Tennis elbow, also known as humeral epicondylitis, is generally considered to be the result of chronic cumulative strain injury, and the clinical treatment of the disease using conventional acupuncture points can achieve good results. From October 2004 to December 2005, the author applied Qi prick Tianzong acupuncture point as the main treatment for recalcitrant tennis elbow with highly sensitive pressure points on the back of the scapula, and achieved more satisfactory results, which are reported below.
Clinical data
General data
All 62 patients in this group came from the outpatient clinic of the Department of Orthopedics and Acupuncture of the hospital, and were divided into treatment and control groups according to the lottery grouping method. 32 patients in the treatment group, 14 males and 18 females, aged from 34 to 65 years old, with an average age of 48.25 years, had a minimum duration of 1 month and a maximum duration of 3 years, with an average duration of 7.4 months. The minimum age was 36 years old, the maximum age was 68 years old, the average age was 49.13 years old, the shortest duration of disease was 1 month, the longest duration was 2 years, the average duration was 7.63 months, the age and duration of disease in the two groups were analyzed by t-test, P>0.05, there was no significant difference between the two groups.
Diagnostic criteria (based on the “Diagnostic and efficacy criteria for Chinese medical conditions” promulgated by the State Administration of Traditional Chinese Medicine)
Pain in the lateral aspect of the elbow, not daring to wring the towel, sudden “loss of strength” when lifting objects, limited pressure points in the external epicondyle of the humerus, pressure pain can spread in the direction of the general tendon of the radial extensor tendon, no local redness or swelling, elbow flexion and extension activities are generally unaffected, local pain when the forearm is rotated forward or backward. There is stiffness in the elbow joint in the morning, and most patients are in the flexed elbow and posterior forearm rotation position.
The Mills test is positive, i.e., when the elbow, wrist and fingers are flexed and the forearm is passively rotated forward and gradually straightened, there is pain at the lateral epicondyle of the humerus.
There was no significant abnormality on line examination.
Inclusion criteria
In addition to meeting the above diagnostic criteria, and both of the following two conditions were met.
The duration of the disease must be more than one month and ineffective after at least one local treatment of the elbow joint such as local closure.
The pressure pain response is significantly stronger on the affected side than on the healthy side when comparing pressure on the bilateral Tianzong points.
Exclusion criteria
Those who are suffering from other serious diseases and are unable to finish a course of treatment or need to take painkillers, hormones and other drugs that affect the observation of the efficacy.
Bilateral comparison, the pressure pain on the affected side of Tianzong point is not sensitive.
Treatment method
Treatment group
Using a 0.3 mm × 40 mm milli-needle, the affected side of the Tianzong acupoint was centered on a Qi-pricking method, and the twisting diarrhea method was performed to obtain Qi. At the same time, acupuncture was routinely taken from Quchi, Hand Sanli and A-Yi points (3), and the area was irradiated with a TDP lamp for 30 minutes each time after acupuncture was completed.
Control group
Using 0.3 mm × 40 mm milli-needle, acupuncture was routinely performed at Quchi, Hand Sanli and A-Yi points, and after acupuncture, the area was irradiated with a TDP lamp for 30 minutes each time.
Both groups were treated on alternate days, 10 times as a course of treatment, and the results were observed uniformly at the end of the course of treatment.
Observation of therapeutic effect
Observation content
The observation included three aspects: the degree of improvement of pain, the degree of improvement of ability of daily living (ADL) and the determination of comprehensive efficacy.
Treatment results
(1) Pain improvement scoring standard: The visual analogue scoring method (VAS) was used to measure pain with a 10-cm long ruler, and patients’ pain was regarded as 10 points before treatment. Analgesic effect evaluation (refer to VAS scale): analgesic score = (pre-treatment pain score – post-treatment pain score)/pre-treatment pain score × 100%. Significant effect: analgesic score > 60%, effective: analgesic score between 30% and 60%, ineffective: analgesic score < 30%. Comparison of analgesic scores between the two groups is shown in Table 1.
Table 1 Results of pain improvement scores in two groups of tennis elbow patients (cases)
Group
Number of cases
Effective
Effective
Ineffective
Evidence rate (%)
Treatment group
Control group
The apparent efficiency of the two groups was tested by chi-square test, X2 = 6.566, P<0.05, statistical treatment showed that there was a significant difference, and the treatment group was significantly better than the control group.
(2) ADL improvement degree score: reference combined with part of the patient’s ADL score , including combing hair, washing face, brushing teeth, unbuttoning, belting, lifting objects, wringing towels, dressing 8 items (1), each action completion is divided into 5 levels, can not be completed for 0 points, completed with help for 1 points, partially completed for 2 points, completion time extended for 3 points, normal completion for 4 points, out of 32 points. The comparison of ADL scores between the two groups is shown in Table
Table 2 Results of ADL scores in two groups of tennis elbow patients
Group
Number of cases
Before treatment
After treatment
Difference before and after treatment
P-value before and after treatment
Treatment group
±
±
± ±
Control group
± ±
±
± ±
The data of both groups were processed, and the ADL scores of the treatment and control groups showed statistically significant differences before and after treatment of patients. There was no statistical difference in ADL scores between the two groups of patients before and after treatment, P>0.05; however, there was a statistical difference between the two groups in the difference before and after treatment, P<0.05.
(3) Comprehensive efficacy: According to the diagnostic efficacy criteria for TCM diseases promulgated by the State Administration of Traditional Chinese Medicine in 1994
Cured: the pain and pressure pain of the lateral elbow joint disappeared, the function of joint movement was normal, and there was no recurrence in the follow-up period of 3 months.
Effective: pain on the lateral side of the elbow joint is reduced, pressure pain is still present, and joint movement is improved.
Ineffective: no improvement in the pain and joint activity of the lateral elbow joint. The comparison of the efficacy of the two groups is shown in Table 3.
Table 3 The results of comprehensive efficacy evaluation of two groups of tennis elbow patients
Group
Number of cases
Cured
Effective
Ineffective
Cure rate (%)
Treatment group
Control group
Comparison of data between the two groups by Ridit analysis, u = 2.085, P<0.05, statistical treatment showed a significant difference, and the treatment group was significantly better than the control group.
. Discussion
Tennis elbow is also known as “elbow strain” and “tendon paralysis”, which belongs to the category of “injury to tendon” and “paralysis”. In the book of Nei Jing, it is said that “wind, cold and dampness are combined to form paralysis”. Tennis elbow, mostly due to long-term strain on the elbow, damage to blood and Qi, the veins are empty, the evil of cold and damp accumulate in the elbow joint; or long-term engaged in spin forward, wrist extension and other activities, so that the tendons and veins are damaged, siltation of blood within the stop, tendons and veins lost harmony. External cold and dampness and local strain on the elbow joint are two important causes of tennis elbow, and local strain on the elbow joint is usually valued, so conventional treatment is mainly based on the hand Yangming meridian points and elbow joint points, which are located on the lateral side of the elbow. In recent years, there have been few reports in the literature on the treatment of tennis elbow with acupuncture points on the hand-sun meridian.
The pathogenesis of tennis elbow has not been fully understood by modern medicine for more than 100 years, among which the most influential is the theory of the total tendon tear of the extensor muscle proposed by Cyriax. In 1976, Gunn found that nearly 50% of patients with intractable tennis elbow had a combination of neurogenic cervical spondylosis, and the treatment of intractable tennis elbow from the neck was also reported in China (2). In our clinical practice for many years, we have also found that persistent tennis elbow is often combined with a highly sensitive pressure point in the soft tissue on the back of the affected scapula, which is actually not uncommon, and that point is the Tianzong point of the Hand Sun and Small Intestine meridian.
The name of the Tianzong acupoint was first mentioned in the Acupuncture and Moxibustion Book, “in the sunken part of the large bone after Bingfeng”. According to the Huiyuan Acupuncture, “Tianzong is a point where the sky is the border of the upper shoulder plate bones, and Zong is a point where the roots are cloned in the sky, which is the name for the combined overlapping Zong Qi. This point is the origin of the hand-sun meridian chakra qi, and is used to treat “heavy shoulders and painful elbows and arms that cannot be lifted”. It is also described in classical medical texts such as the Song Dynasty’s “Acupuncture and Moxibustion Acupoints of the Copper People” as a treatment for “pain in the outer back of the elbow and arm”. This shows that the ancients were aware of the important role of the Tianzong point in the treatment of elbow pain. The Ling Shu? The “Official Needle” chapter “Qi stab, straight into one, the side into two, to treat the cold small deep. Or said three pricks. Three pricks, the treatment of paralysis small deep also”. The Tianzong acupuncture point, which is the point of origin of the Sun meridian, has the function of dispersing wind and relaxing tendons, clearing heat and reducing swelling.
In the treatment group, the acupuncture point Tianzong is used in combination with the twisting diarrhea method, so that the acupuncture sensation can go through the scapula and reach the place of disease, and it is also used in combination with the acupuncture points on the lateral side of the elbow.