Lateral epicondylitis

　　Pain around the lateral epicondyle of the humerus caused by acute or chronic injury is called lateral epicondylitis. Since it is more common in tennis players, it is also known as tennis elbow. This disease is often caused by chronic cumulative trauma, leading to tears at the attachment of the extensor tendon of the wrist to the lateral epicondyle of the humerus, resulting in hemorrhage, organization, and fibrosis, which causes the disease. There are many names for this disease, such as lateral epicondylitis syndrome, lateral epicondylar bursitis, lateral epicondylitis, and tennis elbow. Originating from the lateral epicondyle of the humerus are the extensor carpi radialis longus, extensor carpi radialis brevis, and supinator muscles, with the main function of extending the wrist and fingers, and secondarily rotating the forearm posteriorly.

　　Overextension of the wrist or supination of the forearm can cause the extensor compartment and fascia attached to the lateral epicondyle of the radius to be strained and injured.

　　The inflammation of the lateral epicondyle of the humerus belongs to the category of 'Bi syndrome' in traditional Chinese medicine. It is often caused by weakness and invasion of pathogenic factors, overuse of the forearm and wrist during work and labor, or for a long time lifting heavy objects and other reasons.

　　1. Weakness and invasion of pathogenic factors, after middle age, Qi and blood gradually decline, the body's healthy Qi begins to decline, and in addition to physical labor and sweating, wind or cold and dampness invade the body surface, remain in the joints and meridians, causing damage to the body surface, meridians and joints, Qi and blood blockage and unobstructed, and long-term occurrence of the inflammation of the lateral epicondyle of the humerus.

　　2. Injuries due to falls, twists, and sprains, which may damage the meridians and collateral channels of the human body, resulting in poor circulation of Qi and blood. Or because of long-term forceful exertion, the elbow meridians are damaged, and Qi and blood become stagnant over time, causing the tendons and meridians to lose nourishment, which can lead to the inflammation of the lateral epicondyle of the humerus.

　　2. The theory of microvascular neural entrapment. Some people believe that there is an unnamed small blood vessel and nerve bundle deep in the common extensor tendons of the forearm, which emanates from the deep layer of the muscle and fascia, passes through the fascia or synovial membrane, and then passes through the deep fascia to the subcutaneous tissue. When there is a work-related tendinitis of the fascia, local swelling occurs, with lymphocytic infiltration around it, causing the narrow blood vessel and nerve bundle distributed at the lateral epicondyle of the humerus to cause pain, and the trigger points are often located at the place where the blood vessel and nerve bundle pass through the fascia or synovial membrane. If the blood vessels and nerves in this fascial gap are cut, local pain can be relieved.

　　The inflammation of the lateral epicondyle of the humerus is mainly caused by repetitive traction and cumulative injury at the origin of the flexor muscles of the forearm at the medial epicondyle of the humerus, which is similar to the pathogenesis of tennis elbow. As it is common in golfers, students, and miners, it is also known as golf elbow, student elbow, and miner's elbow.

　　The inflammation of the medial epicondyle of the humerus can generally be diagnosed based on the history and clinical manifestations. If further diagnosis is needed, the examiner can ask the patient to sit on a chair, place the forearm on the table with the palm facing up, flex the wrist and clench the fist with force, and the examiner resists it. This will trigger pain in the medial epicondyle and the flexor tendons. Generally, no other auxiliary examination methods are needed. In special cases, X-ray examination can also be performed, which should be based on the specific diagnosis of the doctor. This disease generally has few complications, but if it is not treated in time, it can also cause other diseases over a long period of time. The main possible complications include the following types:

　　1. Bursitis deep to the common flexor tendons of the forearm.

　　2. Degenerative changes of the annular ligament of the radius.

　　3. Excessive hyperplasia of the synovial sac of the radius or the synovial folds.

　　The inflammation of the lateral epicondyle of the humerus belongs to the category of 'Bi syndrome' in traditional Chinese medicine. It is often caused by weakness and invasion of pathogenic factors, overuse of the forearm and wrist during work and labor, or for a long time lifting heavy objects and other reasons.

　　This disease is mainly manifested as localized pain at the lateral epicondyle of the elbow joint, which radiates to the forearm, especially when it is rotated internally. Patients often complain of weakness in holding objects, and occasionally, objects can be dropped due to severe pain. The pain intensifies after rest and activity or when exposed to cold.

　　During clinical examination, it can be found that there is a tender point at the lateral epicondyle of the humerus, and the Mills sign is positive, that is, pain can be induced when the wrist is flexed and the forearm is supinated and the elbow is extended. In addition, resistance to pronation of the forearm can also cause pain.

　　Avoid vigorous activities in daily life, especially the activities of the wrist extensors. When necessary, appropriate fixation can be done, and the fixation should be removed in time after the pain is significantly relieved, and then gradually start the functional activities of the elbow joint, but avoid actions that cause the wrist extensors to be stretched significantly.

　　The onset of humeral epicondylitis is related to chronic injury, and middle-aged and elderly people often suffer from it due to overexertion. The intensity of labor should not be too high, and it is not advisable to carry heavy objects for a long time, or to wash too many clothes at one time to prevent the tendinitis of the humeral epicondyle. Pay attention to physical exercise in daily life, actively move the upper limb joints to enhance muscle strength, which helps prevent the occurrence of this disease.

　　In daily life, it is generally possible to prevent from the following aspects:

　　1. Strengthen the strength and flexibility training of the arms and hands.

　　2. Pay attention to the intensity of exercise during practice; it should be reasonable and not cause excessive fatigue of the arms.

　　3. Before typing on the computer or doing housework, it is necessary to do sufficient warm-up exercises, especially the internal and external rotation and extension exercises of the arms and wrists.

　　4. After each activity, it is important to pay attention to relaxation exercises. It is best to massage the arms to make the muscles softer and not stiff, ensuring the coordination of arm muscles with contraction, and reducing the occurrence of 'tennis elbow'.

　　5. Effectively using elastic bandages and elbow supports can limit the extension of chronic 'tennis elbow' injuries.

　　Tennis elbow, as it is commonly seen in tennis players, is called tennis elbow. It is a disease caused by overexertion that leads to inflammation and pain of the tendons on the outer side of the elbow. Since the pain in the elbow area often confuses with other diseases, it is important to do a check-up at the early stage of the disease to treat it promptly. The following introduces the main aspects of clinical treatment, hoping that everyone can pay attention:

　　1. Physical examination signs:During the examination, there is no local redness and swelling, and joint function is not limited. There is localized tenderness over the humeral epicondyle. A careful examination can reveal sensitive tender points.

　　2. Extensor tendon stretch test:Extend the elbow, clench the fist, and flex the wrist. Then pronate the forearm; if severe pain on the outer side of the elbow is induced, it is positive. Humeral epicondylitis due to myofascitis is characterized by marked pain during this test.

　　3. X-ray examination:X-ray films generally show no abnormalities. In patients with a longer course of disease, there may be periosteal reactions, and calcified deposits can be seen near the humeral epicondyle.

　　What examinations should be done for tennis elbow? From the above introduction, you can roughly understand some information. For the treatment of tennis elbow, only by being well-informed can we avoid being blind in our examination and treatment. In addition, the author reminds all tennis elbow patients: while treating the condition, more physical activity should be done, and a positive attitude towards treatment should be maintained.

　　Tennis elbow refers to the inflammation and pain of the tendons on the outer side of the elbow. The pain is caused by the repeated use of muscles responsible for the extension of the wrist and fingers. It severely affects the health of patients and this article will introduce the dietary care for tennis elbow in detail.

　　I. What should be eaten for the good health of patients with humeral epicondylitis?

　　1. Consume more foods rich in trace elements. Animal livers, seafood, soybeans, sunflower seeds, and mushrooms contain more zinc. Animal livers, eggs, legumes, green leafy vegetables, and flour contain more iron. Oats, turnips, egg yolks, and cheese contain more manganese.

　　2. Eat more fresh vegetables and fruits to ensure sufficient vitamin intake.

　　Secondly, what foods should not be eaten for humeral epicondylitis

　　1. Eat less greasy and fried foods.

　　2. Avoid smoking, alcohol, and spicy刺激性 foods.

　　3. Drink less tea, as tea contains a high amount of tannins, which can affect the absorption of calcium, iron, and protein.

　　If conservative treatment for tennis elbow cannot relieve the symptoms of ulnar nerve or humeral epicondylitis, and the symptoms do not improve or the symptoms of ulnar nerve are exacerbated after two local closures, surgical treatment should be adopted.

　　1. Use the anterior oblique collateral ligament as the anatomical landmark for the operation.

　　2. Make a 2-3 cm longitudinal incision in front of the medial epicondyle to avoid injury to the medial antebrachial cutaneous nerve. Incise the fascia of the pronator teres and leave a 2mm margin on the medial epicondyle.剥离肌肉止点自内上髁面上，保留关节囊不要解剖，剥离到前斜韧带前缘为止，肌腱止点剥离后，一般不要缝合。

　　3. The important ligament that provides stability for the prevention of external rotation of the elbow is the anterior oblique ligament, which is located deep to the anterior oblique collateral ligament. Therefore, the operation generally does not enter the posterior part of the anterior oblique collateral ligament to avoid injury to the anterior oblique ligament and cause instability of the elbow joint.

　　4. If it is an A1 type patient, simple osteolysis of the medial epicondyle can be performed. If it is an A2 type, the ulnar nerve needs to be explored. If there is pressure in the cubital tunnel, it should be relieved and cubital tunnel decompression should be performed. If there is ulnar nerve subluxation, adhesion or other anatomical abnormalities, ulnar nerve anterior displacement can be performed. If it is a type B patient, ulnar nerve anterior displacement under the muscle should be performed. The cast is fixed for 2-3 weeks after surgery, followed by the use of an anti-bracing, muscle stretching exercises are performed after 6 weeks, and attention should be paid to rest within 6 months to avoid the involvement of flexor muscles. The recovery period is 6 months to 2 years. The efficacy of surgical treatment for humeral epicondylitis depends on the degree of ulnar nerve involvement. Therefore, the efficacy of A1 and A2 type patients is relatively good, and the efficacy of type B patients is poor, which is due to the poor recovery of ulnar nerve function. Therefore, it is very important to perform ulnar nerve state detection before surgery, and special treatment can be performed according to the specific condition of the ulnar nerve, and individual treatment can be given to the patient's ulnar nerve condition. It is not appropriate to perform cubital tunnel decompression uniformly at the proximal end.