Orthopedic specialty clinics in the treatment of patients with chronic soft tissue injuries, often encountered some local pain patients, he (she) asked the doctor not to give them “closed needle”, unwilling to accept closed treatment. But ask them what is “closed needle”, they can not say, they mistakenly think, with hormonal drugs needle is called “closed needle”, in fact, this is a misunderstanding.
”Closed” is a treatment method, where the drug (injection) for pain or nerve channel local injection is called closed, and not with what drugs. Of course, most doctors will add some hormonal drugs to the local closure, such as prednisolone, Coninectone A or Depo-Provera. But also sometimes will not add, such as the clinical often use vitamin B1 or B12 for closure therapy.
The treatment is also called “local seal”, which is actually a method of pain treatment evolved from local anesthesia by injecting drugs locally (painful spots). It is a method of treatment for pain that evolved from local anesthesia. Through clinical examination of the patient, the doctor finds the local pressure point and then injects drugs into the painful area to achieve anti-inflammatory and pain-relieving effects and to relieve local muscle tension. It is a symptomatic treatment measure that has a better effect on eliminating local pain symptoms. Therefore, closure therapy is a simple, safe, efficacious and reliable method of treating patients’ pain or discomfort.
Soft tissue chronic injury is the body to long-term, repeated, continuous posture or occupational movements in the local harmful stress, resulting in chronic minor injuries accumulated, delayed and formed. It occurs in handicraft and semi-mechanized industrial workers, sports workers, theater and acrobatic performers, ambulatory workers and housewives, and is commonly associated with tennis elbow, snapping fingers, tenosynovitis, tendonitis or fasciitis. Tennis elbow is mostly caused by long-term strain and repeated stretching stimulation of the starting point of the extensor carpi radialis muscle, resulting in partial tearing, sprain, calcification or scar formation of the extensor generalis tendon of the forearm.
Tendonitis of the radial tuberosity is caused by the common tendon sheath of the extensor digitorum longus and extensor digitorum shortus in the radial tuberosity, which has a narrow and inelastic lumen. When the two tendons walk in the same narrow and hard tendon sheath, repeatedly pulling and rubbing against each other, the synovial membrane shows inflammatory changes such as edema and thickening and exudation, which thickens the wall of the fibrous sheath and causes the tendon sheath to narrow, resulting in pain and dysfunction and other symptoms.
The pathological changes of chronic soft tissue injury are mostly limited, chronic, injurious and aseptic inflammatory reactions, which produce local pain under the stimulation of inflammatory mediators. Its clinical characteristics are long history, heavy symptoms, few signs, and negative auxiliary examinations. Its main manifestations are.
(1) Long-term chronic pain in a part of the trunk and limbs, mostly without an obvious history of trauma;
②A limited pressure point in a specific area, often accompanied by some special signs;
③ local inflammation is not obvious;
④Recent history of excessive activity related to the painful area;
⑤ history of the occupation or type of work that produced the chronic injury.
The key to the treatment of chronic soft tissue injuries is to limit injury-causing movements, correct poor posture, enhance muscle strength, maintain non-weight-bearing activities of the joint, and change posture regularly to dissipate harmful stresses. Traditional treatment methods include the use of non-steroidal anti-inflammatory analgesics, local hot compresses, acupuncture, tui na, Chinese herbs, plasters, fire cupping and surgery, all of which are not easily accepted by patients due to long treatment course, many side effects, poor results, easy infection and recurrence.
The drug formulas of closure therapy are mostly composed of anesthetics and a small amount of hormonal drugs. The anesthetics are local anesthetics, such as procaine and lidocaine, and the hormonal drugs are prednisolone acetate, Coninextrone and Depo-Provera. The effect of local anesthetics is to temporarily block local nerve conduction, so that the corresponding areas innervated by these nerves produce anesthesia, thereby relieving pain. Lidocaine has the advantages of good nerve blocking effect by local injection, rapid pharmacological effect, strong tissue penetration, wide diffusion range, low toxicity, and no need for skin testing. Local injection of hormonal drugs is the most common and effective method for the treatment of chronic soft tissue injuries, and this therapy has been used in China for more than 40 years. The drug can regulate glucose metabolism, with anti-inflammatory, anti-toxic and anti-metabolic effects.
Its main functions are.
①reduce the permeability of capillaries and cell membranes, reduce local congestion and extravasation of body fluids, accelerate the absorption of inflammation, eliminate edema, and promote the repair and regeneration of damaged tissues;
②Regulate humoral and cellular immunity, prevent abnormal proliferation of connective tissue and granulation tissue formation;
③Improve local blood circulation, improve metabolic capacity, facilitate local self-regulation and repair, and maintain the stability of local microenvironment.
Some people worry that the use of hormonal drugs will cause side effects to human body, in fact, because the dose of hormones used in local seal treatment is small and the interval time is long (more than 4 weeks), so the local seal treatment produces few adverse reactions. Some people are worried that the use of hormonal drugs will cause osteonecrosis after local closure, so they are reluctant to make closure treatment. Clinical medicine proves that the use of large doses of hormones in the short term may cause osteonecrosis, but it has little to do with whether or not the treatment is closed, and intravenous or intramuscular injections or even oral administration can also cause it.
As we know, when treating SARS in 2003, many patients used large doses of hormonal drugs by intravenous injection, as a result, some patients later developed femoral head necrosis. The specialist for each patient for closed treatment, the use of hormonal drugs than intravenous or intramuscular injections are smaller doses, and the provisions of a certain interval each time, and does not advocate multiple consecutive use, so this concern is unnecessary.
In short, local closed treatment of soft tissue chronic injury has no hospitalization, short course of treatment, good results, low price, less side effects, easy to accept the advantages of patients, some diseases can be cured by closed treatment. However, the closed treatment should pay attention to the aseptic operation, injection site accuracy, the choice of appropriate drugs and other issues.