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J Bodyw Mov Ther. 2023 Jan;33:142-145. doi: 10.1016/j.jbmt.2022.09.025. Epub 2022 Sep 22.
Kettlebell snatches are an efficient and effective exercise. If the kettlebell being utilized is too heavy or too many repetitions are executed, this can lead to an overuse injury such as a tendinopathy. Multiple orthopedic tests exist to evaluate for a distal biceps tendon rupture. At present, there are no publications utilizing shockwave and active rehabilitation to treat distal bicipital tendinopathy with Lateral Antebrachial Cutaneous Nerve (LABCN) entrapment. Currently, no published manuscripts are reporting distal bicipital tendinopathy with LABCN nerve entrapment being treated successfully with shockwave and active rehabilitation over the course of 5 weeks.
The objective of this case report is to examine the conservative management of a 37-year-old male with a diagnosis of distal bicipital tendinopathy and LABCN entrapment. The patient presents with discomfort originated weeks prior after an intense block of kettlebell training. The patient was diagnosed with brachioradialis tendinopathy due to the specifics of his injury. Following the initial evaluation, the patient was unable to supinate the forearm past 45° actively, yet he can passively achieve 90°, although this is done with minor discomfort.
The patient's rehab began with the execution of wrist, elbow, and shoulder controlled articular rotation (CARS). The concept of CARs is to train the joint and soft tissues to respond to full range activity. A progressive approach utilizing isometric to eccentric exercise with extracorporeal shockwave was used. The authors studied forty-eight patients with chronic distal biceps tendinopathy. After five shockwave therapy treatments over three months, there was a significant decrease in symptomology without complications (Furia et al., 2017).
This case report demonstrates that active rehabilitation and shockwave therapy effectively resolved the patient's symptoms with no adverse reactions. Additionally, the case report can be a suggested management protocol for successful conservative management for patients with suspected distal bicipital tendinopathy with LABCN entrapment going forward.
壶铃 snatch 是一种高效且有效的运动。如果使用的壶铃太重或重复次数过多，可能会导致过度使用损伤，如腱病。有多种骨科测试可用于评估肱二头肌远端肌腱断裂。目前，尚无利用冲击波和主动康复治疗伴有桡神经前臂外侧皮支（LABCN）卡压的肱二头肌远端肌腱病的出版物。目前，尚无文献报道成功使用冲击波和主动康复治疗伴有 LABCN 神经卡压的肱二头肌远端肌腱病，且治疗时间为 5 周。
本病例报告的目的是检查一名 37 岁男性的保守治疗，该男性患有肱二头肌远端肌腱病和 LABCN 卡压。患者在进行密集的壶铃训练数周后出现不适。由于受伤的特殊性，患者被诊断为肱桡肌肌腱病。在最初评估后，患者无法主动将前臂旋后超过 45°，但他可以被动达到 90°，尽管这会引起轻微不适。
患者的康复治疗始于手腕、肘部和肩部的受控关节旋转（CARS）。CARS 的概念是训练关节和软组织对全范围活动的反应。采用渐进的方法，从等长到离心运动，结合体外冲击波治疗。作者研究了 48 例慢性肱二头肌远端肌腱病患者。经过三个月五次冲击波治疗后，症状显著减轻，无并发症（Furia 等人，2017 年）。
本病例报告表明，主动康复和冲击波治疗有效地解决了患者的症状，没有不良反应。此外，该病例报告可以作为疑似伴有 LABCN 卡压的肱二头肌远端肌腱病患者成功保守治疗的建议管理方案。
