Tsim thiab kho lub luj tshib tennis

Kev txhais ntawm lateral epicondylitis ntawm humerus

Kuj tseem hu ua tennis luj tshib, leeg nqaij ntawm extensor carpi radialis leeg, los yog sprain ntawm qhov txuas ntawm lub extensor carpi tendon, brachioradial bursitis, tseem hu ua lateral epicondyle syndrome. Kev mob aseptic o ntawm cov nqaij mos nyob ib puag ncig lub lateral epicondyle ntawm humerus vim mob, mob ntev..

Pathogenesis

Nws muaj feem cuam tshuam nrog kev ua haujlwm, tshwj xeeb tshaj yog nyob rau hauv cov neeg ua haujlwm uas feem ntau tig lub hauv pliaj thiab txuas ntxiv thiab flex lub luj tshib thiab dab teg. Lawv feem ntau yog cov poj niam hauv tsev, cov kws ntoo, cov cib, cov kws kho mob, cov kav dej, thiab cov neeg ncaws pob.

Dkab

Qhov tseem ceeb ntawm ob sab ntawm qis kawg ntawm lub humerus yog qhov nruab nrab thiab sab nraud epicondyles, medial epicondyle yog qhov sib txuas ntawm cov leeg ntawm cov leeg flexor ntawm lub forearm, thiab lateral epicondyle yog qhov txuas ntawm cov leeg ntawm cov leeg extensor ntawm lub forearm. Qhov pib taw tes ntawm cov leeg brachioradialis, flex lub forearm thiab me ntsis pronate. Qhov chaw pib ntawm extensor carpi radialis longus, extensor carpi radialis brevis nqaij, extensor digitorum majoris, extensor digitorum propria ntawm tus ntiv tes me, extensor carpi ulnaris, supinator nqaij.

Pathogen

Qhov pib ntawm condyle yog tshwm sim los ntawm kev mob hnyav thiab ncab, tab sis feem ntau cov neeg mob muaj qhov pib qeeb thiab feem ntau tsis muaj keeb kwm ntawm kev raug mob, thiab nws muaj ntau dua rau cov neeg laus uas xav tau rov tig lub forearm thiab txuas lub dab teg quab yuam. Nws kuj tuaj yeem raug strained los yog sprained vim rov ua dua dorsal txuas ntawm lub dab teg sib koom ua ke thiab ntau dhau ntawm lub dab teg ntawm lub dab teg ntawm qhov txuas ntawm lateral epicondyle ntawm humerus thaum lub forearm nyob rau hauv txoj hauj lwm pronation.

Pathology

1.Vim kev raug mob rov qab, lub lateral epicondyle ntawm cov nqaij fiber ntau yog torn thiab hemorrhaged, tsim subperiosteal hematoma, thiab tom qab ntawd koom thiab ossifying, ua rau periosteitis thiab pob txha hyperplasia ntawm lateral epicondyle ntawm humerus (feem ntau nyob rau hauv daim ntawv ntawm ib tug ntse ntug nodule). Pathological kev kuaj mob biopsy yog hyaline degeneration ischemia, yog li nws tseem hu ua ischemic o. Qee lub sij hawm nws yog nrog los ntawm kev tsim kua muag ntawm cov pob qij txha, thiab cov ntaub so ntswg ntawm cov pob qij txha yog proliferated thiab thickened vim lub sij hawm ntev stimulation ntawm cov leeg.
2.Tear ntawm qhov extensor tendon txuas taw tes. 
3.traumatic o los yog fibrohistolitis ntawm annular ligament. 
4. bursitis ntawm brachioradial ob leeg thiab extensor cov leeg.
5.Inflammation ntawm lub synovium ntawm humerus thiab radial sib koom ua ke tshwm sim los ntawm intercalation ntawm lub humerus thiab lub taub hau me me ntawm lub vojvoog.
6. Kev so ntawm lub ligament humerioradial thiab kev sib cais me me ntawm qhov sib thooj radial-ulnar sib koom kuj tuaj yeem tshwm sim, uas ua rau lub taub hau radial cephalic dislocation. Cov kev hloov pauv pathological no tuaj yeem ua rau cov leeg nqaij spasms, mob hauv zos, ua rau mob hnyav los ntawm cov leeg pob qij txha mus rau hauv pliaj.

Kev nthuav qhia kho mob

1.Qhov mob nyob rau sab nraud ntawm lub luj tshib yog aggravated thaum pronation, tshwj xeeb tshaj yog thaum tig rov qab extension, nqa, rub, xaus, thawb thiab lwm yam kev ua, thiab radiating downward raws lub dab teg extensor leeg. Thaum pib, kuv feem ntau hnov ​​​​mob thiab tsis muaj zog nyob rau hauv qhov chaw raug mob, thiab maj mam tsim qhov mob ntawm sab nraud ntawm lub luj tshib, uas feem ntau ua rau hnyav dua nrog kev ua kom muaj zog. (Qhov xwm ntawm qhov mob yog mob los yog tingling)
2.Nws yog aggravated tom qab exertion thiab relieved tom qab so.
3.Forearm rotation thiab tsis muaj zog ntawm kev tuav cov khoom, thiab txawm poob nrog cov khoom.

Cov cim

1.Lateral humeral epicondyle Lub posterolateral nam ntawm lub lateral epicondyle ntawm humerus, qhov chaw ntawm lub humeral-radial sib koom, lub cephalic cephalic thiab lub lateral ntug ntawm lub radial caj dab condyle yuav palpated, thiab musculosis thiab nqaij nqaij daim tawv nyob rau hauv lub radial sab ntawm lub sab sauv forearm kuj yuav palpated nrog mildness. Qee zaum cov npoo ntse ntawm hyperostosis tuaj yeem hnov ​​​​ntawm lub lateral epicondyle ntawm humerus, thiab lawv muaj kev sib tw heev.
2.Qhov kev kuaj Mills yog qhov zoo. Khoov koj lub hauv pliaj me ntsis thiab ua ib nrab nrig, flex koj lub dab teg kom ntau li ntau tau, tom qab ntawd ua kom tiav koj lub hauv pliaj thiab ncab koj lub luj tshib. Yog tias qhov mob tshwm sim ntawm sab sab ntawm lub brachioradial sib koom thaum lub luj tshib ncaj, nws yog qhov zoo.
3.Positive extensor resistance test: tus neeg mob clenched nws lub nrig thiab flexed nws lub dab teg, thiab tus kws kuaj mob nias lub nraub qaum ntawm tus neeg mob txhais tes nrog nws txhais tes kom tus neeg mob tiv taus thiab ncua lub dab teg, xws li qhov mob ntawm sab nraud ntawm lub luj tshib yog qhov zoo.
4.X-ray kuaj tej zaum yuav qhia tau tias periosteal irregularity, los yog ib tug me me ntawm cov ntsiab lus calcification sab nraum lub periosteum.

Kev kho mob

Conservative kev kho mob:

1. Tso tseg kev cob qhia hauv zos ntawm stimulation thaum ntxov, thiab qee cov neeg mob tuaj yeem kho tau los ntawm kev so lossis hauv zos plaster immobilization condyle.
2.Massage therapy, siv thawb thiab kneading cov tswv yim los txo qhov spasm thiab mob nyem ntawm cov leeg extensor ntawm lub forearm, thiab tom qab ntawd siv cov ntsiab lus siab thiab kneading cov tswv yim ntawm lub lateral epicondyle ntawm humerus thiab cov ntsiab lus mob nyob ze.
3. Tuina kho, tus neeg mob zaum. Tus kws kho mob siv maj mam dov thiab kneading ua rau sab nraub qaum thiab sab nraud ntawm lub luj tshib thiab reciprocating raws lub dorsal sab ntawm lub forearm. Tus kws kho mob siv tus ntiv tes xoo los nias thiab rub Ah Shi (sab tom qab epicondyle), Qi Ze, Quchi, Tes Sanli, Waiguan, Hegu acupoint, thiab lwm yam. Tus neeg mob zaum, thiab tus kws kho mob plucks tus neeg mob qhov chaw pib ntawm extensor carpi thiab extensor carpi longus thiab brevis radialis. Rub thiab ncab, nyob lub luj tshib. Thaum kawg, siv thenar rubbing txoj kev los txhuam cov lateral epicondyle ntawm lub luj tshib thiab cov leeg extensor ntawm lub forearm, thiab cov cua sov hauv zos yog siv rau qib.
4. Kev kho tshuaj, qhov ncauj uas tsis yog-steroidal anti-inflammatory tshuaj nyob rau theem mob.
5. Occlusive kev kho mob: glucocorticoids (xws li compound betamethasone txhaj) yog txhaj rau hauv qhov kev sib tw taw tes thiab txhaj rau hauv cov leeg pob qij txha thiab qhov chaw subaponeurosis (tsawg dua lossis sib npaug li 3 zaug), uas tuaj yeem ua rau muaj kev tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob, thiab cov tshuaj sib xyaw betamethasone thiab ropivacaine los yog kev sib xyaw ua ke tam sim no nrog levo-accompatibility. ntev-ua yeeb yam, siab anti-inflammatory titer, thiab qhov kev nyab xeeb tshaj plaws, ntev tshaj plaws thaiv lub sij hawm, tsawg kawg yog tshuaj lom neeg cov tshuaj tiv thaiv thiab qis tshaj qhov mob rebound tshuaj compatibility rau lub zos occlusion.
6. Kev kho mob acupuncture, qhov kev txiav yog nyob ze rau ntawm pob txha nto kom tev tawm cov nplaum mos cov ntaub so ntswg nyob ib ncig ntawm cov txheej txheem ntawm cov pob txha, dredge lub extensor dab teg nqaij, extensor ntiv tes cov leeg nqaij leeg thiab supinator tendon, thiab rub tawm cov riam nrog lub siab ntawm looseness. Kev kho phais: haum rau cov neeg mob uas tsis teb rau kev kho mob.

1. Lub cev & Meleod txoj kev, kev ua haujlwm yuav luag tag nrho cov ntaub so ntswg ntawm qhov txhab, nrog rau kev txiav tawm ntawm 2 hli lateral epicondyle, kev tso tawm ntawm qhov pib ntawm extensor ntau tendon, ib feem ntawm qhov kev txiav txim siab ntawm qhov kawg ntawm qhov kawg ntawm lub ligament, qhov ntxig ntawm humeroradial sib koom ua ke rau hauv cov ntaub so ntswg ntawm cov pob txha los yog cov pob txha resection. qhov chaw.

2. Nischl txoj kev, cov extensor tendon thiab extensor carpi longus radialis tendon yog sib cais longitudinally, qhov sib sib zog nqus extensor carpi radialis brevis tendon yog nthuav tawm, lub ntsiab lus insertion yog tev tawm ntawm qhov chaw ntawm lub lateral epicondyle, cov ntaub so ntswg degenerated yog cleared, ib feem ntawm cov pob txha cortex thiab residual cortex nyob rau hauv pem hauv ntej. sutured los yog reconstructed ntawm cov pob txha. Intra-articular kev koom tes tsis tau tawm tswv yim.

Prognosis

Lub sijhawm ntawm tus kab mob yog ntev thiab nws yuav rov tshwm sim dua.

Nua ote

1. Ua tib zoo ua kom sov thiab tsis txhob txias;
2. Txo cov kab mob pathogenic;
3.Kev ua haujlwm ua haujlwm;
4. Nyob rau theem mob hnyav, cov txheej txheem yuav tsum maj mam, thiab cov txheej txheem kev kho mob yuav tsum maj mam ua rau cov neeg mob tau ntev, uas yog, cov txheej txheem yuav tsum mos nrog rigidity, rigidity nrog softness, thiab rigidity thiab softness yuav tsum tau ua ke.