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ECU Tendinopathy at Snapping ECU

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Illustrasyon ng gilid ng maliit na daliri sa likod ng pulso, na nagpapakita ng ECU tendon na tumatakbo sa kanyang guhit sa ulna, na may sakit na naka-highlight sa ibabaw ng guhit.
Ang ECU tendon ay tumatakbo sa isang mababang guhit sa gilid ng pulso na may kaugnayan sa maliit na daliri, na hawak pababa ng sarili nitong manggas. Ang sakit ay nagmumula o sa tendon mismo na naging iritadado, o sa paglipat-lipat nito papasok at lumabas sa guhit. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Ito ay sakit sa gilid ng pisngi ng kamay sa likod ng pulso — ang gilid kung saan pinakamalapit ang strap ng relo mo kung suot mo ito mababa. Karaniwan itong pinakamasakit kapag ibinababa mo ang palad pataas at yumuyuko ang pulso patungo sa iyong pisngi, na eksaktong nangyayari sa tennis backhand, golf swing, o pagpigil ng tela.

May dalawang bersyon ng problema, at maraming tao ang may kaunting pareho.

Isang iritadong tendon. Ang sakit ay isang mapait na pananakit sa haba ng tendon, minsan ay may pamamaga na nararamdaman mo, at masakit ito kapag pinilit ang pulso pabalik laban sa resistensya. Karaniwan itong umuunlad sa loob ng mga linggo sa pamamagitan ng paulit-ulit na paggamit kaysa magsimula sa isang sandali.

Isang tendon na lumilipad mula sa kanyang grooves. Dito, mayroon kang natatanging snap, click o clunk habang ikinikiling ang forearms — madalas na isang bagay na maaari mong ipakita sa sarili mo, at madalas na isang bagay na unang napansin mo pagkatapos ng isang partikular na insidente, tulad ng club na nakadikit sa lupa o isang matinding backhand. Maaari itong maging nakakatakot, parang may sumisira.

Ano ang nangyayari talaga

Ang tendon na kinasasangkutan ay ang extensor carpi ulnaris, karaniwang pinapapait na ECU. Ito ay tumatakbo mula sa kalamnan sa iyong forearms pababa sa gilid ng maliit na daliri ng pulso, na nakatira sa isang mababaw na guhit sa dulo ng ulna — ang buto ng forearms sa gilid na iyon. Isang maliit na manggas ng tisyu, ang sarili nitong pribadong tunnel, ang nag-iingat na nasa guhit na iyon.

Ang guhit na iyon ay tunay na mababaw, karaniwang humigit-kumulang 1.5 milimetro ang lalim, kaya ang manggas ang nagbibigay ng karamihan sa trabaho upang panatilihin ang tendon sa lugar. Kung ang manggas ay naputol o napalawak — karaniwan dahil sa isang malakas na pag-ikot habang ang palad ay nakaharap pataas at ang pulso ay nakababa — ang tendon ay maaaring lumabas sa guhit at bumalik. Kung sa halip ang tendon at ang kanyang lining ay napapalaki at napapalaki dahil sa paulit-ulit na paggamit, ito ay magiging masakit kapag gumagalaw, na ang bersyon ng tendinopathy.

Mahalagang alam ito, dahil nagbabago ito kung paano dapat i-interpreta ang mga pagsusuri: isang tiyak na halaga ng paggalaw ng tendon ay ganap na normal. Kapag sinuri ng mga mananaliksik ang 755 tao na walang anumang sintomas sa pulso, humigit-kumulang 1 sa 15 ay may snapping ECU, at halos kalahati ng mga ito ay may nakikitang paglabas ng tendon sa guhit sa ultrasound — nang walang sakit at walang problema. Ang isang snap sa sarili nito ay hindi patunay na may mali.

Ano ang maaari naming gawin dito

Sa Mater Private Hospital Rockhampton, si Dr Kieran Hirpara ang maglalaan ng diagnosis pangunahin sa pamamagitan ng pagsusuri kaysa sa paggamit ng scan, at mahalagang ipaliwanag kung bakit.

Ang mga scan ay nangangailangan ng maingat na pagpapaliwanag. Sa isang pag-aaral na may higit sa 4,000 MRI ng pulso, ang mga pagbabago sa tendon ng ECU ay lumitaw sa humigit-kumulang isa sa walong scan, kasama na sa mga taong nagsagawa ng scan para sa ibang layunin. Kukuin mo ang isang ECU na tila hindi normal sa MRI at itanong kung gaano kadalas ang taong ito ay may tunay na problema sa ECU, ang sagot ay humigit-kumulang 6% lamang ng oras. Ang MRI ay talagang kapaki-pakinabang upang mapatunayan ang kawalan ng ibang dahilan ng sakit sa gilid na iyon ng pulso — halimbawa, isang sugat sa cartilage — ngunit ang marka sa tendon ay hindi sagot sa sarili. Ang ultrasound ay madalas na mas kapaki-pakinabang, dahil makikita namin ang tendon na gumagalaw sa real-time habang ikaw ay nagre-reproduce ng snap.

Ang karamihan ay gumagaling nang walang operasyon. Ang paggamot ay karaniwang nagsisimula sa pagbabago ng gawain na nagpapakilala nito at isang panahon sa splint o cast. Para sa tendon na lumilipad labas ng groove nito, ang posisyon ay mahalaga: ang pulso ay karaniwang hawak na may forearm na nakapatong palad-pababa at ang pulso ay bahagyang nakahiga pabalik, sa loob ng apat hanggang anim na linggo, dahil ito ay kabaligtaran ng posisyon na nagpapahintulot sa tendon na lumikas.

Ang steroid injection sa tendon sheath ay isang makatwirang susunod na hakbang para sa bersyon ng iritadong tendon. Sa pinakamahusay na pag-aaral na available, 13 pasyente na may kumpirmadong diagnosis ay lahat ay nakakuha ng ilang ginhawa, 10 sa kanila ay kumpletong ginhawa, at walang isa ang naging kailangan ng operasyon — karamihan ay nanatiling komportable apat hanggang limang taon pagkatapos. Isang kapaki-pakinabang na maagang signal: kung ang unang injection ay lubos na nag-aayos ng mga bagay, ito ay karaniwang tumatagal. Kung ito ay kalahating gumagana, mas madalas na naiiwan ang ilang natitirang sakit.

Limitado namin ang mga injection sa maximum na humigit-kumulang tatlo, at mas maingat kami sa mga manlalaro ng throwing at racquet, dahil may pag-aalala — hindi patunayan ng numero, ngunit naiulat — na ang paulit-ulit na steroid sa paligid ng tendon na ito ay maaaring mag-ambag sa pagkakabasag nito sa huli.

Ang operasyon ay inialok lamang sa mga taong ang instability ay patuloy na nagdudulot ng sakit kahit na may tamang pagsubok ng casting, karaniwang sinusuri sa humigit-kumulang dalawang buwan. Ang operasyon ay muling binubuo o pinapalakas ang sleeve na nag-iingat sa tendon sa groove. Maraming teknik ang umiiral at lahat ay nag-uulat ng magagandang resulta.

Ano ang inaasahan

Ang paggaling mula sa hindi operasyong paraan ay nakadepende sa kung gaano karaming iritasyon ang mayroon. Ang mga atleta na may mild na problema ay madalas ay bumabalik sa loob ng dalawa hanggang tatlong linggo; ang mas malalang mga kaso ay kumukuha ng anim hanggang walong linggo; at ang isang kumpletong pag-slide na ginagamot sa isang cast ay maaaring kumuhin ng limang hanggang anim na buwan bago bumalik sa isang demanding na sports tulad ng tennis.

Pagkatapos ng operasyon, inaasahan ang humigit-kumulang apat hanggang anim na linggo sa isang cast o splint na may hawak na forearm na palm-down, pagkatapos ay unti-unting pagbabalik ng galaw, pagpapalakas mula sa humigit-kumulang dalawang buwan, at espesipikong trabaho para sa sports sa tatlo hanggang apat na buwan. Ang mga published na series ay nag-uulat na ang mga tao ay bumabalik sa kanilang nakaraang aktibidad sa humigit-kumulang dalawang kalahati hanggang tatlong kalahati na buwan.

Dalawang tapat na punto tungkol sa operasyon. Una, halos lahat ng published na series ay nag-uulat na ang snapping ay hindi na bumabalik — ngunit ang iisang study na nag-scan ng mga tao pagkatapos ay natagpuan na ang tendon ay nananatiling nasa labas ng groove sa humigit-kumulang kalahati ng kanila, kahit na sila ay masaya at nagkakaroon ng magandang resulta. Sa ibang salita, ang operasyon ay maaasahan na nagpapagaan ng mga sintomas, ngunit hindi nito palaging inilalagay ang anatomy pabalik sa eksaktong posisyon nito. Pangalawa, ang mga pagtaas sa grip strength at range of movement ay maliit; ang operasyon ay ginagawa para sa sakit at para sa snapping, hindi upang gawing mas malakas ang pulso.

Ang mga komplikasyon ay bihira ngunit tunay: numbness o isang tender na spot mula sa iritasyon ng isang maliit na skin nerve sa likod ng pulso, stiffness, at bihira ang isang persistent na pain syndrome.

Kung ang iyong snapping ay hindi nakakaramdam ng sakit, malamang na hindi ito nangangailangan ng pag-aayos. Ang mga tao na may painless na snapping ECU ay karaniwang patuloy na nasa mataas na antas lamang sa pamamagitan ng taping at monitoring.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong GP kung ang sakit sa gilid ng pulso na may kaugnayan sa maliit na daliri ay hindi gumagaling pagkatapos ng ilang linggo ng pagbabawas sa aktibidad na nagdudulot nito, o kung ito ay naghihigpit sa iyong isports o trabaho.

Humingi ng opinyon mula sa isang hand surgeon kung ang pulso ay nag-s-snaps o nag-clunks nang masakit kapag ikaw ay nag-iikot ng iyong forearms, kung ang sakit ay sumunod sa isang tiyak na twisting injury, o kung ikaw ay nagsubok na ng pahinga, isang splint, at isang injection nang walang pangmatagalang benepisyo.

Maghanap ng mabilisang atensyon kung ang pulso ay magiging mainit, pula, at pamamaga, kung ikaw ay magkaroon ng numbness o weakness sa kamay, o kung ikaw ay nakaramdam ng biglaang pagbigay na may kasamang agad na pagkawala ng lakas — ang huli sa mga ito ay maaaring magpahiwatig na ang tendon mismo ay naputol.


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