背景 屈指肌腱腱鞘炎，叉稱扳機指、彈響指，屬於中醫「傷筋」、「筋辨」範疇 。本病好發於拇指 、中指、無名指，患者女性多於男性，中老年發病較多 。本病是由於各種原因造成屈指肌腱在腱鞘內長時間、反復過度的機械性摩擦，出現纖維結締組織增生、粘連、增厚，或過度勞累、受涼，導致血瘀停滯，經脈受阻不能濡清養經筋而發為本病 。 目的 本文將從文獻研究及臨床病例報告兩方面，了解本病的診療情況。於文獻研究方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法，更著重從療效、復發、不良事件發生三方面探討各種類療法，從中了解屈指肌腱腱鞘炎的各種診療方法並找出更準確、更快捷、更方便的診治方法。於臨床病例報告方面，分享自己和跟診病例的經驗和體會，從而學習、了解本病 。 方法 本文將從文獻統計及臨床病例報告兩方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法。 （一）文獻研究 於數據庫中搜索文獻，並篩選及分類，把所需文獻分為實驗研究文獻和臨床研究文獻。於臨床研究文獻中根據一定的納入／排除標準選用相關文獻，然後分為診斷／ 檢查與治療兩部分作統計，得出療效、復發、不良事件發生的相關統計結果，最後根據統計探討相關診斷／檢查與治療方法 。 （二）臨床病例報告 於臨床時遇到此類患者的病例報告。跟據記錄臨床表現及治療結果作出報告和總結。 結果 （一）文獻研究 數據庫中沒有本病的實驗研究文獻，亦僅有少量文獻的內容包括專項檢查及影像學檢查。 在統計療法方面時，針刀類和手術治療的治愈率普遍較高，而針刀類、手術治療的復發率最低，沒有不良事件發生率的比較 。 （二）臨床病例報告 收錄了四個臨床病例，本病早期、中期、後期均有最少一個病例。整體而言，針灸加推拿治療對屈指肌腱腱鞘炎有一定的療效。尤其針對其疼痛，效果較明顯，但是對於減輕彈響、交鎖現象則效果不大。雖然從文獻中知道針刀治療療效不錯，但對操作者的要求較高，如對病位解剖有深入認識、了解操作原理、如何避免不 良事件發生。 結論 因為針刀類和手術治療的治愈率最高和復發率最低，故於多種療法中為最佳的療法。從臨床研究文獻之中，發現有很多有待發掘的方向，如客觀化研究、不同等級療效研究等。於臨床病例中，針灸、推拿對屈指肌腱腱鞘炎的疼痛、活動受限有一定的療效，但對彈響、交鎖則療效不大 。

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal, 2002. / Purpose . Rotator cuff tendinitis is a common problem, however, its diagnosis and management is not completely understood. The purpose of this research project was to investigate the efficacy of the chiropractic adjustment to determine whether or not it is an effective approach in the treatment of rotator cuff tendinitis. Methods This randomized controlled trial consisted of two groups. Each group consisted of thirty subjects, of any age, selected from the general population and randomly allocated to Group 1 or 2, participation in this trial was voluntary. Group 1 received chiropractic adjustment of the glenohumeral or acromioclavicular joint according to the fixations found on motion palpation and group 2 received placebo laser. Subjects in both groups had to comply with certain inclusion criteria before being allowed to participate in the study. Goniometer readings were taken to measure range of motion, algometer readings to measure pain threshold and the Numerical Pain Rating Scale was answered at the initial consultation, and on the third and sixth consultations. The Unpaired and Friedman's T- tests were used to assess the intra and intergroup information from the first, third and sixth consultations. Groups 1 and 2 were compared in terms of age, gender, race and clinical severity prior to onset. / M

El presente estudio se realizó en el Hospital Nacional Hipólito Unanue en un período de 6 meses (febrero a julio 2004) en que se logró captar 17 pacientes, que fueron divididos aleatoriamente en dos: grupo experimental y grupo control, previo cumplimiento de los criterios de inclusión. Este es un estudio pre-experimental, prospectivo y longitudinal, donde el objetivo principal es demostrar la eficacia del Método Cyriax considerando dos variables: dolor y capacidad funcional. Los pacientes seleccionados fueron sometidos a dos exámenes ecográficos, el primero para confirmar el diagnóstico clínico y el segundo para controlar la evolución del proceso. Del mismo modo se realizó la evaluación fisioterapéutica al inicio y término de ambos tratamientos y se controló mediante una ficha la evolución de cada paciente diariamente. En la presente investigación se encontró que el método Cyriax es más eficaz en el manejo del dolor, con resultados significativamente beneficiosos. El tratamiento experimental presentó un índice de mejora de 76.3% y el convencional de 54.3%; con lo cual es el método Cyriax el que disminuye el dolor con mayor eficacia. Con respecto a la capacidad funcional no se presentaron significativas diferencias estadísticas entre ambos tratamientos.

No description available.

El presente estudio se realizó en el Hospital Nacional Hipólito Unanue en un período de 6 meses (febrero a julio 2004) en que se logró captar 17 pacientes, que fueron divididos aleatoriamente en dos: grupo experimental y grupo control, previo cumplimiento de los criterios de inclusión. Este es un estudio pre-experimental, prospectivo y longitudinal, donde el objetivo principal es demostrar la eficacia del Método Cyriax considerando dos variables: dolor y capacidad funcional. Los pacientes seleccionados fueron sometidos a dos exámenes ecográficos, el primero para confirmar el diagnóstico clínico y el segundo para controlar la evolución del proceso. Del mismo modo se realizó la evaluación fisioterapéutica al inicio y término de ambos tratamientos y se controló mediante una ficha la evolución de cada paciente diariamente. En la presente investigación se encontró que el método Cyriax es más eficaz en el manejo del dolor, con resultados significativamente beneficiosos. El tratamiento experimental presentó un índice de mejora de 76.3% y el convencional de 54.3%; con lo cual es el método Cyriax el que disminuye el dolor con mayor eficacia. Con respecto a la capacidad funcional no se presentaron significativas diferencias estadísticas entre ambos tratamientos. / Tesis

M.Tech. (Chiropractic) / Lateral elbow tendinopathy is the most frequent periarticular lesion which affects 1% to 3% of the general population and is a difficult condition to manage with a wide range of procedures and management protocols advocated (Abrahamson and Comfort, 2010). This study aimed to assess the efficacy of managing lateral elbow tendinopathy using therapeutic ultrasound (U/S), interferential current (IFC) or alternatively a combination of IFC and therapeutic U/S in addition to chiropractic manipulative therapy of the cervical spine and elbow. This study was a comparative study consisting of three groups of ten participants each with an equal gender ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. Group A received therapeutic U/S; Group B received IFC and Group C received combination therapy of IFC and therapeutic U/S. All three groups received chiropractic manipulative therapy to the cervical spine and joints of the elbow complex. Subjective data was obtained using the Numerical Pain Rating Scale (NPRS). Objective data was obtained using the pressure algometer (pain pressure threshold) and the Jamar grip strength dynamometer (pain-free grip strength) on the affected side. The study was conducted over a course of three weeks for a total of seven visits per participant. Subjective and objective data was collected pre-intervention on the first and fourth visits and on the seventh evaluation only visit. Analysis of the data collected was performed by a statistician. All three groups showed statistically significant clinical improvements in all measures. The only group not exhibiting a statistical significance was the therapeutic U/S group in the initial pain pressure threshold results. In the objective measures of all intervals none of the groups showed statistical superiority over one another. However, the final NPRS results showed statistically significant improvement in therapeutic U/S and combination therapy groups over IFC alone. From the results it can be concluded that all groups were effective for lateral elbow tendinopathy in conjunction with chiropractic manipulative therapy. With respects to subjective pain therapeutic U/S and combination therapy appeared to have a greater efficacy than IFC, but no superior modality was identified with respects to objective measures.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute Of Technology, 2006. / Purpose Repetitive strain injuries, especially rotator cuff tendonitis, are increasing and reaching epidemic proportions in certain industries and in most industrialized countries (Yassi et al. 1996). Fatigue of the rotator cuff allows the humeral head to translate anteriorly, with resultant mechanical impingement of the supraspinatus tendon. At this point inflammatory changes become evident (Fu et al. 1995). According to Greenman (1996), muscle energy technique (MET) is a 'manual medicine treatment procedure that involves the voluntary contraction of a patients muscle in a precisely controlled direction, at varying levels of intensity, against a distinctively executed counterforce applied by the operator.' It has been hypothesized that MET can be used to lengthen and strengthen muscles, to increase fluid mechanics and decrease local edema, and to mobilize a restricted articulation (Greenman 1996). However, these statements have been made in the absence or appropriate research in order to support such statements, therefore. the aim of this study was to assess the efficacy of Muscle Energy Technique in the treatment of rotator cuff tendonitis in terms of subjective and objective clinical findings. Methods Objective measures included: Diagnostic ultrasound which was used to evaluate changes in inflammation and thickness of the involved tendon, the algometer was used to assess point tenderness, whilst inclinometer readings were taken to evaluate the associated changes in range of motion that may have taken placei / M

Augmented soft tissue mobilization therapy (ASTM) is a newly developed massage technique. ASTM is applied with the aid of specifically designed, solid instruments and has been successfully used in the treatment of chronic tendinitis patients. In a study on collage nase -injure d rat Achilles tendons treated with ASTM, Davidson et. al (1997) reported gait improvement as well as fibroblasts proliferation and suggested ASTM may augment healing by the recruitment of fibroblast. The present study examined the morphological response of enzyme-induced rat Achilles tendons to 3 different ASTM pressure application: 1 newton; 2 newtons and 3 newtons. Collagenase-injured tendons exhibited disrupted and randomly arranged collagen fibers. Treatment applications were performed for 4 days for a total of 4 treatments. Morphological differences were demonstrated between groups in proportion to the ASTM treatment pressure application. The ASTM group treated with 3 newtons demonstrated the greatest mean fibroblast count (370.3 +/- 51.6). Further, electron microscopy revealed the presence of activated fibroblasts in the tendons of the 3 newtons, ASTM group. However, immunochemical staining comparisons of Type I and III collagen, fibroblast growth factor receptor, and insulin-like growth factor between groups were not remarkable. / Department of Physiology and Health Science

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.