Epicondylitis of the humerus, also known as radial extensor tendon strain, or wrist extensor tendon attachment point sprain, brachioradialis bursitis, may also be called humeral epicondylitis syndrome. Some people call it “tennis elbow” and believe that it occurs mostly in tennis players. In fact, the disease occurs in workers who often rotate the forearm and extend and flex the elbow and wrist joints. For example, housewives, carpenters, bricklayers, clerks, plumbers and electricians, etc.
Anatomy and physiology
The radial extensor carpi radialis is located on the back of the forearm, starting from the lateral epicondyle of the humerus and ending distally at the dorsal base of the 2 and 3 metacarpals with a tendon. The muscle is innervated by the radial nerve, and its function is to extend the wrist and deflect the wrist joint to the radial side.
Etiology]
The disease is usually caused by prolonged and repeated rotational activities of the forearm, or by a single violent over-rotation. The strain or sprain can also occur due to repeated dorsiflexion of the wrist joint when the forearm is in the rotated position, and the wrist extensor tendon at the attachment of the humeral epicondyle is overstretched. The main pathological changes are: due to repeated injury, the tendon fibers of the humeral epicondyle tear and bleed, forming a subperiosteal hematoma, followed by mechanization and ossification, producing osteophytes of the humeral epicondyle (mostly in the form of a sharp edge or nodularity).
From pathological histological section, it is hyaline-like degenerative ischemia, so it is also called ischemic inflammation. It is sometimes accompanied by tearing of the joint capsule and thickening of the synovial membrane due to long-term stimulation by muscle pull. When the wrist joint is flexed and extended and the forearm is rotated, the synovial membrane may be embedded between the brachioradial articular surfaces. Laxity of the brachioradial ligament and mild separation of the proximal radial-ulnar joint may also occur, resulting in dislocation of the radial tuberosity. These pathological changes can cause muscle spasm, local pain or radiating pain along the wrist extensor muscle to the forearm.
Clinical manifestations and diagnosis
(A) Clinical manifestations
1, the disease mostly occurs after youth, no obvious history of trauma, but closely related to certain occupations and types of work.
2. Initially, the injured limb often feels painful and weak, and gradually the pain of the lateral elbow occurs, which is aggravated by the increase in the amount of movement. In the repetition of the injury, the pain is also increased (the nature of the pain is soreness or tingling), and can occasionally spread to the forearm or upper arm. In severe cases, the wrist and hand weakness, or even holding the object in the hand to fall off on its own.
(II) Diagnosis
1. Obvious pressure points can be palpated on the posterior lateral aspect of the lateral epicondyle of the humerus, the humeral-radial joint space, the radial tuberosity and the outer edge of the radial neck, and mild swelling, pressure pain or stiffness of the fascial tissue on the radial side of the upper forearm can also be palpated. Sometimes sharp edges of osteophytes can be felt at the lateral epicondyle of the humerus, and the pressure pain is severe.
2.The humeral epicondylitis test (first let the patient bend the elbow, wrist and fingers, rotate the forearm forward, and then slowly straighten the elbow joint, and pain will appear in the humeral epicondyle) is positive.
3.Resistance wrist extension test, resistance forearm external rotation test, can appear pain at the humeral epicondyle.
4.X-ray examination may occasionally show irregularity of the periosteum, or a small amount of calcification points outside the periosteum.
Treatment
(A) Massage treatment
1.Principle Relax the tendons and activate the blood, peel off the adhesions, anti-inflammatory and pain relief.
2, the application site injured limb elbow and forearm back radial side.
3.Acupuncture points Absence of basin, Jiuquan, shoulder mu, upper arm radial nerve point, Quchi, sprain, hand three li, hegu and other points.
4.Application techniques Rolling, kneading, rubbing, moving, plucking, and tending.
5.Time and stimulation amount Each treatment 15 to 20 minutes, chronic once a day, acute once every other day or 3 days; to medium stimulation amount is appropriate.
6.Manipulation operation (divided into the following steps)
(1)Stroking and rolling to loosen the tendon method
The patient takes a sitting position. The operator stands on the side of the injury, with one hand to hold up the forearm, the other palm or large fissure strokes the injury local and up and down for 2 minutes; then, with the small fissure roll the forearm extensor carpi radialis and humeral epicondyle for a few minutes, in order to achieve the purpose of loosening the tendons.
(2) rubbing the elbow to disperse stasis method
Immediately following the above method. The operator’s hand is changed to rub or palm rub the humeral radial joint with the large fissure, in order to feel the heat, which can achieve the purpose of activating blood circulation and dispersing stasis.
(3) Rotation and extension of the elbow top push method
Following the above method. The operator holds the elbow of the injured limb with one hand (the thumb presses the proximal end of the pain point, and the remaining four fingers are placed on the inner side of the elbow), and the wrist of the injured limb with the other hand (the thumb is placed on the side of the radial tuberosity, and the remaining four fingers are placed on the palm surface). Then, the injured elbow is flexed, the forearm is fully internally rotated and the elbow is extended, and when the elbow joint will be straightened, the forearm is rapidly externally rotated under traction, so that the elbow is overextended, while the hand holding the elbow pushes hard against the top (the thumb is pressed against the outer epicondyle), and the “creaking” sound is heard, the flexed elbow joint is flexed, and the synovial inlay of the humeral radial joint and the radial tuberosity can be rectified.
(4)Flicking and pushing to relax the tendons method
Continue the above method. The operator holds the wrist of the injured limb with one hand, flexes the elbow joint to the maximum, presses the thumb of the other hand firmly on the front upper part of the humeral epicondyle, pushes it to the top of the front of the radial tuberosity while straightening the elbow joint, and flicks the starting point of the wrist tendon along the outer edge of the radial tuberosity backward several times; then, with the elbow joint extension and flexion activities, pushes the tendon tissue from the bottom upward several times to achieve the purpose of tendon relaxation.
(5) Massage the painful points of Yu points method
Pressing the lack of basin, shoulder even, plucking shoulder mu, pole spring and radial nerve point of upper arm, rubbing the Quchi, Waiguan and Hegu points for zero point five to one minute each. For acute injuries, apply braking to the elbow for 1 week after the application of the technique.
(II) Hot vinegar bath
Put one kilogram of vinegar into the enamel basin and boil it, then smoke and wash the injured area, twice a day for twenty-five minutes each time. If possible, vinegar ion introduction therapy is available.
(C) Closure therapy
Use prednisolone twenty-five mg plus two percent procaine 6 ml, for painful point closure. Once a week, 3 to 5 times for a course of treatment.