Laban Myron M, Iyer Rajesh, Tamler Martin S
Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA.
Am J Phys Med Rehabil. 2005 Nov;84(11):895-8. doi: 10.1097/01.phm.0000176548.18362.67.
Nineteen outpatients, nine women and ten men, all right-handed, ranging in age from 33 to 87 yrs, with an average age of 53.5 yrs, presented with complaints of lateral epicondylitis (i.e., tennis elbow). Each was subsequently identified as having a heretofore unrecognized loss of ipsilateral shoulder internal rotation. The authors suggest that in this scenario the occult shoulder periarthrosis is interlinked in a pathokinetic chain potentially predisposing to the presenting symptoms of tennis elbow. During a tennis serve, excessive wrist flexion may be substituted as to compensate for a restricted arc of shoulder internal rotation. The extensor carpi radialis longus and brevis cross both the elbow and wrist. Functionally, they have the capacity of reversing their osseous attachments, both at their origin and insertion, as these muscles cycle under load from a concentric/shortening to an eccentric/elongating contraction. Aging muscle, with its increased viscoelastic stiffness, may be "too slow" to accommodate this transition recoil, especially when repetitive. Instead, it is pathomechanically absorbed at the proximal elbow extensor tendon insertion.
19名门诊患者，9名女性和10名男性，均为右利手，年龄在33至87岁之间，平均年龄为53.5岁，均主诉患有外侧上髁炎（即网球肘）。随后发现他们均存在同侧肩部内旋功能丧失，而这一情况此前未被认识到。作者认为，在这种情况下，隐匿性肩部关节周围炎在一条病理动力学链中相互关联，可能是导致网球肘症状的潜在因素。在网球发球过程中，可能会出现过度的腕关节屈曲来代偿受限的肩部内旋弧度。桡侧腕长伸肌和桡侧腕短伸肌跨过肘部和腕部。从功能上来说，当这些肌肉在负荷下从向心/缩短收缩循环到离心/拉长收缩时，它们能够在起点和止点处反转其骨性附着点。随着年龄增长，肌肉的粘弹性刚度增加，可能“反应过慢”，无法适应这种转换性回缩，尤其是在反复发生时。相反，它会在近端肘部伸肌腱止点处通过病理力学方式被吸收。
