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Lateral epicondylitis: intramuscular blood flow, pressure and metabolism in the ECRB muscle
Örebro University, School of Health and Medical Sciences. (Research in musculoskeletal health and disease)
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 [en]
Lateral epicondylitis, ECRB, intramuscular microcirculation, intramuscular pressure, botulinum toxin, muscle metabolism, pain
National Category
Medical and Health Sciences
Research subject
Sports Science
Identifiers
URN: urn:nbn:se:oru:diva-10892ISBN: 978-91-7668-731-4 (print)OAI: oai:DiVA.org:oru-10892DiVA: diva2:321759
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
List of papers
1. Decreased intramuscular blood flow in patients with lateral epicondylitis
Open this publication in new window or tab >>Decreased intramuscular blood flow in patients with lateral epicondylitis
2007 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 17, no 3, 211-215 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this pilot study was to investigate intramuscular microcirculation in extensor carpi radialis brevis (ECRB) in patients with lateral epicondylitis.

Ten patients with unilateral epicondylitis, mean duration of symptoms of 39 (12-96) months participated. The diagnosis was based on clinical examination and none was under treatment for the last 6 months. Isometric handgrip strength, 2-pinch grip strength and muscle strength during radial deviation and dorsal extension was determined. Functional perceived pain was evaluated by a modified BRS and perceived pain during contraction by VAS. Intramuscular and skin blood flow was recorded by a laser-Doppler flowmetry system technique (LDF) during stable temperature condition.

Intramuscular blood flow was significantly lower in the affected side, 22.7 ± 9.8 PU as compared to 35.2 ± 11.9 PU in the control side (P = 0.01). There was no difference in skin blood flow or temperature between affected and control side. A positive correlation was found between duration of symptoms and the difference in intramuscular blood flow between affected and control arm (r = 0.65, P = 0.06).

The present data indicate that decreased microcirculation and anaerobic metabolism in ECRB may contribute to the lateral epicondylitis symptoms.

Place, publisher, year, edition, pages
Blackwell Munksgaard, 2007
Keyword
microcirculation, skeletal muscle, laser Doppler flowmetry, lateral epicondylitis
National Category
Medical and Health Sciences Social Sciences Interdisciplinary Sport and Fitness Sciences
Research subject
Sports Science
Identifiers
urn:nbn:se:oru:diva-4036 (URN)10.1111/j.1600-0838.2006.00567.x (DOI)
Available from: 2007-09-21 Created: 2007-09-21 Last updated: 2017-10-18Bibliographically approved
2. Improved intramuscular blood flow and normalized metabolism in lateral epicondylitis after botulinum toxin treatment
Open this publication in new window or tab >>Improved intramuscular blood flow and normalized metabolism in lateral epicondylitis after botulinum toxin treatment
2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 3, 323-328 p.Article in journal (Refereed) Published
Abstract [en]

Lateral epicondylitis is a common cause of elbow pain, and decreased microcirculation in extensor carpi radialis brevis (ECRB) has recently been suggested to contribute to the symptoms. The purpose of this pilot study was to investigate the treatment response after injection of botulinum toxin type A. Ten patients with unilateral epicondylitis and decreased intramuscular blood flow in ECRB participated. Handgrip, 2-pinch grip and muscle strength during radial deviation and dorsal extension of the wrist were recorded. Perceived pain during contraction was evaluated with the Visual Analogue Scale (VAS) and function in daily activities was assessed using the Disability of Arm, Shoulder and Hand instrument (DASH) and the Canadian Occupational Performance Measure instrument (COPM). Intramuscular blood flow was recorded by laser Doppler flowmetry, and microdialysis was used to analyze muscle metabolism. The difference in intramuscular blood flow between the control and the affected side had decreased 3 and 12 months after treatment (P=0.03). Lactate concentration at the 12-month follow-up had decreased (P=0.02); perceived pain was reduced and function in daily activities had improved. Injection of botulinum toxin is an alternative treatment for epicondylitis. Symptom relief may be due to enhanced microcirculation causing an aerobic metabolism.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2009
National Category
Medical and Health Sciences Sport and Fitness Sciences
Research subject
Medicine; Sports Science
Identifiers
urn:nbn:se:oru:diva-4607 (URN)10.1111/j.1600-0838.2008.00804.x (DOI)000266431300004 ()18435689 (PubMedID)2-s2.0-66249083500 (Scopus ID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-10-18Bibliographically approved
3. Microvascular response in the ECRB muscle of patients with lateral epicondylitis
Open this publication in new window or tab >>Microvascular response in the ECRB muscle of patients with lateral epicondylitis
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The microvascular response in extensor carpi radialis brevis (ECRB) muscle was studied in thirteen patients with unilateral epicondylitis. At rest the intramuscular blood flow was significantly lower in the affected arm than in the unaffected (P = 0.006). During dorsal extension for 1 min at 40% maximal voluntary contraction (MVC) and 2 min at 20% MVC, blood flow increased significantly in both arms (P = 0.02). Microcirculation remained above resting level both 1 and 2 min after contraction at 40% MVC but was back to the precontraction level 2 min after contraction at 20 % MVC. The reactive hyperaemic response after occlusion of the brachial artery for 5 min, showed no significant difference between the arms. The reason for the hampered microcirculation in ECRB at rest does not seem to be due to a decreased ability of the vessel wall to dilate. Other plausible reasons merits further investigation.

Keyword
tennis elbow, laser Doppler flowmetry, muscle perfusion, static contraction, muscle force, post-occlusive reactive hyperaemia
National Category
Physiology Sport and Fitness Sciences
Research subject
Sports Science
Identifiers
urn:nbn:se:oru:diva-10889 (URN)
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2017-10-18Bibliographically approved
4. Intramuscular pressure in the ECRB muscle of patients with lateral epicondylitis
Open this publication in new window or tab >>Intramuscular pressure in the ECRB muscle of patients with lateral epicondylitis
Show others...
(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
Tennis elbow, intramuscular pressure, muscle perfusion, laser Doppler flowmetry, static contraction
National Category
Physiology
Research subject
Sports Science
Identifiers
urn:nbn:se:oru:diva-10891 (URN)
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2017-10-18Bibliographically approved

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