Summary of 58 cases of lateral elbow pain syndrome treated with acupuncture and knife Yao Yajie, Department of Orthopedics, Suzhou Pingjiang Hospital Overview In clinical practice, some patients with humeral epicondylitis still have unsatisfactory results after closure, physical therapy, acupuncture and massage, or even multiple acupuncture treatments. syndrome. The author applied acupuncture with manipulation to treat 58 cases of lateral elbow pain syndrome and achieved satisfactory results, which are reported below. Keywords acupuncture, lateral elbow pain syndrome 1 General information Among the 58 cases, 21 cases were male, 37 cases were female, the oldest was 75 years old, the youngest was 20 years old, the average was 43.5 years old; 20 cases were on the left side, 38 cases were on the right side; the longest duration of the disease was 4 years, the shortest was 2 months, the average was 10 months; 58 cases were treated with local closure, the least was 2 times, the most was 6 times, another 40 cases were treated with physiotherapy acupuncture acupuncture or traditional Chinese medicine external application. treatment. 2 treatment methods 2.1 patients sitting backwards in a reclining chair or prone position acupuncture treatment 2.1.1 neck treatment: according to the three-step localization diagnosis method to determine the treatment point, gentian violet in the posterior cervical muscle group striae, hard nodes, blunt thick, stiffness and other positive points at the fixed point, routine iodine disinfection lay sterile hole towel, no anesthesia or 0.5% ~ 1% lidocaine fixed point at the local infiltration anesthesia. Apply type I 4 needle knife to loosen. 2.1.2 Scapular area treatment: fixation at the positive point of supraspinatus infraspinatus muscle on the affected side, disinfection and laying of sterile towel and anesthesia as before, fixation of the positive point by the left thumb or middle index finger, type Ⅰ type 4 needle knife cutting and loosening. 2.2.1 Cervical transverse process treatment: the patient lies supine with the head on the healthy side and selects the most obvious pressure point, hard nodes or swelling at the tip of the 4th, 5th, 6th and 7th transverse processes of the cervical spine. The type I 4 needle knife is aligned with the transverse process tip perpendicular to the skin, and the incision line is parallel to the longitudinal axis of the spine to quickly pierce the skin only to reach the subcutaneous, slowly explore and penetrate deeply into the bone surface of the transverse process tip, and shovel and cut the bone surface of the transverse process tip and the anterior and posterior edges of the tip 3 to 4 times (the depth is not more than 0,5 cm), when the operator feels loose under the hand and the patient appears sore and swollen (part of it can be dissipated to the upper limb). 2.2.2 Treatment of the lateral elbow: The patient lies supine with the affected elbow flexed and a pillow under the elbow to fully expose the lateral elbow. Carefully touch the lateral epicondyle of the humerus and the crest of the lateral epicondyle of the humerus, the annular ligament of the radial tuberosity, and the lateral collateral ligament of the elbow, etc., and fix the positive point at the positive point; the patient flexes the wrist and forearm before rotation, and moderately tenses the forearm extensor, and looks for the positive point at the brachioradialis, radial carpal long extensor, radial carpal short extensor, and posterior rotator muscle belly (generally 4-8 cm from the lateral epicondyle of the humerus). Disinfection and anesthesia were performed as before, and the type I 4 needle knife was used to loosen the needle. 2.3 Manipulative treatment The “two points and one side” technique of Mr. Zhu Hanzhang was applied to correct the misalignment of the small joints of the cervical spine, and the supraspinatus, infraspinatus and forearm extensor muscles were passively pulled 2 to 3 times. 3 Efficacy assessment criteria and results 3.1 Efficacy criteria Cured: symptoms and signs completely disappeared, functional activities were normal, and there was no recurrence in the follow-up period of two years. Effective: symptoms and signs basically disappeared, functional activities were close to normal, and slight pain or mild discomfort after exertion. Effective: Significant improvement in symptoms, signs and functional activities. Ineffective: no improvement of symptoms and signs. 3.2 Results: 58 patients were cured in 56 cases, accounting for 96.55%; 1 case was effective, accounting for 1.72%; 1 case was effective, accounting for 1.72%; the effective rate was 100%. 4.Discussion 4.1 About the diagnosis of the syndrome The syndrome should be thought of in patients with repeatedly unremarkable treatment of humeral epicondylitis, and every patient with lateral elbow pain should be examined in detail with a detailed medical history to avoid misdiagnosis and omission. Non-needle indications should also be excluded, such as “vascular infiltration on the surface of the lateral humeral epicondyle”, which is a disease with widespread pain in the whole elbow and no localized pressure pain, with vascular exposure and palpable cystic material, should be identified. In general, simple humeral epicondylitis has significant pressure pain on the epicondylar surface, limited extension of the elbow and wrist, and a positive Mill’s sign. In contrast, in this syndrome, some patients have positive points and mild dysfunction at the lateral epicondylar crest of the humerus, the annular ligament of the radial tuberosity, and the lateral collateral ligament of the elbow; some, mainly caused by neck and shoulder injuries, have only sensory pain on the lateral elbow without pressure pain and elbow dysfunction, and this lateral elbow pain seems to be regarded as one of the clinical manifestations of neck and shoulder diseases. 4.2 Treatment of the syndrome The syndrome involves a wide range of treatment points that need to be determined based on careful palpation combined with imaging, so not all of the above-mentioned points should be treated, all at once, but also according to the condition of the individual, and treatment should be divided into sessions, usually 1 to 3 times. For those who consider that the syndrome is mainly caused by the neck and shoulder and the disease duration is relatively short, the neck and shoulder will be treated first, and the patient’s elbow symptoms will disappear without the need for elbow acupuncture treatment. 4.3 Discussion of the pathological mechanism of the syndrome 4.3.1 The theory of double entrapment; as early as 1973 Upton and McComas have observed clinically that seventy percent of carpal tunnel syndrome and ulnar neuropathy can be found in the proof of cervical and thoracic nerve root lesions, and pointed out that diabetic patients are prone to carpal tunnel syndrome because the nerves are compressed in multiple places. Even if each compression is not sufficient to produce any symptoms, together they have the full potential to cause functional impairment. In lateral elbow pain syndrome, the pain is produced by compression of the small branch of the posterior interosseous nerve toward the lateral epicondyle of the o-bone. If the cervical nerve root is compressed, a slight lesion on the lateral elbow may produce pain, and the syndrome is often difficult to cure without release of the cervical nerve root compression. Once the cervical nerve roots are released, the pain on the lateral side of the elbow improves. When the neuropathy in the neck and elbow is severe, it is necessary to treat both the upper and lower parts simultaneously to achieve good results. 4.3.2 Interaction between homologous nerve distribution tissues The supraspinatus and infraspinatus muscles are innervated by the suprascapular nerve, which consists of fibers of the 5th to 6th cervical nerve, and the radial nerve, which contains fibers of the 5th to 8th cervical nerve. The lateral elbow skin and forearm extensor muscles are innervated by the radial nerve. We believe that there is some connection and influence between the tissues distributed by homologous nerves, how they are interconnected and influenced is to be further confirmed. References Principles of Acupuncture Medicine Zhu Hanzhang People’s Health Press Acupuncture for neurogenic cervical spondylosis Shi Xiaoyang Acupuncture Medicine Cui Xiufang Beijing Science and Technology Press