网球肘(肱骨外上髁炎)精要.pptVIP

TENNIS ELBOW Pathophysiology Lat epicondylitis is a result of inflammation, or enthesitis , at the muscular origin of the extensor carpi radialis brevis (ECRB). This inflammation leads to microtears of the tendon, with subsequent fibrosis and, ultimately, tissue failure. Less commonly , the attachments of the extensor carpi radialis longus (ECRL), extensor digitorum communis (EDC), or extensor carpi ulnaris (ECU) are involved. Cause Lat epicondylitis is an overuse syndrome generally caused by repetitive use of the wrist extensors or sustained power gripping. Lat epicondylitis can be associated with an imbalance secondary to muscle weakness and soft-tissue inflexibility. History The patient usually describes a gradual onset of lat elbow pain, which is characterized as follows: The aching pain generally increases with activity he patient may describe symptoms occurring during simple activities of daily living (ADL), such as picking up a cup of coffee or a gallon of milk Pain may be present at night. Symptoms are typically unilateral. Most commonly, the examination reveals localized tenderness to palpation just distal and anterior to the lat epicondyle Other symptoms include the following: Pain increases with resisted wrist extension, especially with the elbow in extension. The patient may have a weakened grip on the affected side. Elbow range of motion (ROM) is typically normal. In chronic, refractory cases, be sure to fully assess shoulder integrity and scapular stability. Weakness or instability of the scapular stabilizers may perpetuate lat epicondylitis by leading to overuse of the wrist extensors. Differential Diagnoses Radiocapitellar Chondromalacia Posterolateral Elbow Instability 后外侧肘关节不稳 Plica 皱襞 Loose Bodies Malignancy 恶性肿瘤 Cervical Radiculopathy (C6 or C7) 神经根型颈椎（C6或C7） Compression of the Posterior Interosseous Nerve at the Arcade of Frosche (supinator syndrome) (Bisset et al., 2005; Taylor Hannafin, 2012) 旋后肌综合征 Staging Stag