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Intramuscular pressure in the ECRB muscle of patients with lateral epicondylitis
Örebro University, School of Health and Medical Sciences. (Research in musculoskeletal health and disease)
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(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Abstract [en]

An increased tension and a low intramuscular blood flow in the extensor carpi radialis (ECRB) muscle in patient with lateral epichondylitis has been suggested to contribute to the symptoms. The reason for the lower blood flow may be increased intramuscular pressure. The purpose of this pilot study was to determine intramuscular pressure and blood flow in affected and unaffected ECRB in ten patients with unilateral epicondylitis, with a mean duration of symptoms of 24 (13-48) months. Intramuscular pressure (IMP) was measured using the microcapillary infusion technique and intramuscular blood flow using the laser Doppler flowmetry technique, bilaterally with the non-affected arm serving as a control. The recordings were performed at rest, during isometric dorsal extension of the wrist for 1 min at 40 % and 2 min at 20 % of maximal voluntary contraction (MVC) and during recovery after contractions. At rest the median IMP was 7-8 mm Hg regardless of arm while the median intramuscular blood flow was lower on the affected side compared with the unaffected side (P=0.03). During contraction the IMP and blood flow increased regardless of arm. The IMP fell to pre-contraction level within 2 s after contraction, independent of arm and contraction force. Recovery, regarding the intramuscular blood flow, tended to be faster on the unaffected side than on the affected after contraction at 20 % MVC. After contraction at 40 % MVC the blood flow was equal on both sides. When the IMP value in the unaffected muscle was corrected for the higher force elicited compared to affected muscle the adjusted IMP was significantly lower (P=0.006) at 20 % MVC. In summary, affected ECRB has a lower intramuscular blood flow during rest and a higher intramuscular pressure in relation to the unaffected muscle at contraction for 2 min at 20 % MVC.

Keyword [en]
Tennis elbow, intramuscular pressure, muscle perfusion, laser Doppler flowmetry, static contraction
National Category
Physiology
Research subject
Sports Science
Identifiers
URN: urn:nbn:se:oru:diva-10891OAI: oai:DiVA.org:oru-10891DiVA: diva2:321747
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Lateral epicondylitis: intramuscular blood flow, pressure and metabolism in the ECRB muscle
Open this publication in new window or tab >>Lateral epicondylitis: intramuscular blood flow, pressure and metabolism in the ECRB muscle
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lateral epicondylitis is classified as an overuse injury and the main symptom is pain from the lateral side of the elbow. There is general agreement that the extensor carpi radialis brevis (ECRB) muscle and its proximal tendon play a central role in the development of lateral epicondylitis. However, the pathophysiology is to a large extent unclear. The aim of the thesis was to investigate the intramuscular blood flow, the muscle metabolism as well as the vascular reactivity and the intramuscular pressure (IMP). Patients having chronic unilateral epicondylitis were investigated, with the unaffected arm serving as a control. Measurements were performed during rest, before and 3 and 12 months after an injection of botulinum toxin type A to cause relaxation of the muscle as well as after muscle contraction and occlusion of blood flow.

Initial intramuscular blood flow in the affected ECRB was lower compared with the unaffected muscle and anaerobic metabolism was recorded. The dif­ference in intramuscular blood flow between the affected and the unaffected arm was reduced after injection of botulinum toxin type A and muscle metabolism was aerobic. Perceived pain (VAS-score) was reduced and functional daily activity was improved, evaluated using the instrument Canadian Occupational Performance Measure (COMP) and the Disability of Arm, Shoulder and Hand instrument (DASH). Vascular reactivity during recovery after muscle contraction tended to be faster on the unaffected side than on the affected side. No difference in the post-occlusive reactive hyperaemia response between the affected and the unaffected ECRB was observed. The intramuscular pressure tended to be elevated in affected muscle.

In conclusion, decreased microcirculation and an anaerobic metabolism in ECRB may contribute to the symptoms in chronic lateral epicondylitis, which has not previously been showed. The impaired blood flow in the affected arm does not seem to be caused by impaired vascular reactivity but may partly be due to an elevated IMP probably due to an increased tension in the affected ECRB.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 59 p.
Series
Örebro Studies in Sport Sciences, ISSN 1654-7535 ; 7
Keyword
Lateral epicondylitis, ECRB, intramuscular microcirculation, intramuscular pressure, botulinum toxin, muscle metabolism, pain
National Category
Medical and Health Sciences
Research subject
Sports Science
Identifiers
urn:nbn:se:oru:diva-10892 (URN)978-91-7668-731-4 (ISBN)
Public defence
2010-09-03, HSP1, Prismahuset, Örebro universitet, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-06-07 Created: 2010-06-02 Last updated: 2017-10-18Bibliographically approved

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Oskarsson, Eva

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