目的:本研究的目的是调查是否存在广泛的压力性痛觉过敏,腕部伸肌腱和肌肉的结构变化,及其在外侧上髁疼痛(LE)患者中的关联。
方法:37例LE患者(43%为女性;平均年龄=45.5[SD=9.5]岁)和37例年龄、性别匹配且无疼痛的对照者参与了这项研究。在症状区域(肘部)两侧评估压力疼痛阈值(PPTs),2个分段相关区域(C5-C6接头,第二掌骨间隙),和1个偏远地区(胫骨前)的盲设计。超声测量(例如,横截面积,厚度,评估了腕部常见的伸肌腱和桡骨腕伸肌的宽度)以及旋后肌的厚度。
结果:与无症状侧相比,LE患者在所有部位的双侧PPTs较低,在有症状侧的外侧上髁和第二掌骨间隙的PPTs较低(η2为0.123-0.369;大效应)。患者表现出较高的腕关节伸伸肌腱的横截面积和宽度(η2从0.268-0.311;影响大),而疼痛侧的肌腱厚度也高于非疼痛侧(η2=0.039;影响小)。
结论:这项研究报道了双侧广泛的压力性疼痛痛觉过敏和肌腱的形态变化,但不是肌肉,在LE。LE患者的压痛敏感性和形态学变化无关。
■LE的治疗应将改变的伤害性疼痛处理和结构性肌腱变化视为LE患者的2种不同现象。
OBJECTIVE: The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE).
METHODS: Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, width) of the common wrist extensor tendon and extensor carpi radials brevis muscle as well as thickness of supinator muscle were assessed.
RESULTS: Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space at the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side.
CONCLUSIONS: This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE.
UNASSIGNED: Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.