2013-8-23 肘部筋伤 Elbow diseases

Chronic strain慢性劳损

Long-term rotation of the forearm will make the muscle of the radial aspect of the wrist maintain in a strained and pulled status, consequently leading to chronic strain. 慢性劳损，由于长期从事屈腕、 旋转、伸腕、伸指的活动， 肌肉长期劳累且经常处于 紧张状态，使伸腕伸指肌腱 起点受到反复牵拉刺激， 产生疼痛。
Flexion range is 140 degree while pronation and supination range is 140 to 150 degree. 屈伸运动范围约为140º , 旋前和旋后运动的范围约 为140º ～150º 。


Causes

Direct force of hit 直接暴力的打击 Indirect force (causes more sprain) 间接暴力 (致伤较多见)
肘部筋伤 ELBOW DISEASES
林江豪 LIM CHIANG HOU 23/8/2013
肘部扭挫伤
sprain of elbow
Introduction

Elbow joint sprain is often seen, when the joint is flexed or extended over the normal range of activity, will cause the sprain of elbow joint. 肘关节扭挫伤是常见的肘部闭合性损伤，凡使 肘关节发生超过正常活动范围的运动，均可导 致肘部筋的损伤。



To confirm whether myositis ossificans occur at the same time through X ray examination. 可通过X线检查，确定是否合并骨化性肌炎。 If serious case, the sprain have to be differentiate with fracture, as the annular ligament tear can cause radius bone dislocate and upper part of ulnar bone fracture. 严重的扭挫伤要与骨折相区别，环状韧带的断裂常 使桡骨头脱位合并尺骨上段骨折

Extend-straightening menipulation – physician put his left hand on affected elbow part, then right hand hold the affected wrist part, first doing the flexion extension exercise which within the normal angle, to relax the muscle and when the elbow is placed at half flexing position, the wrist part is released to let forearm extend, coordinate with left hand palm to straighten the elbow at the same time, a crackling sound will be heard. 伸挺法：术者左手托患侧肘部，右手握患侧腕，先作适 当范围的肘关节屈伸活动一次，使肌肉放松，待患肘处 于半伸直位时，握患侧腕部的手一放顺势将前臂伸直， 配合左手掌将患肘向上一挺伸，亦可听到响声，此时术 者的手仍应扶持腕部，以防摆动
LATERAL HUMERAL EPICONDYLITIS
肱骨外上髁炎
Introduction
It is also named tennis elbow又称网球肘 Main symptoms are swollen humeral epicondyle, pain and restricted movement 其临床主要特征是肱骨外上髁处红肿、疼痛和 活动受限 Caused by sprain or chronic strain of the carpal extensor tendon 发生可因急性扭伤或拉伤而引起

Pathogenesis
Fall from high position or accidentally slip and using palm to hold on floor 如跌仆，由高坠下，失足滑倒，手掌着地，
the elbow joint extend more than the range 肘关节处于过度外展，伸直位臵，



This disease belongs to the category of tendon and joint injuries in TCM 属于中医“筋伤”、“筋痹”范畴。 It may be caused invasion of wind, cold, and dampness into the tendons due to Qi Blood deficiency, leading to stagnation of Qi and blood, adherence of tendons, spasm and pain of joints as well as difficult flexion and extension 中医认为是由于气血虚弱，血不荣筋，风寒湿邪承 袭而瘀阻经筋、流注筋肉关节而引起，属于劳损病 变。
Acute injury急性损伤

When the forearm rotates forwards and the wrist joint stretches backward suddenly and violently, radial aspect of extensor muscle of the wrist will contract, pulling the tendon area and leading to acute injury. 急性损伤者，常见于当前臂处于旋前位时，腕关 节突然猛力背伸，致使前臂桡侧腕伸肌于强力 收缩状，导致肌肉起点附着处因受强力牵拉而 部分撕裂，对肌腱造成反复经常性刺激引发此 病。

After adjustment of mild dislocate of joint, physician place his both palm over elbow part, press it gently for one to two minutes, it can reduce pain. Then softly massage the lateral side muscle of elbow joint, but it cannot be repeated too frequent. 关节微细错缝矫正后，术者以两手掌环抱肘部， 轻轻按压1～2分钟，有减轻疼痛的作用。然后 将肘关节内外两侧的筋肉轻轻地拿捏平整，但 不宜反复操作。
Pathogenesis病机
Rotation of forearm with improper exertion
Injuring the radial aspect of extensor muscle of the wrist of the forearm
Causing non specific inflammation, stimulating nerve ending and periost

After two to three weeks, to protect the adhesion of elbow joint, we can use soft manipulation press acupoints, kneading and seperating tendon or extend and flexing the elbow joint. 2～3周后，为了防止肘关节粘连，可应用轻柔 的手法进行按摩，给予点穴、揉按、分筋、肘 关节屈伸活动等手法

TREATMENT
tuina manipulation

Weigh-straightening manipulation – physician placed patient’s wrist of the affected part under his armpit, the palm is facing upward while elbow facing down. Then physician put his both hands over the elbow part and shake it softly with upward and outward motion for 1 to 2 times, if there is any adjustment will heard the sound. 掂挺法：术者将患侧腕部夹于腋下，掌心朝上，肘 尖朝下，术者双手掌环握肘部，轻轻地向肘外上侧 摇摆，同时灵活地做肘部向上掂挺1～2次，稍有错 落处，可听到调整的响声。
causing elbow over turned, so sprain of elbow joint
迫使肘关节过度扭转 , 即可致肘关节扭伤。


If overdoing forearm exercise during daily life, or wrong position when throwing exercise, also can cause elbow joint sprain. 在日常工作和生活中做前臂过度拧扭动作，以 及做投掷运动时姿势不正确，均有可能造成肘 关节扭伤