Vedung Torbjörn, Werner Michael, Ljung Björn-Ove, Jorfeldt Lennart, Henriksson Jan
Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden.
J Hand Surg Am. 2011 Dec;36(12):1974-80. doi: 10.1016/j.jhsa.2011.08.028. Epub 2011 Oct 19.
Based on previous evidence of muscle fiber injury and decreased blood flow in the extensor carpi radialis brevis (ECRB) muscle in lateral epicondylitis (LE), we hypothesized that there would also be an abnormal (vasoconstrictive) vascular response to adrenaline in the ECRB muscle in LE.
In a case-control study, we measured skeletal muscle blood flow in 8 patients with LE and in 8 healthy controls in response to a 30-minute intravenous infusion of adrenaline. We used local clearance of technetium-99m in the main portion of the ECRB muscle to calculate muscle blood flow.
In support of the hypothesis, the blood flow response to the adrenaline infusion was markedly different in the 2 study groups. Whereas the continuous decrease in technetium-99m clearance rate over time was interrupted by the adrenaline-induced vasodilatory effect in the control group, we detected no such effect in the patient group.
In the ECRB muscle in LE, there is a shift in the balance of vasodilatory and vasoconstrictory influences of adrenaline, leading to vasoconstriction during low-dose adrenaline infusion. The adverse adrenaline effect is similar to what was previously observed after minor muscle injury. Whether the vasoregulatory change, by causing relative muscle ischemia, represents the primary etiology in LE or results from muscle injury cannot be determined, but it is likely to contribute to the development and continuation of chronic muscle pain in LE. New ways of thinking about the condition may be required, and pharmacological treatment might be an option to improve the blood supply and avoid further damage to the affected ECRB muscle-tendon unit.
基于先前关于外侧上髁炎（LE）患者桡侧腕短伸肌（ECRB）肌纤维损伤及血流减少的证据，我们推测LE患者的ECRB肌对肾上腺素也会有异常（血管收缩性）的血管反应。
在一项病例对照研究中，我们测量了8例LE患者和8例健康对照者在静脉输注肾上腺素30分钟期间的骨骼肌血流。我们利用ECRB肌主要部分的99m锝局部清除率来计算肌肉血流量。
支持该假设的是，两个研究组对肾上腺素输注的血流反应明显不同。对照组中，随着时间推移99m锝清除率的持续下降被肾上腺素诱导的血管舒张作用所中断，而在患者组中我们未检测到这种效应。
在LE患者的ECRB肌中，肾上腺素的血管舒张和血管收缩影响的平衡发生了改变，导致在低剂量肾上腺素输注期间血管收缩。肾上腺素的这种不良效应与先前在轻度肌肉损伤后观察到的情况相似。血管调节变化是否通过导致相对的肌肉缺血而代表LE的主要病因，或者是由肌肉损伤引起，尚无法确定，但它可能有助于LE慢性肌肉疼痛的发生和持续。可能需要对这种情况有新的思考方式，药物治疗可能是改善血液供应并避免对受影响的ECRB肌腱单元造成进一步损伤的一种选择。
