forearm passive pronation and gradually straightening, pain in the upper jaw of the humerus.
Local redness and swelling, elbow flexion and extension activities are generally unaffected, lateral elbow pain, local tenderness is obvious, lighter does not dare to twist the towel, heavy extract has sudden "power loss" phenomenon, mil (Mills) test is positive, you can Establish a diagnosis.
Examine
Examination of external humeral epicondylitis
There was no redness and swelling at the time of examination, joint function was not limited, and there was localized tenderness in the external iliac crest. A careful examination revealed a sensitive tender point.
Extensor tendon pull test: elbow straight, clenched fist, wrist, and then the forearm pronation, can induce positive pain on the lateral elbow, the tibial traumatic tendinitis due to myofascial inflammation, the pain is obvious when doing this test.
X-ray examination: X-ray film generally has no abnormal performance, and the periosteal reaction can be seen in the long course of the disease, and there is calcification deposition near the upper iliac crest.
Diagnosis
Diagnosis and differentiation of external humeral epicondylitis
diagnosis
The disease can be diagnosed based on typical clinical manifestations.
Differential diagnosis
Diagnosis should pay attention to the differentiation of cervical spondylosis. Cervical spondylotic radiculopathy can show lateral pain of the upper extremity, radiation pain, sensory dysfunction in the hand and forearm, no localized tenderness, attention to the interphalangeal nerve compression in the elbow Identification.
