Anatomy of the extensor carpi radialis brevis muscle related to tennis elbow

The lateral elbow region was studied in embalmed specimens and living persons. The area is characterized by the origin of muscles extending wrist and fingers. Particular attention was paid to the extensor carpi radialis brevis muscle. It is shown that its anatomical features are different from the other muscles involved in movements like grasping and pinching. Consideration of the functional anatomy and biomechanics shows that repeated relatively large forces are exerted at the tendon of the extensor carpi radialis brevis muscle and at its origin at the lateral epicondyle of the humerus.     

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow.

OBJECTIVE: Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. METHODS: We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. RESULTS: Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17-44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. CONCLUSIONS: Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.     

网球肘的综合康复治疗

目的探讨网球肘的综合康复疗效。方法对50例网球肘患者行局部封闭、理疗、按摩、运动疗法及小针刀等综合康复治疗，观察患者症状和体征的改善情况。结果综合康复治疗痊愈率、显效率、好转率、总有效率分别为68．0％、16、0％、12．0％、96．0％。结论局部封闭、理疗、运动疗法及小针刀等综合治疗是治疗网球肘的有效方法。     

关节镜下关节外操作治疗顽固性网球肘*

目的探究关节镜下关节外操作治疗顽固性网球肘的临床疗效。方法 2015年9月-2017年11月连续收治顽固性网球肘患者21例(21例肘)。其中,男8例,女13例,手术时患者年龄33~62岁,平均43岁;保守治疗时间为7~41个月,平均15.0个月。21例顽固性网球肘均采用关节镜下关节外操作手术治疗。结果 21例患者均获随访,随访时间6~26个月,平均17.3个月,无感染和神经损伤等严重并发症。21例在视觉模拟评分(VAS)、Mayo肘关节功能评分(MEPS)及外上髁压痛点压痛程度等方面术前术后有明显差异;19例对治疗结果非常满意,2例对治疗结果满意,无不满意病例。结论关节镜下关节外操作治疗顽固性网球肘,手术方式直观、安全,临床效果满意。     

Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews

BackgroundLateral epicondylitis (LE) is one of the most commonly reported musculoskeletal disorders in the upper extremity. The mechanism of LE is repetitive motion that causes a strain of the extensor tendons. This consequently causes pain and tendinosis at the tendinous attachment site on the lateral epicondyle. Most cases of LE are treated nonoperatively with a variety of interventions, such as injections.PurposeThe aim of this systematic review (SR) is to synthesize the current evidence on the efficacy of platelet rich plasma (PRP) injections versus corticosteroid (CS) injections as treatment interventions for LE.Study DesignSystematic ReviewMethodsOnline databases were searched from database inception to February 24th, 2020 for relevant SR’s evaluating PRP vs. CS injections as treatment methods for LE. Two independent researchers searched and screened for articles that were systematic reviews that directly compared PRP to CS injections for LE.ResultsA total of five SR’s were included in this review that were published between 2016 and 2020. CS injections were more efficacious for short-term pain relief, and PRP injections were more efficacious for long-term pain relief and improved function.ConclusionPRP injections appear to be a more effective long-term treatment option than CS injections for those with LE who did not respond to conservative management.Level of evidence1     

针刺肘穴治疗网球肘康复评价及机理探讨

目的：观察针刺新穴“肘穴”医治网球肘的疗效,探讨其作用机理。方法：对确诊的患者采用单一针刺“肘穴”治疗,并对压痛度、自发性痛、 Ｒ Ｏ Ｍ（ 关节活动范围） 、 Ａ Ｄ Ｌ（ 日常生活能力） 进行每１ 疗次后的康复评定。结果：痊愈率达７３ ．２ ％ ,显著好转达１４．３％ ,无效仅１ ．８ ％ ,总有效率９８ ．２ ％ 。其中第１ 次疗后４ 项评分均有明显提高, Ｐ＜ ０ ．００１。结论： 第１“肘穴”系既往文中无记载的新穴,针刺该穴具有医治网球肘的良好效果,值得推广应用。第２ 针刺该穴的机理可能与“生物全息律”、脊髓交互抑制等有关。     

超声引导下改良经皮抽吸治疗钙化性冈上肌腱炎效果研究

目的 分析超声引导下改良经皮抽吸治疗钙化性冈上肌腱炎效果及安全性。方法 选取2017年1月—2019年1月期间,我院收治的钙化性冈上肌腱炎患者60例作为研究对象。根据随机数字表原则,将患者分为对照组和观察组,每组各30例。对照组患者在超声引导下行单针头经皮抽吸治疗,观察组患者在超声引导下行双针头经皮抽吸治疗。分别在术前、治疗后3d、7d、1个月、6个月,利用数字评价量表(NRS)评价患者疼痛程度,利用美国加州大学肩关节评分系统(UCLA)和Constant-Murley肩关节功能评分系统评价患者肩关节功能和活动范围。比较两组患者DR片检查结果及二次、三次治疗比率。同时记录治疗和随访期间不良反应发生情况,以评价安全性。结果 NRS方面,两组患者治疗前比较,差异无统计学意义(P＞0.05),治疗后3d、7d时,观察组患者NRS评分低于对照组,差异具有统计学意义(P＜0.05),治疗后1个月、6个月时,两组患者NRS评分比较,差异无统计学意义(P＞0.05)。UCLA评分和Constant-Murley评分方面,两组患者治疗前比较,差异无统计学意义(P＞0.05),治疗后3d、7d、1个月、6个月时,两组上述评分比较,差异无统计学意义(P＞0.05)。观察组患者DR片结果显示,治疗后7d时,钙化灶减小或消失。观察组患者二次、三次治疗比率低于对照组,差异具有统计学意义(P＜0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P＞0.05)。结论 相比于传统超声引导下单针头经皮抽吸术,超声引导下改良经皮抽吸治疗钙化性冈上肌腱炎,尽管不能改善患者肩功能和活动范围,但可在早期减轻患者疼痛,治疗效果显著,且具有较好的安全性。     

Measurement issues in the sonographic assessment of tennis elbow

Sonography is increasingly being used for assessment in tennis elbow research and clinical practice, but there are a lack of data regarding its validity, reliability, and responsiveness to change for this application. Studies using the modality were reviewed to establish current levels of evidence for these measurement properties. There is reasonable evidence regarding its validity for identifying tennis elbow tendinopathy, but a lack of data addressing its reliability and responsiveness. Practical issues affecting image quality are discussed, and recommendations for further investigation are suggested, to enhance the credible use of sonography with this debilitating condition. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

Physiotherapy,Steroid Injections,or Rest for Lateral Epicondylosis? What the Evidence Suggests

Objective: To identify effective lateral epicondylosis interventions and assess the quality of research over time. Methods: Relevant MEDLINE and EMBASE searches respectively yielded 226 and 187 potential studies. Additional citations were extracted from bibliographies. Thirty controlled trials met inclusion criteria. The Cochrane Collaboration guidelines “quality score” served to rate studies. Results: In the short term (<2 to 3 months) steroid injections and physiotherapy outperformed relative rest. Physiotherapy appears efficacious regardless of time frame. After 3 months, active physiotherapy outperforms injections, but does not appear significantly better than rest. Evidence was neutral or insufficient regarding ultrasound, splinting, or manipulation. Nonsignificant correlations between publication year and study quality score were found. Conclusions: Overall research quality has not improved with time. Steroid injections appear the most successful short‐term intervention for pain relief. Active physiotherapy appears efficacious regardless of time frame.     

体外冲击波疗法治疗网球肘患者有效性的Meta分析

目的:系统评价体外冲击波疗法(ESWT)治疗网球肘患者的有效性。方法:计算机检索PubMed,Embase,The Cochrane library和Web of science数据库,搜集有关冲击波治疗网球肘患者的随机对照试验(RCT),检索时限均设定为从建库至2017年8月。由2名研究者按照纳入与排除标准独立进行文献筛选、资料提取和研究质量评价后,使用RevMan 5.3软件进行Meta分析。结果:共纳入10个RCTs,合计患者928例。Meta分析显示冲击波组的疼痛评分[MD=-9.05,95%CI(-12.93,-5.18),P0.01]和握力[MD=3.45,95%CI(2.46,4.43),P0.01]明显优于对照组。结论:现有的临床试验表明,体外冲击波疗法能有效缓解网球肘患者的疼痛,改善患者的运动功能,可以作为治疗网球肘患者的常规备选方法之一。     

体外冲击波治疗网球肘的镇痛效果研究

目的:探讨体外冲击波治疗网球肘的即刻镇痛效应及累积效应。方法:使用国产电磁式体外冲击波治疗机治疗45例网球肘患者,5日1次,共3次。分别在每次治疗前、治疗后、疗程结束后1周,采用现时疼痛状况(PPI)、视觉模拟量表(VAS)、Mills征评定进行疗效评价。结果:3次治疗后即刻均比治疗前疼痛程度显著降低,差异有显著性意义(P<0.001)。在治疗间歇期,疼痛较上次治疗后即刻增加,差异有显著性意义(P<0.001),但均比上次治疗前的疼痛程度低(P<0.001),疗程结束后疼痛程度显著减轻,由治疗前的(2.29±0.76)分降到治疗后的(0.74±0.52)分。治疗后VAS评分比上次评定均有显著改善,由治疗前的(5.06±1.51)分降到治疗后的(1.99±1.82)分。治疗前Mills征阳性率为95.6%,3次治疗后阳性率分别为86.7%、64.4%、33.3%,差异有显著性意义(P<0.001)。结论:体外冲击波治疗网球肘具有显著的即刻镇痛效果,多次治疗后的镇痛作用有累积效应。     

不同中医辨证分型网球肘超声表现与浮针治疗效果

目的 观察不同中医辨证分型网球肘超声表现及浮针治疗效果。方法 纳入60例中医辨证分型明确并接受浮针治疗的网球肘患者，观察疗效并比较不同疗效患者之间网球肘证型及超声表现差异。结果 浮针治疗后网球肘治愈率为31.67%(19/60)、显效率为43.33%(26/60),总体有效率75.00%(45/60),无效率25.00%(15/60)。不同疗效患者之间，肌腱厚度、肌腱评分(包括回声、钙化及有无撕裂)及肌腱内血流评分差异均有统计学意义(P均<0.05);浮针用于伸肌总腱较薄、肌腱评分较低及血流评分较高者疗效更佳。治愈率、显效率及无效率在风寒阻络型网球肘分别为47.62%(10/21)、42.86%(9/21)及9.52%(2/21),在湿热内蕴型分别为31.58%(6/19)、57.89%(11/19)及10.53%(2/19),在气血亏虚型分别为15.00%(3/20)、30.00%(6/20)及55.00%(11/20)。3种证型之间，疗效、患侧伸肌总腱钙化比例及肌腱血流评分差异均有统计学意义(P均<0.05);风寒阻络型、湿热内蕴型疗效均优于、而患侧伸肌总腱钙化比例低于...     

穴位埋线法治疗网球肘的疗效研究

摘要 目的：本研究旨在探讨穴位埋线法治疗网球肘的临床疗效。 方法：本研究将68例符合纳入标准的患者随机分为两组,治疗组予以穴位埋线法,对照组予以中频电治疗。运用VAS评分、Mayo肘功能12点评分在疗程0周、2周时进行评估,对所获得分值进行比较,对比临床效果。临床疗效分析运用尼莫地平法分为临床痊愈、显效、有效、无效4级。 结果：两组治疗措施均有疗效,治疗组2周后总有效率为88.24％,对照组总用效率为76.47％,治疗组、对照组两组患者治疗后2周与治疗前比较疼痛、Mayo肘功能及总分差异均有显著性意义（P＜0.05),治疗后两组比较疼痛、Mayo肘功能及总分差异有显著性意义（P＜0.05)。 结论：应用穴位埋线法治疗网球肘安全、有效有助于疼痛缓解及改善关节功能。     

Evaluating the long-term effect of ultrasound-guided needle puncture without aspiration on calcifying supraspinatus tendinitis

Introduction  The aim of this study was to evaluate whether aspiration affects patient outcome during ultrasound-guided needle puncture treatment for calcifying supraspinatus tendinitis. Methods  Eighty-one patients with calcifying supraspinatus tendinitis received needle puncture therapy under ultrasonography guidance. Group A received ultrasound-guided percutaneous needle punctures and aspiration of calcareous deposits, while Group B received ultrasound-guided punctures only. Patients were evaluated using a visual analog scale (VAS) for pain, shoulder function, and satisfaction 1, 2, 3, 6, 12, 24, and 36 weeks after treatment. The different VAS parameters were combined and the differences between groups were analyzed. Results  In both groups, VAS scores significantly decreased over the 36 weeks following treatment (P<0.05). Overall, the majority (6/7) of the VAS scores were not statistically different between groups. Conclusion  The results of the study suggest that aspirating calcified deposits do not affect patient outcome. Puncturing the calcified deposits (without aspiration) appears to be an effective treatment method for calcifying supraspinatus tendinitis.     

微创经皮肾镜取石术后大出血的介入治疗

目的分析微创经皮肾镜取石术（MPCNL）后大出血的原因，总结介入治疗的经验。方法回顾性分析2004年8月～2007年1月862例MPCNL患者的临床资料，术后发生大出血5例，行超选择性肾动脉栓塞止血，均取得满意疗效。结果MPCNL术后大出血的发生率为0．58％（5／862），其中4例行1次介入栓塞后成功止血，1例行2次介入栓塞后止血。结论介入栓塞治疗是MPCNL术后大出血安全、有效的治疗手段。     

微创治疗创伤性肘关节僵硬及对肘关节功能、血清学指标的影响

目的探讨微创治疗创伤性肘关节僵硬(TES)及对肘关节功能、血清学指标的影响。方法选取2015年1月至2019年12月我院收治的TES患者116例,按照随机数字表法分为微创组与对照组各58例。对照组行开放松解术,微创组行微创松解术。比较两组切口长度、术中出血量及手术时间等围术期指标;术前及术后6个月肘关节活动度及Mayo评分;术前及术后3 d血清内啡肽(β-EP)、神经肽Y(NPY)、P物质(SP)等疼痛因子,血清丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD)等氧化应激因子;两组术后并发症。结果微创组切口长度、术中出血量及手术时间等围术期指标均小于对照组(P<0.05);术后6个月,两组伸直、屈曲、内旋、外旋活动度及Mayo评分比较,差异均无统计学意义(P>0.05);术后3 d,微创组血清β-EP、NPY、SP及SOD、GSH-Px水平低于对照组,LPO、MDA水平高于对照组(P<0.05);微创组术后并发症发病率低于对照组(P<0.05)。结论微创松解术治疗TES不但可获得与开放松解术一致的手术效果,还可有效避免机体过度损伤及氧化应激,抑制疼痛因子生成,降低术后并发症发生率。     

Eccentric training programmes in the management of lateral elbow tendinopathy

Background. Eccentric training has shown promising results in the management of Achilles and patellar tendinopathy. Recently, studies have investigated eccentric training in the treatment of lateral elbow tendinopathy.

Purpose. The purpose of this review was to describe eccentric training programs used to treat LET in order to inform clinicians and identify areas requiring further study.

Method. An electronic search of publications indexed in the MEDLINE database was performed in May 2007. Studies comparing eccentric training with at least one other intervention were included.

Results. Four studies investigating a total of 248 participants were identified. Three of the four studies reported superior results for eccentric training compared with other interventions, although this included one pilot study and another study that did not include an extended follow-up. There were several differences between the studies, including whether eccentric training was painful or pain-free, the duration of eccentric training (4 – 12 weeks) and whether training was performed in a clinical setting or at home.

Conclusion. Eccentric training in the management of LET has demonstrated encouraging results, although the literature is limited and eccentric programs are varied. Future studies should investigate factors that may influence the outcome of eccentric training, including whether training is painful and the duration of eccentric training.     

B超引导钢针十字投影在经皮肾镜穿刺定位中的应用体会

目的评价B超引导钢针十字投影在经皮肾镜穿刺定位临床治疗中的应用价值。方法选取该科2015年7月-2017年7月采用B超立体精准定位引导经皮肾镜取石术(PCNL)病例307例,结石分别有鹿角形结石、肾盏内多发性肾结石、体外冲击波碎石(ESWL)治疗失败、孤立肾结石、肾盂输尿管连接部(UPJ)梗阻合并结石、开放取石手术后复发和输尿管上段结石等。参照术前CT和腹部平片+静脉肾盂造影(KUB+IVP)确定穿刺角度及要穿刺的肾盏。然后,在B超立体精准定位下选择好第一标记线和第二标记线,两线交汇处为最终穿刺点,此点与第一标记点连线需与肾脏纵轴垂直。最后在最终穿刺点在B超立体探测引导下调整好探针角度进行目标肾盏穿刺。结果 307例患者中281例1或2次穿刺成功,21例3~5次穿刺成功,总的成功率98.4%(302/307),5例小切口分离至肾周在手指指导下穿刺成功。1例术后第2天出血严重(经选择性肾动脉栓塞止血)。结石取净率95.8%(294/307),13例残余结石,均≤0.5 cm。结论 B超立体精准定位应用于PCNL中安全有效,细化了定位方法,简便易行,值得推广。