Ka hana ʻana a me ka mālama ʻana i ka kuʻekuʻe tennis

Ka wehewehe o ka epicondylitis lateral o ka humerus

ʻIke ʻia hoʻi ʻo Tennis elbow, tendon strain o ka extensor carpi radialis muscle, a i ʻole sprain o ka wahi hoʻopili o ka extensor carpi tendon, brachioradial bursitis, ʻike ʻia hoʻi ʻo lateral epicondyle syndrome. ʻO ka ʻeha aseptic traumatic o nā ʻiʻo palupalu e hoʻopuni ana i ka epicondyle ʻaoʻao o ka humerus ma muli o ka ʻeha ʻeha mau..

Pathogenesis

He pili pili loa ia i ka hana, ʻoi aku ka nui o nā limahana e hoʻohuli pinepine i ka forearm a hoʻolōʻihi a hoʻopaʻa i nā hui kuʻe lima a me ka lima. ʻO ka hapa nui o lākou he mau wahine hale, kamana, kaʻa pōhaku, nā mea hana, nā paipu, a me nā mea pāʻani.

Disect

ʻO nā hiʻohiʻona ma nā ʻaoʻao ʻelua o ka ʻaoʻao haʻahaʻa o ka humerus, ʻo ia ka epicondyles medial a me ka ʻaoʻao, ʻo ka epicondyle medial ka hoʻopili ʻana o ka tendon maʻamau o nā ʻiʻo flexor o ka forearm, a ʻo ka epicondyle ʻaoʻao ka hoʻopili ʻana o ka tendon maʻamau o nā ʻiʻo extensor o ka forearm. ʻO ka wahi hoʻomaka o ka ʻiʻo brachioradialis, e hoʻololi i ka forearm a hoʻopololei iki. ʻO ka wahi hoʻomaka o ka extensor carpi radialis longus, extensor carpi radialis brevis muscle, extensor digitorum majoris, extensor digitorum propria o ka manamana liʻiliʻi, extensor carpi ulnaris, supinator muscle.

Pathogen

ʻO ka hoʻomaka ʻana o ka condyle ma muli o ke kīpē nui a me ka hohola ʻana, akā ʻo ka hapa nui o nā maʻi he lohi ka hoʻomaka ʻana a maʻamau ʻaʻohe moʻolelo maopopo o ka trauma, a ʻoi aku ka maʻamau o nā pākeke e pono e hoʻohuli pinepine i ka forearm a hoʻolōʻihi i ka lima me ka ikaika. Hiki ke hoʻopaʻa ʻia a hoʻopaʻa ʻia paha ma muli o ka hoʻolōʻihi pinepine ʻia o ke kua o ka hui lima a me ka hoʻolōʻihi ʻana o ka ʻāʻī o ka lima ma ka hoʻopili ʻana o ka epicondyle ʻaoʻao o ka humerus i ka wā e kū ai ka lima i ke kūlana pronation.

Pathology

1. Ma muli o ka hōʻeha pinepine ʻana, ua haehae ʻia ka epicondyle ʻaoʻao o ka ʻiʻo o ka ʻiʻo a hemorrhaged, e hana ana i kahi hematoma subperiosteal, a laila hoʻonohonoho a ossifying, e hopena ai i ka periosteitis a me ka hyperplasia iwi o ka epicondyle lateral o ka humerus (ka hapa nui ma ke ʻano o ka nodule lihi ʻoi). ʻO ka nānā ʻana i ka biopsy tissue pathological he hyaline degeneration ischemia, no laila ua kapa ʻia ʻo ia ka ischemic inflammation. I kekahi manawa hele pū ʻia me ka waimaka o ka ʻeke hui, a hoʻonui a mānoanoa ka membrane synovial o ka hui ma muli o ka hoʻoulu ʻana i ka wā lōʻihi e ka ʻiʻo.
2. Haehae ma ka wahi hoʻopili tendon extensor. 
3.ʻehaʻeha a i ʻole fibrohistolitis o ka ligament annular. 
4. bursitis o ka hui brachioradial a me extensor tendon maʻamau.
5. ʻO ka mumū o ka synovium o ka humerus a me ka hui radial i hanaʻia e ka intercalation o ka humerus a me ke poʻo liʻiliʻi o ka radius.
6. ʻO ka hoʻomaha ʻana o ka ligament humerioradial a me ka hoʻokaʻawale haʻahaʻa o ka hui radial-ulnar proximal hiki ke hana ʻia, e hopena i ka dislocation o ke poʻo radial cephalic. Hiki i kēia mau hoʻololi pathological ke hoʻoulu i ka ʻiʻo o ka ʻiʻo, ka ʻeha kūloko, ka ʻeha mai nā ʻiʻo lima lima a hiki i ka forearm.

Hōʻike hōʻike lapaʻau

1. Hoʻonui ʻia ka ʻeha ma waho o ka hui kuʻekuʻe i ka wā e hoʻolaha ai, ʻoi aku hoʻi i ka wā e hoʻohuli ai i ka hoʻonui hope, hāpai, huki, hoʻopau, paʻi a me nā hana ʻē aʻe, a hoʻomālamalama i lalo ma ka pulima extensor muscle. I ka hoʻomaka ʻana, ʻike pinepine wau i ka ʻeha a me ka nāwaliwali o ka lālā ʻeha, a hoʻomohala mālie i ka ʻeha ma waho o ka kuʻekuʻe, ʻo ia ka mea i hoʻonui ʻia me ka hoʻonui ʻana i ka hoʻoikaika kino. (ʻO ke ʻano o ka ʻeha he ʻeha a ʻeha paha)
2. Ua hoʻonui ʻia ma hope o ka hoʻoikaika ʻana a hoʻomaha ʻia ma hope o ka hoʻomaha.
3. Forearm rotation a nāwaliwali i ka paʻa ʻana i nā mea, a me ka hāʻule pū me nā mea.

Nā hōʻailona

1. Lateral humeral epicondyle Hiki ke palpted ka aoao posterolateral o ka epicondyle lateral o ka humerus, ka lewa o ka hui humeral-radial, ka cephalic cephalic a me ka lihi aoao o ka condyle neck radial hiki ke palpted, a me ka musculosis a me ka io ma ka aoao radial o ka forearm hiki ke palp. ʻoʻoleʻa. I kekahi manawa hiki ke ʻike ʻia nā kihi ʻoi o ka hyperostosis ma ka epicondyle ʻaoʻao o ka humerus, a palupalu loa lākou.
2. He maikaʻi ka hōʻike Mills. E kūlou iki i kou lima a hana i ka hapalua lima, e hoʻopololei i kou lima e like me ka hiki, a laila e hoʻopololei i kou lima a hoʻopololei i kou kuʻe lima. Inā loaʻa ka ʻeha ma ka ʻaoʻao ʻaoʻao o ka hui brachioradial ke hoʻopololei ʻia ka kuʻekuʻe, he maikaʻi ia.
3.Positive extensor resistance test: ʻo ka mea maʻi i kīkoʻo i kona lima a wili i kona lima, a ua kaomi ka mea nānā i ke kua o ka lima o ka mea maʻi me kona lima i mea e pale ai ka mea maʻi i ke kū'ē a hoʻolōʻihi i ka lima, e like me ka maikaʻi o ka ʻeha ma waho o ka kuʻekuʻe.
4. Hiki ke hōʻike i ka nānā ʻana i ka lāʻau X-ray i kekahi manawa i ka hewa ʻole o ka periosteal, a i ʻole kahi helu liʻiliʻi o nā helu calcification ma waho o ka periosteum.

Lapaʻau

Ka mālama mālama ʻana:

1. E ho'ōki i ka hoʻonaʻauao kūloko o ka hoʻoulu ʻana i ka wā mua, a hiki i kekahi mau maʻi ke hoʻomaha ʻia e ka hoʻomaha a i ʻole ka plaster immobilization condyle.
2.Massage therapy, e hoʻohana i nā ʻenehana hoʻokuke a kāwili ʻia e hoʻomaha i ka spasm a me ka hoʻomaha ʻeha o nā ʻiʻo extensor o ka forearm, a laila e hoʻohana i ke kaomi kiko a me nā ʻenehana kneading ma ka epicondyle lateral o ka humerus a me nā wahi ʻeha kokoke.
3. Tuina therapy, noho ka mea mai. Hoʻohana ke kauka i ka ʻōwili mālie a me ka kāwili ʻana e hana ma ke kua a ma waho o ka kuʻekuʻe a me ka pānaʻi ʻana ma ka ʻaoʻao hope o ka forearm. Hoʻohana ke kauka i ka piko o ka manamana lima e kaomi a hamo iā Ah Shi (lateral epicondyle), Qi Ze, Quchi, Hand Sanli, Waiguan, Hegu acupoint, etc. Noho ka mea maʻi, a huki ke kauka i ka wahi hoʻomaka o ka mea maʻi o ka extensor carpi a me ka extensor carpi longus a me brevis radialis. Huki a kikoo, ola kuʻekuʻe lima. ʻO ka hope loa, e hoʻohana i ke ʻano ʻānai thenar e hamo i ka epicondyle ʻaoʻao o ka kuʻekuʻe a me nā ʻiʻo extensor o ka forearm, a hoʻohana ʻia ka wela kūloko i ke degere.
4. ʻO ka lāʻau lapaʻau, nā lāʻau anti-inflammatory oral non-steroidal i ka wā acute.
5. Occlusive lapaʻau: glucocorticoids (e like me ka betamethasone injection) ua hoʻokomo 'ia i loko o ka palupalu wahi a injected i loko o ka tendon insertion point a me ka subaponeurosis space (emi a like me 3 manawa), hiki ke pāʻani i ka anti-inflammatory a me analgesic hopena, a me ka betamethasone compound a me ka ropivacaine a i 'ole ka hoʻokō 'ana me ka levocaine i kēia manawa. kiʻekiʻe anti-inflammatory titer, a me ka palekana loa, ka lōʻihi o ka pale ʻana, ka liʻiliʻi o ka ʻawaʻawa a me ka haʻahaʻa haʻahaʻa rebound lāʻau lapaʻau kūpono no ka occlusion kūloko.
6. Hoʻomaʻamaʻa Acupuncture, kokoke ka ʻoki i ka ʻili o ka iwi e ʻili i ka adhesion palupalu a puni ke kaʻina o ka iwi, dredge i ka extensor wrist muscle, extensor finger muscle tendon maʻamau a me supinator tendon, a huki i ka pahi me ke ʻano o ka looseness. ʻO ka lāʻau lapaʻau: kūpono i nā maʻi i pane ʻole i ka mālama conservative.

1. ʻO ke kino a me Meleod, ʻo ka hana e pili ana i nā ʻiʻo āpau o ka lesion, me ka excision o ka epicondyle lateral 2mm, ka hoʻokuʻu ʻana o ka wahi hoʻomaka o ka extensor common tendon, ka ʻāpana ʻāpana o ka hope proximal o ka annular ligament, ka hoʻokomo ʻana o ka humeroradial hui i loko o ka synovium a i ʻole ka hoʻohui ʻana o ka humeroradial.

2. ʻO ke ala Nischl, ua hoʻokaʻawale ʻia ka tendon extensor maʻamau a me ka extensor carpi longus radialis tendon i ka longitudinally, ʻike ʻia ka hohonu extensor carpi radialis brevis tendon, ʻoki ʻia ka wahi hoʻokomo mai ke kikowaena o ka epicondyle ʻaoʻao, wehe ʻia ka ʻiʻo degenerated tendon, wehe ʻia kahi ʻāpana o ka iwi a me ke koena a puni ka iwi a puni. hana hou ʻia ma ka iwi. ʻAʻole kākoʻo ʻia ke komo ʻana i loko o ka articular.

Prognosis

He lōʻihi ke kaʻina o ka maʻi a hiki ke hoʻi hou.

Note

1. E hoʻolohe i ka mahana a pale i ke anuanu;
2. Hoʻemi i nā kumu pathogenic;
3. Hoʻoikaika kino;
4. Ma ke kahua acute, pono e akahai ke ano hana, a e hoomahuahua iki ka hana lapaau no ka poe i ma'i no ka manawa loihi, oia hoi, he palupalu me ka oolea, ka paakiki me ka palupalu, a e hui pu ia ka oolea a me ka palupalu.