Imiterere n'uburyo bwo kuvura inkokora ya tenisi

Igisobanuro cya epicondylitis yo ku ruhande rw'umugongo

Bizwi kandi nka tennis elbow, tendon strain y'imitsi ya extensor carpi radialis, cyangwa kuvunika kw'aho tendon ya extensor carpi ihurira, brachioradial bursitis, izwi kandi nka lateral epicondyle syndrome. Kubyimba kw'ingingo zoroshye zikikije lateral epicondyle ya humerus guterwa n'imvune ikomeye kandi idakira..

Pathogenesis

Bifitanye isano rya hafi n'akazi, cyane cyane ku bakozi bakunze kuzunguruka ukuboko, bakagura kandi bagapfunyika ingingo z'ukuboko n'iz'ikiganza. Abenshi muri bo ni abagore bo mu rugo, ababaji, abubatsi, abakora ibikoresho byo mu rugo, abakora amazi n'abakinnyi b'imikino ngororamubiri.

Dudukoko

Impande zombi z'inyuma yo hasi ya humerus ni epicondyles zo hagati n'izo ku ruhande, epicondyle yo hagati ni ugufatana kw'imitsi isanzwe y'inyuma y'ukuboko, naho epicondyle yo ku ruhande ni ugufatana kw'imitsi isanzwe y'inyuma y'ukuboko. Aho imitsi ya brachioradialis ihera, irapfuka ukuboko hanyuma ikagira pronate gato. Aho imitsi ya extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum majoris, extensor digitorum propria y'urutoki ruto, extensor carpi ulnaris, imitsi ya supinator.

Pathogen

Gutangira kwa condyle biterwa no gukomereka no kunanura umubiri, ariko abarwayi benshi bagira ikibazo cyo gukomereka buhoro buhoro kandi muri rusange nta mateka agaragaza ko bahuye n’ikibazo, kandi bikunze kugaragara ku bantu bakuru bakeneye kuzunguruka ukuboko kenshi no kunagura ukuboko cyane. Bishobora kandi kunanurwa cyangwa gucika intege bitewe no kwaguka kenshi kw’ingingo y’ukuboko no kunanura cyane imitsi y’ukuboko ku gice cyo ku ruhande cya humerus iyo ukuboko kuri mu mwanya wo kuririmba.

Pimiterere y'abantu

1. Bitewe no gukomereka kenshi, epicondyle yo ku ruhande rw'imitsi iracikagurika ikava amaraso, igakora hematoma yo ku ruhande rw'inyuma, hanyuma ikagenda ihinduka, bigatera periosteitis na hyperplasia y'amagufwa yo ku ruhande rw'inyuma rw'umugongo (akenshi mu buryo bw'agahu gakomeye). Isuzuma rya biopsy y'imitsi ni ischemia ya hyaline degeneration, bityo byitwa ischemic inflammation. Hari igihe iherekezwa no gucika k'agasaho k'ingingo, maze synovial membrane y'ingingo irakura kandi ikagira ubunini bitewe no gukangurwa n'imitsi igihe kirekire.
2.Shyira aho umutsi ufata extensor tendon. 
3.kubyimba gukomeye cyangwa fibrohistolitis y'umuyoboro w'amaraso. 
4. bursitis y'ingingo ya brachioradial na extensor common tendon.
5. Kubyimba kwa synovium ya humerus na radial joint guterwa no gushyira hamwe kwa humerus n'umutwe muto wa radius.
6. Kuruhuka kw'imitsi yo mu kibuno no gutandukana gato kw'ingingo yo hafi ya radial-ulnar nabyo bishobora kubaho, bigatera kwimuka k'umutwe wo mu kibuno. Izi mpinduka zishobora gutera imitsi kubabara, ububabare buturutse ahantu runaka, ububabare buturutse ku mitsi yo mu kiganza kirekire bujya ku kuboko.

Icyerekezo cy'ubuvuzi

1. Ububabare bwo hanze y'inkokora burushaho kwiyongera iyo umuntu avugije imiterere ye, cyane cyane iyo azungurutsa umugongo, azamuye, akurura, asoza, asunika n'ibindi bikorwa, kandi amanuka ku mitsi yo mu kiganza. Mu ntangiriro, nkunze kumva ububabare n'intege nke mu kuguru kwakomeretse, kandi buhoro buhoro nkagira ububabare inyuma y'inkokora, burushaho kwiyongera iyo myitozo ngororamubiri yiyongera. (Imiterere y'ububabare ni ububabare cyangwa gucika intege)
2. Birushaho gukomera nyuma yo gukora imyitozo ngororamubiri no koroherwa nyuma yo kuruhuka.
3.Kuzunguruka kw'ukuboko no kudakora neza ibintu, ndetse no kugwa hamwe n'ibintu.

Ibimenyetso

1. Ishusho y'inyuma y'umugongo Ishusho y'inyuma y'umugongo w'inyuma y'umugongo w'inyuma, umwanya w'ingingo y'inyuma y'umugongo w'inyuma, igice cy'inyuma cy'umugongo w'inyuma n'inkombe z'inyuma z'umugongo w'inyuma y'umugongo w'inyuma bishobora gukosorwa, kandi imitsi n'inyama ku ruhande rw'inyuma rw'ukuboko byo hejuru nabyo bishobora gukosorwa no kubyimba gake, kubabara cyangwa gukomera. Hari igihe impande zikomeye za hyperostosis zishobora kumvikana ku gice cy'inyuma cy'umugongo w'inyuma, kandi ziba zoroshye cyane.
2. Ikizamini cya Mills cyagaragaje ko ari cyiza. Kura ukuboko kwawe gato hanyuma ukore igice cy'ikiganza, zunguza ukuboko kwawe uko bishoboka kose, hanyuma uhindure ukuboko kwawe neza hanyuma ugorore inkokora yawe. Iyo ububabare bubaye ku ruhande rw'ingingo ya brachioradial iyo inkokora igororotse, iba ari nziza.
3. Ikizamini cyo kurwanya indwara yo mu nda: umurwayi yapfunyitse ukuboko kwe maze akoza ukuboko kwe, maze umupimisha agakanda inyuma y'ukuboko k'umurwayi n'ukuboko kwe kugira ngo umurwayi arwanye indwara yo kurwanya indwara no kongera ukuboko, nk'uko ububabare bwo hanze y'inkokora buba bwiza.
4. Gusuzuma X-ray rimwe na rimwe bishobora kugaragaza ko periosteum idakora neza, cyangwa umubare muto w'ingingo za calcium zitagaragara inyuma y'inyuma.

Ubuvuzi

Uburyo bwo kuvura indwara zishingiye ku mikorere y’umubiri (conservative):

1. Hagarika imyitozo yo gukangura aho hantu hakiri kare, kandi bamwe mu barwayi bashobora koroherwa no kuruhuka cyangwa gufunga plaster aho hantu.
2. Gukoresha massage, gukoresha uburyo bwo gusunika no gukaranga kugira ngo ugabanye ububabare n'imitsi yo mu kiganza, hanyuma ukoreshe uburyo bwo gukanda no gukaranga ku gice cyo ku ruhande cy'umugongo n'aho ububabare buri hafi.
3. Ubuvuzi bwa Tuina, umurwayi yicara. Umuganga akoresha uburyo bwo gukurura no gukaranga buhoro kugira ngo akore ku mugongo no hanze y'inkokora no ku ruhande rw'inyuma rw'ukuboko. Umuganga akoresha umutwe w'igikumwe kugira ngo akande Ah Shi (lateral epicondyle), Qi Ze, Quchi, Hand Sanli, Waiguan, Hegu acupoint, nibindi. Umurwayi yicaye, maze muganga agakura aho umurwayi ahera kuri extensor carpi na extensor carpi longus na brevis radialis. Kurambura no kurambura inkokora nzima. Hanyuma, koresha uburyo bwa thenar rubbing kugira ngo ucure lateral epicondyle y'inkokora n'imitsi yo ku kuboko, maze ubushyuhe bwo mu gace bukoreshwa ku rugero.
4. Kuvura imiti, kunywa imiti igabanya ububabare itari steroide mu gihe cy’ububabare.
5. Uburyo bwo kuvura indwara zifata: glucocorticoids (nk'inshinge za betamethasone) zishyirwa mu gice cyoroshye hanyuma zigashyirwa mu gice cyo gushyiramo imitsi no mu mwanya wa subaponeurosis (ziri munsi cyangwa zingana n'inshuro 3), zishobora kugira ingaruka zo kurwanya ububyimbirwe no kugabanya ububabare, kandi betamethasone na ropivacaine cyangwa uburyo bifitanye isano na levobupivacaine muri iki gihe bizwi nk'imiti ikora vuba, ikora igihe kirekire, irwanya ububyimbirwe bwinshi, kandi ikaba ifite umutekano, igihe kirekire cyo guhagarika, ingaruka nke z'uburozi ndetse n'imiti igabanya ububabare mu gihe gito cyo kuziba aho hantu.
6. Uburyo bwo kuvura acupuncture, gukata igice kiri hafi y'igufwa kugira ngo gikureho ingirangingo zoroshye zikikije inzira y'amagufwa, gukurura imitsi yo mu kiganza, imitsi yo mu rutoki yo mu kiganza n'imitsi yo mu mutwe, no gukuramo icyuma ukumva ko kidakora neza. Ubuvuzi bwo kubaga: bukwiriye abarwayi banze ubuvuzi busanzwe.

1. Uburyo bwa Body & Meleod, igikorwa cyo kubaga gikubiyemo hafi ya ingingo zose z'igisebe, harimo no gukata epicondyle ya 2mm lateral, kurekura aho tendon itangira, gukata igice cy'intambwe ya proximal y'umugongo w'inyuma, gushyira igice cy'umugongo muri synovium, no gukuraho granulation tissue cyangwa bursa mu mwanya uri munsi y'umugongo.

2. Uburyo bwa Nischl, umutsi usanzwe wo gukurura umugongo n'umutsi usanzwe wo gukurura umugongo wa carpi longus radialis biratandukanye mu buryo burambuye, umutsi urekuye umugongo wa carpi radialis brevis uragaragara, aho umuntu yinjira hagakurwa hagati mu gice cyo hagati cy'inyuma, igice cy'umutsi cyangiritse kirakurwaho, igice cy'igufwa imbere kirakurwaho, kandi umutsi usigaye n'igice cy'imbere gikikije bishyirwa ku igufwa cyangwa bigashyirwa ku igufwa. Ntabwo byemewe ko habaho uruhare mu mitsi.

Prognose

Indwara iragenda igihe kirekire kandi ishobora kongera kugaruka.

Nintebe

1. Witondere kugira ngo ukomeze gushyuha kandi wirinde gukonja;
2. Kugabanya ibintu bitera indwara;
3. Imyitozo ngororamubiri;
4. Mu gihe cy’ubukana bw’indwara, uburyo bugomba kuba bworoshye, kandi uburyo bwo kuvura bugomba kwiyongera buhoro buhoro ku bamaze igihe kinini barwaye, ni ukuvuga ko uburyo bugomba kuba bworoshye kandi buhamye, buhamye kandi bworoshye, kandi bugomba guhuzwa no gukomera.