Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
Koc University, Faculty of Medicine, Orthopedics and Traumatology Department, Hand Surgery Unit, İstanbul, Turkey.
Med Hypotheses. 2018 Jan;110:125-131. doi: 10.1016/j.mehy.2017.12.009. Epub 2017 Dec 5.
Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.
肘部疼痛综合征是常见的上肢肌肉骨骼疾病，通常与重复性职业暴露有关。由于韧带具有机械和神经特性，因此它们通常是肌肉骨骼疾病的来源之一。腕部韧带是最容易受到职业暴露影响的韧带之一。由于大多数职业任务都需要手腕伸展来处理工具和加载，因此在加载过程中，舟月骨间韧带（SLIL）承受更大的应变，导致蠕变变形和滞后。韧带蠕变可能导致在关节运动过程中检测信号变化的能力下降，从而损害由韧带中的机械感受器引发的韧带肌肉反射弧建立的神经肌肉控制。由于韧带肌肉反射减弱，前臂肌肉的肌肉激活模式发生变化，可能会引发正反馈循环，导致肌肉骨骼疼痛综合征。通过两个假设和相关的疼痛机制，将介绍肘部疼痛综合征与 SLIL 损伤之间的关系：1.重复性任务可能导致 SLIL 的蠕变变形，从而损害韧带肌肉反射，导致肘部疼痛障碍。2.外侧肱骨上髁炎可能通过增加尺侧腕伸肌的活动来补偿桡侧腕伸肌的活动，从而增加 SLIL 损伤的风险，这可能会改变腕部运动学，随着时间的推移导致 SLIL 退化。在肌肉骨骼疼痛障碍的鉴别诊断通常很复杂。治疗方法的失败是许多研究人员关注的问题之一。制定治疗策略的关键要素是了解疾病的来源和损伤的性质。我们提出，在描述肘部疼痛综合征时，包括 SLIL 损伤，特别是外侧肱骨上髁炎，应进行鉴别诊断。
