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Minimally invasive medicine learning materials

( Minimally invasive soft tissue limb section )

Foreword
Chronic pain caused by soft tissue injury is well known but difficult to cure symptoms. Its pathogenesis early in the twentieth
century, there are two different people understanding that soft tissue adhesions degeneration and bone changes
(osteoarthritis) doctrine of two kinds. The former, because of its pathogenesis is not yet sufficient knowledge nor have
reliable means of inspection and treatment, non-surgical therapy can not be treated radically. The surgical treatment of the
neck, waist, buttocks and other parts in a wide range of tingling, pain alone is a prominent lesion surgery release, back or leg
pain caused by neglect of other lesser extent, risk factors, and only after can reduce the symptoms. Therefore, the relevant
conduct from the soft tissue neck angle, low back pain research at a standstill. Since the latter can make use of imaging
studies to prove that the degeneration of bone tissue in the objective disc exists to make people more attention to bone
changes. Combined efforts of many scholars, so that surgery achieved a certain effect , so the " bone theory" This nerve root
compression caused by the mechanical theory of soft tissue pain caused widespread international attention , and in the
clinical occupy a major position.
With the continuous development of medicine, there have been many and "bone oppression theory" does not match the
phenomenon, such as clinical: Symptoms and hyperplasia site separation; asymptomatic lumbar disc, etc.; had so people will
look again doctrine came into the soft tissue. Early sixties declared sting proposed pathogenesis of pain and soft tissue
damage, "aseptic inflammatory lesions " Through extensive clinical practice . After years of clinical practice, has basically
become the theoretical basis of the doctrine of degeneration of soft tissue adhesions. The emergence of minimally invasive
therapy of traditional Chinese medicine has brought a new starting point for the treatment of soft tissue injury. It fills the
gaps in chronic soft tissue injury and surgical therapy in the treatment of African -surgical therapy between the soft tissue
damage in the clinical treatment of pain has made great development.
TCM minimally invasive soft tissue is soft tissue injury in many basic treatment, according to previous experience, the
method of treatment of soft tissue injuries summed up the combination of different characteristics of Western medicine and
traditional Chinese medicine. Which has a representative, such as release of sharp knife , blade needles, beryllium needles,
water knife , loosen the needle to release represented dial blunt needle , pine needle bars , round bladeless release pin and
flat blade release pin head no and another has developed a sharp release of both functional release another blunt needle
cannula release. Since the exact efficacy of minimally invasive medicine, medical workers and patients deeply loved. But it is
worth noting that the essence of traditional Chinese medicine minimally invasive therapy has evolved into a closed lysis.
However, currently engaged in the minimally invasive treatment of traditional Chinese medicine doctors are engaged in
most of the previous acupuncture, massage, physical therapy and other non- surgical therapy anesthesia medical workers,
which requires knowledge of the structure and minimally invasive work there are some differences. When the diagnosis of
doctors who still own the original theoretical knowledge to guide, doctors who treat the majority of its local anatomy and
physiology , pathology and surgery methods applied are not clear purpose , the negative impact on the clinical brought is
very serious . Therefore, the system of the present study is to improve the professional knowledge of the efficacy and
priority levels.

Minimally invasive techniques
Minimally invasive surgery is a new treatment techniques developed in the past 20 years, since the restrictions anatomical
structures and technical conditions, mainly used in the cervical and lumbar spine. With the maturing of the passage of time,
the accumulation of experience and clinical technology, its use will be more extensive. Commonly used techniques are: radio
frequency technology, intradiscal radiofrequency thermocoagulation by radiofrequency make the disc becomes tough
collagen fibers shrink, thus contributing to a tear or rupture of the intervertebral disc repair. Into the annulus intradiscal
electrothermal annuloplasty (IDET) and disc nucleus gasification angioplasty. Laser technology percutaneous laser disc
decompression (PLDD) was first proposed by the United States Choy (1984 ), the physical effects of nucleus pulposus tissue
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laser vaporization , cutting , freezing , so prominent intradiscal pressure drops, the annulus back reduced , thereby reducing
the spinal cord and nerve root irritation. This approach is most scholars agree that, because of trauma, maximize the
retention of the stability of the spine, the disadvantage is narrower indications, whether vaporization laser radiation heat
damage has been caused more concern. Ozone technology, surgery may produce ozone nucleus dissolution mechanism of
therapeutic action by the following: 1 oxidation proteoglycan, 2 destroy the nucleus pulposus, three anti-inflammatory and
analgesic . Ozone can seriously damage the structure of the nucleus pulposus and cartilage endplate but the spinal cord,
nerve roots and the smaller muscles affected. Although advantageous in that it has a strong oxidation no permanent
residue. Knife technique, knife technology is developed in the traditional Chinese medicine on the basis of a nine -pin
minimally invasive therapy, the use of special needles in the treatment area for cutting, separating, reduce tension,
decompression. For high stress points around the spine have a good effect, because it is through the method of skin closure
release, it requires the operator to grasp a good knowledge of anatomy and structural level, and the intensity of the
practices, stability, precision, there are very strict requirements.
A minimally invasive lysis: for superficial soft tissue scar adhesions diseases, such as scar formation after traumatic
hemorrhage, wound partial adhesions after surgery. Commonly used needle with knife, water, knife, blade needle.
Depending on the size of scar formation , high stress levels using a simple cut fiber , "Z" shaped cut sneak peeling ;
2 of minimally invasive surgery to reduce tension : pain point for soft tissue local high tension diseases, such as fascial
compartment pressure, high- stress stimulation of local fascia caused by long-term high- tension formed cord , nodule or
mass. Commonly used needle with beryllium needles, blades needles, crochet and so on. Usually without anesthesia , in the
fascia prick from 1 to 3 points can be achieved to reduce tension decompression therapy;
3 minimally invasive orthopedic surgery: For a number of conditions to allow the deformity correction, mainly through
dynamic balance and static balance in two ways;
4 minimally invasive dissection: for blocking deep soft tissue disease;
5 minimally invasive stimulation: for the system to adjust the treatment of diseases , such as bladder full sun by stimulating
acupoints back treatment of cervical vertigo, ridge -derived indigestion, irritable bowel syndrome and other endogenous
spinal visceral surface correlation disease;
6 minimally invasive suturing: Some percutaneous arthroscopic suture techniques and suture technique carried out
gradually in recent years to promote the application. Such as percutaneous suture acromioclavicular joint dislocation,
arthroscopic suture cruciate ligament injury.

Directory
The first chapter Basics
A soft tissue injury .......................................... ( 5 )
2 pathological basis of soft tissue injury .......................................................... ( 6 )
3 clinical application of minimally invasive soft tissue ............................................................ ( 7 )
4 soft tissue minimally invasive surgery ........................................................................ ( 7 )
5 minimally invasive soft tissue and relieve the high stress fibers ..................................................................... ( 10 )
6 minimally invasive soft tissue and bone fiber tube high-pressure ..................................................................... ( 11 )
The second chapter in the monograph
1 , supraspinatus tendinitis ........................................................................ ( 14 )
2 , subacromial bursitis ........................................................................ ( 15 )
3 , biceps tenosynovitis ............................................................... ( 17 )
4 , supinator syndrome ........................................................................ ( 18 )
5 , total humeral epicondyle extensor tendinitis .............................................................................. ( 20 )
6 , pronator teres release ( volar forearm interosseous nerve entrapment syndrome ) ................................................ ( 22 )
7 , narrow radial styloid tenosynovitis .............................................................................. ( 23 )
8 , transverse carpal ligament contracture ........................................................................ ( 25 )
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9 , stenosing flexor tendon sheath ............................................................... ( 27 )
10 , ischial tuberosity bursitis ............................................................... ( 28 )
11 , gluteus greater trochanter bursitis ........................................................................... ( 29 )
12 , popliteal muscle strain .......................................... ( 31 )
13 , knee medial collateral ligament release ............................................................... ( 32 )
14 , knee ligament release ............................................................... ( 34 )
15 , knee synovitis ............................................................... ( 35 )
16 , the common peroneal nerve fiber tubes release .............................................................................. ( 37 )
17 , the first release from the ligament ( ankle sprain ) ..................................................................... ( 38 )
18 , tarsal tunnel syndrome ........................................................................ ( 39 )
19 , under the Achilles tendon bursitis ........................................................................ ( 41 )
20 , foot pain ........................................................................ ( 42 )
Appendix
Common limbs tenderness ........................................................................ ( 44 )

The first chapter Basics
A soft tissue injury
In addition to the human bones, organs and other tissues outside the sensory organs are soft tissue. Soft tissue injury
disease refers to the skin, muscles, tendons, tendon sheaths, ligaments, fascia, synovium, synovial, spinal cord, peripheral
nerves, blood vessels and other diseases due to the injury or chronic strain occurred. Pain caused by soft tissue injury are
well known worldwide, but is difficult to cure diseases. In ancient Greece, people have a soft tissue injury awareness, hippo
Socrates once said, "to treat pain as geniuses ." Ancient Western visible damage to soft tissue pain caused by attention, and
recognizing the complex and difficult treatment.
The first is Hegmar.Freibeg.ober.Steindier.GrateCopemar, Strong and Japan as the representative of the mountains inland
sea of soft tissue : For chronic soft tissue injury caused pain pathogenesis , early in the twentieth century on the existence of
two different points of view adhesions degeneration is the cause of pain. ( Which in 1843 Fororiep that " rheumatism " in
patients with muscle pain induration in 1951 , Lewellym and Jones co-wrote " fibrositis " (Fibrositis) a book that fibromyalgia
is pain in the muscles and bones of the most common causes . ) the second is the thirties Williem.Mixter, Verbiert fifties
considered as the representative of bone changes ( osteoarthritis ) is causing the pathogenesis of pain. Since then the
former course of the pathogenesis of soft tissue injury and did not have enough knowledge , reliable screening methods and
treatments have not mastered ; non-surgical acute phase heat, physical therapy , massage therapy , such as the partial
closure of up to a certain therapeutic purposes, but the pathological after changing the development of tissue fibrosis and
scar contracture formation to the above treatment can not be treated fundamentally recurrent symptoms . The surgery at
the waist, hip pain part in a wide range of hair , pain alone a prominent lesion surgery release , ignoring the other causes of
low back pain to a lesser extent risk factors, can only alleviate the symptoms of postoperative and no cure , and the relapse
rate is high , so after that, on making back pain or low back pain from the perspective of the treatment of soft tissue
coverage less and less. Research increasingly stagnant , "soft tissue Doctrine" close to being abandoned. Since the latter can
make use of X -ray, myelography , especially seven , eighty years later , the universal application of CT and MRI scans ,
objectively prove bone tissue degeneration , disc herniation exist , so that people are more more attention to bone changes ,
combined with many scholars in anatomy and physiology , diagnostic techniques and other aspects of the surgical procedure
done a lot of research , so that surgery achieved a certain effect , so the " bone theory" this nerve root compression caused
by mechanical theory of pain caused widespread international attention . From the mid-twentieth century has been in
clinical occupy a major position.
With the continuous development of medicine, there have been many and " bone theory" does not match the phenomenon,
such as clinical : Symptoms and hyperplasia site separation ; asymptomatic lumbar disc ; many spinal stenosis test results,
from objective indicators radiological point of view, has been more severe spinal cord compression, but the lack of any
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clinical manifestations of patients ; portion of objective indicators show the spinal cord, nerve roots oppressed patients after
non-surgical treatment , the symptoms under control, but the spinal cord , nerve root compression phenomenon still exists ;
many cases still postoperative pain, pain reoperation also found no reason , even if the implementation of spinal fusion
surgery , but also can not relieve persistent pain . Therefore , non-surgical therapy in the last ten years more and more
attention by people . Such as: anesthetic nerve block therapy to treat soft tissue pain ; to Feng -day treatment methods
represent promising . Clinically have achieved a certain effect . Early sixties declared sting proposed pathogenesis of soft
tissue damage through a lot of pain in clinical practice known as " aseptic inflammatory lesions ." After years of clinical
practice , has become one of the basic theoretical foundation of non -surgical treatment of soft tissue injury .
2 aseptic inflammation is the pathological basis of soft tissue injury
When the body is compromised , the ability to maintain its survival with two , one for self-defense capability , one for repair
capacity . Inflammation is the most basic form of self-defense , which, blood vessels, nerves reaction has a close relationship
. Inflammation and repair often simultaneously.
Inflammation is a nonspecific defense reaction of the body to the damage occurring factors , which aims to eliminate the
limitations or exclusion of foreign pathogenic factor and lethal cell injury when the body is compromised. Inflammation in
the blood vessel during the reaction is most sensitive , the body is stimulated, venules and capillaries change the
permeability of the wall , so that some of the components within the plasma extravasation , the dilution factor of
inflammation , to reduce or eliminate its destructive power . While pumping blood antibodies , inflammatory mediators ,
conditioning factors, such as resistance against Lysozyme matter .
Aseptic inflammatory mediators occupies a very important position in the inflammatory response . Although a variety of
media , from its source can be divided into plasma , such as hormone bradykinin , complement and coagulation - soluble
fiber system ; derived cells such as histamine , 5 - hydroxytryptamine, allergic reactions and chronic substance , allergic
eosinophilic leukocyte chemotactic factors , prostaglandins, lysosomes, lymphokines like.
According to current knowledge , almost all of these inflammatory mediators under normal conditions or in the form of a
precursor , or in the inactive form. When the body is damaged or compromised, they can be quickly transformed into a
strong medium vigor , its main role is to influence vasodilator prostaglandins , increased vascular permeability mainly
histamine , 5 - hydroxytryptamine, complement C3a and bradykinin ; there leukocyte chemotaxis mainly complement
fragments , C3a, C5a , etc. ; cause fever and heat source for endogenous prostaglandins ; cause pain mainly bradykinin and
prostaglandins ; major cause tissue damage is derived from the neutrophils and macrophages lysosomal enzymes. Although
they played a very strong effect , but the body and quickly generate controlled substances , and timely process to limit
media or excessive reaction , avoid excessive damage.
Pathogenesis of soft tissue injury is damage to the body by some kind of stimulation , resulting in barriers to their
surrounding tissue blood circulation , increased capillary permeability , inflammation, pain caused by substances leaking,
stimulating the surrounding tissue to produce symptoms , the body appeared protective tension, more heavy blood
circulation disorder that metabolites and inflammatory mediators can not be excreted as soon as possible , over time, the
formation of adhesions between organizations , degeneration, fibrosis, and eventually replaced by scar tissue .

3 Clinical application of minimally invasive soft tissue
Minimally invasive soft tissue using some means or methods of organization will loosen stuck together , to restore the
original function . This therapy in many of our subjects had reflected. As in cardiothoracic surgery, chronic constrictive
pericarditis , the pathological changes are visceral and parietal pericardium thickening due to chronic inflammatory changes
, fibrous scar tissue to form a hard , parietal and visceral pericardium sticking to each other , the pericardial cavity disappears
, cardiac scar tissue to be bound by the long-term , resulting in a series of symptoms. Treatment is surgical excision of
pericardial thickening of fibrous tissue , so that the heart is bound to restore the original function ; obstruction of adhesions
in abdominal surgery is the most common complication of abdominal surgery , surgery is required when necessary loosen
adhesions between organizations ; bone surgery because of lower extremity fractures long brake , knee injury or
inflammation of the knee sliding device adhesions, contracture , fibrosis caused by stiff knee adhesive shall adopt the knee
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loose adhesions solution treatment ; tendon adhesions and scar tissue trauma caused by lumbar disc herniation with nerve
root surrounding tissue lysis of adhesions , etc. are required to use different forms of methods to achieve relieve symptoms
caused by the purpose ; gluteal muscle contracture is a large rotor upper gluteus medius only point cut part of the muscle
and tendon tension is too high fiber and achieve their goals. As can be seen above , minimally invasive surgical techniques in
disciplines has occupied a certain position . Another clinical physiotherapy, acupuncture, massage , partial closure , nerve
blocks and other non -surgical therapy treatment mechanism is relaxing its local tissue and reach the goal .
4 soft tissue minimally invasive surgery
Minimally invasive surgery is the use of soft tissue along the edge ( or no edge ) of the needle directly to the lesion, its
organization mechanical release, improving its pathological changes, a treatment to restore the original function of the
organization . Soft tissue is minimally invasive modern medicine, human anatomy , physiology , pathology , biomechanics
and minimally invasive surgical techniques based on sets of traditional medicine acupuncture techniques featured in one of
the modern medical technology. Use direct lesion of the needle blade , the treatments alter the pathological changes in their
muscles, tendons, fascia , ligaments, and other soft tissue synovial restore the normal function of the implicated parts and
reach therapeutic purposes.
First, a lifting mechanism of the high stress fiber: normal development of muscles pulling the bone is important, the size and
direction of the existing bone morphology and its components are related to stress . Due to continuous repeated static
force, muscle or tendon fibers to make long-term state of tension , acting on the bone surface stress generated by the
ending of " osteoarthritis ." Minimally invasive soft tissue can be cut beyond the bone surface or mitigate these high- stress
fibers , change the direction and size of its force in parallel to achieve the purpose of lifting the cause . 2 fiber tube high
pressure to reduce bone : bone fiber tubes , pipes from the bone tissue and the fibers on the rampage , said fibrous tubes .
Their bone structure can be divided into fiber tubes , joints and muscle fiber tube ( or tendon ) vascular three. It may have
associated with blood vessels and nerves and tendons and other tissues through . Mainly from the protection and the fixed
tube tissue. For some reason caused by increased pressure within the tube when the tube is irritation or compression of the
contents produce symptoms . Minimally invasive soft tissue contractures can release tension by fibrous tissue tube , inner
tube to relieve pressure, to achieve the purpose relieve symptoms .
3 . Less pressure within the organization : from trauma or chronic fatigue so that local tissue metabolism disorder caused by
compartment syndrome bone tendons , joint capsule , bursa , or increased pressure within the bone appeared a series of
clinical manifestations, can cut through local tissue lysis needle If the joint capsule , bursa , myofascial 's wall to relieve
pressure within the organization , improve blood circulation local organizations to restore local tissue metabolic imbalance
phenomenon , to reduce or relieve symptoms purposes. 4 lifting adhesions between organizations : due to trauma , chronic
fatigue or surgery, did not receive timely treatment, the local adhesion of muscle fiber and its surrounding tissue occurs ,
such as: between the muscles and the muscles between the muscle and bone , skin and tissue adhesion between the clinical
symptoms affect normal tissue function appears. By loosening reduce tissue adhesion between , to restore normal
physiological state.
5. Improve local organizations aseptic inflammation : the long-term due to trauma or chronic strain , causing local tissue
blood circulation is blocked, increased capillary permeability , inflammatory pain caused by substances accumulate , forming
a partial aseptic inflammation and pain symptoms. Minimally invasive soft tissue can improve local tissue metabolism and
blood circulation , reduce pain caused by substances produced to promote the absorption of aseptic inflammation . Second,
the indications
Adapt to any part of the body due to the soft tissue injury or chronic strain, and local organizations have organic changes (
ie, the formation of adhesions between the soft tissue , fibrous contracture, the pressure increased, wall thickening and
other pathological changes , invalid or symptoms of repeated non-surgical therapy attack ) clinical symptoms caused . 1 neck
soft tissue injury caused by back pain, nerve root of some neck muscles tense as cervical dislocation caused by the
emergence of the vertebral artery and clinical manifestations of sympathetic cervical spondylosis , back of the neck by
loosening tight muscles contracture , coupled with the appropriate traction bonesetting treatment.
2 . Third lumbar transverse process syndrome, heel spurs , knee eminence between hyperplasia and other diseases.
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3 elbows, ankles pipe, tube feet , carpal tunnel and other entrapment caused by clinical syndrome, migraine headaches ,
tenosynovitis , shoulder and neck, lumbar nerve root entrapment in different parts of the surrounding tissue or being
squeezed due to related illness.
4 ganglion cyst , joint caused by increased pressure within the joint pain, synovitis, bursitis, muscle fasciitis caused by various
parts of the body , such as the ischial tuberosity bursitis , calcaneal tuberosity bursitis and so on. 5 by trauma , strain, local
tissue caused by post-operative adhesions , scar . Such as tennis elbow, levator scapula injuries, and medical sequelae of
bone and joint diseases ( arthritis, ankylosing spondylitis, gout , osteoarthritis avascular necrosis, fibrous joints stiff limbs,
etc.) .
Third, contraindications
A fever, infection patients.
2 hemophilia and bleeding tendencies or clotting mechanism .
3 exacerbation of severe visceral lesions , diabetes, mental illness .
4 physical weakness, substandard authors .
5 treatments site infection or redness, swelling, heat, pain, abscess . 6 diagnosis is not clear, cross-sectional anatomical
structures ( congenital deformity or after surgery ) were the treatments of complex parts , pathological changes and the
Board . 7 treatments have important parts of neighboring organs and can not be protector.
IV Treatment
Classification of soft tissue : spinal ( 10% ) ( discectomy surgery , interventional , RF ) ? ? ?
A ) the manner and needle treatments
A sharp separation : release pin flat blade , helical blade release pin ( blade , scissors, periosteal stripping )
Needle acupuncture knife , beryllium needles, pine needles, needle blade , long circular needle , needle spatula , new nine -
pin , water knife , loosen the needle , pick needle , giant crochet , Xiaokuan needle teeth crochet , needle mirror , lily Stubbs
barrier , improved knife
2 blunt dissection : Round release pin , flat head release pin ( knife, forceps and fingers separated ) dial needles, pine needle
bars , floating -pin, flat head release pin , round needles release
3 needle cannula release : You can select the needle core be sharp or blunt treatments according to different needs
Second ) surgery in patients with orthostatic Step 1 : Depending on the way the lesion and the treatments can take a
different position to operate. 2 needle positions : lesion treatments and techniques to choose the right part based on , there
must be an important part of the organization in favor clued as the needle point .
Needle 3 : Using both fast and slow method, namely the needle into the skin and quickly to relieve pain, when the
subcutaneous needle blade , you need to slow the needle tip can shake around when necessary to stimulate more sensitive
tissue ( nerves, blood vessels, etc. ) to generate avoidance reflex action to reduce the unnecessary tissue damage.
4-pin edge direction : The different levels of the various parts , in order to avoid important organization in accordance with
the principle of the needle blade and tissue to the direction parallel to the order of the spinal cord, nerve roots, nerve,
artery, vein , muscle fiber.
Three ) a longitudinal surgical dredge method : pin edge treatments and tissue fibers parallel to the direction , the adhesion
between the organization and the organization 's release , mainly adapted to adhesions organizations. 2 rampant lysis
method: vertical pin edge treatments and tissue fiber parts , cut tight muscle or tendon fibers. Mainly adapted to relieve the
high pressure and high fiber tube bone stress fibrous tissue .
3 cutting method : pin edge of the lesion, selected according to the size of the scar tissue adhesions in different directions
and depth of the line cutting practices in order to reduce the size and extent of tissue adhesion , and promote local lesions
suction change . 4 transparent stripping method : needle up between the organization and the organization , the use of
needle separation of adhesions between the two organizations . This method is mainly suitable for a larger degree of
adhesion area but not severe tissue adhesions ( also known as blunt dissection ) .

5 perforation decompression method: the needle edge of the lesion, the lesion can be punctured or myofascial wall , the
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wall can be expanded if necessary, incision , accelerate metabolism and absorption of organizations. This method is used for
intracapsular pressure and aseptic inflammation . D) Notes 1 . Soft tissue minimally invasive surgery with the continuous
development of its basic theory and technology research , the role of acupuncture almost to lose their function , and was
replaced by closed surgical technique . Everything so the treatment room should have required the operating room and the
surgeon must master strict surgical aseptic technique .
2 soft tissue from acupuncture , although minimally invasive surgery , but already have a functional surgery , patients who
have skills in addition to acupuncture practices , but also must be familiar with modern medical knowledge of local human
anatomy , physiology, pathology and histology , must have a certain surgical techniques and imaging foundation , especially
orthopedic surgery basic knowledge and techniques.
3 For soft tissue invasive , the treatments in , the doctor in addition to their own have the medical knowledge and surgical
experience , patient treatments parts feel a doctor treatments ways a very important indicator , if required to successfully
complete the surgery , doctors between the patients with essential .
4 . Precise soft tissue biggest feature of minimally invasive surgery , treatments that doctors must confirm the diagnosis ,
clear the site , a clear pathological changes, specifically the treatments , explicit avoidance method and the adjacent key
organizations to achieve the purpose of the treatments , except otherwise affect its therapeutic effect, will cause
unnecessary damage , worse postoperative complications.
5 minimally invasive soft tissue and reduce the high stress fibers
Muscles pulling on the normal development of bones is important. 1892 Julius Wolf (Julius wolff 1836 - 1902 year) made this
classic formulation , forming the famous Wolf 's Law: "Every change in bone morphology and function , or just each function
is a variation on them, inevitably followed to determine the cause of the external morphology of secondary bone change .
these changes are carried out in accordance with the law of the digital . " Bosite (Basset) Wolff 's law in modern language
will change as follows : " the existing bone morphology and composition occur automatically Fangxiang settle or
replacement work pressure along their quality based work pressure. the size of the increase or decrease in reflex . "
On the occurrence of lumbar transverse process is highlighted by the pedicle and lamina juncture outward , can be seen
from the transverse abdominal muscle ossification made on the fascia, as the ribbon , thin , round and abdominal wall fit .
First to observe differences in children and adults lumbar transverse lumbar transverse process between the five children of
lumbar transverse process is basically the same , but adult lumbar transverse process , waist three longest , followed by back
two, four , waist a five shortest . Well, from the physiological and anatomical point of view, the third lumbar transverse
process , unlike the first and second lumbar transverse ribs protection , but also from the fourth and fifth lumbar transverse
process has ilium protection. In the tip of the third lumbar transverse process of adhering closely with many activities and
trunk muscles and fascia , especially the middle of the back fascia fibers gradually gathered outside to inside cross into
bundles attached to the tip of the third lumbar transverse . It was palpable in patients using finger -touch fascia and muscle
fibers attached to the tip of the transverse process , feel fibers such as taut bowstring . So according to the law of
development of lumbar transverse process , anatomy and physiology Woiff law, should be considered adult third lumbar
transverse process is too long because of the fascia and muscle attached to the role of high stress fiber tip formed .
Since plantar fascia calcaneal tuberosity , before the line is divided into five beams arrived at the plantar pad. Plantar pad
proximal phalanx firmly fixed on the bottom , and continue with the department periosteum. In normal walking , the body
forward, toe dorsiflexion , plantar proximal phalanx plantar fascia stretch across the metatarsal heads , because this action
plantar fascia easy to make in the beginning part of the stretch excessive stress , then the tendon the beginning part of the
film caused by osteoarthritis , the formation of bone spurs .
How-ever, for such clinical symptoms caused due to high stress fibers , often surgical resection , such as the third lumbar
transverse process syndrome after repeated non- surgical treatment of poor persons , the use of a surgical removal of the
third lumbar transverse process -2cm, in order to reduce high stress fibers and reach the goal . Now release the needle
through the release beyond the tip of the transverse process of high stress fibers , changing the tensile stress beyond the
size and location of the bone surface , reaching the same purpose and effect of surgery .
6 minimally invasive soft tissue and bone fiber tube high-pressure
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With the continuous development of soft tissue science, " fibrous tubes " More and more appear in various professional
magazines , people have recognized the " bone fiber tubes " This particular anatomical structure of the human soft tissue
injury there is a very close relationships. Thus structural changes caused by entrapment syndrome is also not uncommon .
Fibrous tunnel tube is composed of bone tissue and was hung on the fiber. It can be through the nerves , blood vessels,
tendons and other tissues. Exists in many parts of the body . Its main function is to fix or change a direction of movement of
the tube contents , so that they take the trajectory at a fixed or moving lines , some fibrous tube also has the role of the
pulley .
First, the organizational structure of fibrous tubes
From the organizational structure of the bone fiber tubes can be divided into the bone fiber tubes , fiber tube joints , muscle
( or tendon ) fiber tube categories.
A bone fiber tubes : the bone tissue and the crossing of the fibers. If located in the lumbar facet after the outer portion of
the bone , the upper wall of the mastoid , deputy sudden inferior wall , medial wall of the former vice conflict between milk
ditch outside wall of the mastoid collateral ligament milk vice ditch fiber tube there lumbar medial branch nerve branch
through ; under the line of the sternocleidomastoid and trapezius muscle tendon and tendon in the posterior occipital bone
composition , there is a large pillow , the small nerves, blood vessels and the posterior occipital occipital lymph through the
tendon bow bone fiber tube ; the thoracic spine side ditch cross fiber to its previous configuration, there thoracic spinal
nerve after thoracic spinal nerve medial branch through the medial branch bone fiber tubes ; the greater sciatic foramen
and sacrospinous ligaments , sciatic nerve , hips moving , veins, bone piriformis and sciatic foramen obturator muscle fibers
through the tube and so on.
Two fiber tube joint : the joint and fiber ( ligaments ) consisting pipe. Such as carpal tunnel : the carpal bones and the
transverse carpal ligament on both sides composed of fibrous bone tunnel deep flexor tendon , flexor hallucis longus tendon
and the median nerve , which refers to the superficial flexor tendon by means ; ankle tube: Located below the medial
malleolus of the tibia by the flexor retinaculum , the medial malleolus , talus , calcaneus , triangular ligament and tendon
surrounded organize the order in which they are arranged from front to back through the tendon , flexor digitorum longus
tendon , posterior tibial artery, posterior tibial vein and the posterior tibial tibial nerve , flexor hallucis longus tendon ;
lumbar nerve branch bone fiber tube : Located between the lumbar spinal canal after outward , toward the front to the rear
, and the direction perpendicular to the intervertebral tube , the inner sidewall of the lower lumbar facet bone surface and
the outer edge of the transverse process between the upper bound for the transverse ligament between sickle edge , the
upper edge of the lower bound of the transverse process of the lower vertebra , lateral border of the medial border
between transverse ligament , there dorsal branch and with line blood vessels through .
3 muscle or tendon fiber tube ( hole ) : the muscle or tendon fibers fiber tube . Supinator tube: at the top of the back of the
forearm , the supinator shallow depth of two enclosed rear wall of muscle fibers deep near the ending point of the
composition, the anterior wall of muscle fibers shallow or and tendon fibers , within which there is radial nerve through
deep branch ; lateral cutaneous nerve of arm piercing hole : arm lateral cutaneous nerve from the bottom of the radial
nerve in the deltoid point ended flat , wear triceps lateral head to the outside of the arm muscles and triceps brachialis
interval between , on the outside of the arm from the lower third of the septum piercing the deep fascia distributed in the
outer side of the lower arm ; peroneal nerve behind the knee walking through the lateral sulcus , peroneus longus and
peroneus longus muscle fibers from the fibular head and neck starting formed arch ; atlantooccipital after piercing the fascia
hole occipital nerve atlantooccipital film is like.
Two bone fiber tube contents
Most of the bone through the nerve fiber tube and accompanying vessels: such as foot tube , the dorsal branch fibrous
tubes , elbows , etc. The contents of a single organizer mostly tendon , tendon sheath , such as the palm side of the finger
and phalangeal joint board consisting of palm fiber tube flexor tendon bone through ; humeral segment large , small nodules
on the transverse ligament ditch its composition , there fibrous long head of biceps tendon through the tube ; contents of
the more complex , such as carpal bone fiber tube , in addition to nine tendons and a nerve by outside , in some cases , also
lumbrical tube ; nerve within the tarsal tunnel , tendons , blood vessels through ; occipital bone fiber tubes have nerves,
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blood vessels and lymph nodes.
Three special structure of fibrous tube - fibrous septa
In addition to the main tube of fibrous structure composed of fiber tube part also has a memory in the fiber compartment ,
its purpose is to isolate the tube within the tissue . If the tube is emitted from the ankle to the deep flexor support surface
with three fibrous septa that form four fascia sheath ankle , pipe contents from different fascia sheath through ; within the
intervertebral canal , not only through the nerve root , intervertebral arterial and venous blood vessels and connective tissue
protection , there is also the presence of fibrous septa . In the lower part of the intervertebral canal mouth with a fibrous
septa , even in the intervertebral disc and facet joint capsule, the intervertebral canal mouth into the upper and lower tubes,
the tube through the nerve roots, branches and lumbar intervertebral spinal artery vein the branch , under the down tube
through the intervertebral vein branch , otherwise the upper mouth of the intervertebral canal outside a fibrous septum,
between the intervertebral disc and connected to the transverse and transverse ligament , the mouth is divided into upper
and lower two holes , lumbar nerve through the hole from under the root .
Fourth, clinical research
Through clinical observation, fibrous activities of high frequency content of the tube , pipe joints and bone fiber contents can
lead to complicated by entrapment syndrome. If the palm side of the knuckles by the phalanx volar plate and tough
connective tissue ( finger flexor tendon sheath ) jointly surrounded by bony fibers pipes, through the flexor tendon , and its
function is to protect and support the flexor tendon role in preventing muscle contraction when , a " bow hand" tendon pull
the finger joints . From the viewpoint of biomechanical point of view, the tendon sheath to provide a mechanical sliding
fulcrum , changing the direction of the force , which will help play a tendon sliding effect. Under normal circumstances, the
wall is smooth , the inner tube sliding in the tendons without any resistance. But when local damage , or systemic diseases,
such as : When endocrine disorders, fibrous stenosis , so that the movement of the tendon is limited clinical symptoms ,
activity limitation . Common trigger finger , biceps tendinitis and carpal tunnel syndrome, etc, this physiological and
pathological changes in the relevant structures . Fiber tube joints : the human anatomy in many and more common clinical .
People have also had an earlier understanding. Such as carpal tunnel syndrome, cubital tunnel syndrome , tarsal tunnel
syndrome. Reasons other than fiber tube joint fracture more easily wound injury , the anatomical structure of great
significance . On the one hand bone fiber tube is composed of joints , joint surrounding tissue, increased pressure within the
pipe joints and increased contents, ganglion cyst , etc. , can lead to increased pressure within the fiber tube . On the other
hand , if uncoordinated movement in the joints , the shape and volume of the affected bone fiber tube , and secondly, the
tendon fiber tube joints mostly passed . Tendon movement also provides an important factor for the pathological damage of
the pipe. The contents of the tube as the posterior complex fibrous tendinous arch tube , except the occipital inner large and
small nerve and occipital artery , the fiber tube within 2-3 tablets are also present lymph nodes in the normal case, pressure
without any effect , occurs when the body's inner tube systemic diseases , such as influenza, female menstrual and other
reactive lymph nodes can lead to disease , posterior bone fiber tubes due to enlarged lymph nodes , so that increased
pressure within the tube , there occipital small nerve compression clinical manifestations, some patients also appear
occipital artery compression performance , such as the occipital tenderness and so on.
Fifth, the treatment of bone fibrous tunnel syndrome
In the past to use more heat, physical therapy and other methods to partial closure in clinical achieved a certain effect. But
for thickening or fibrous contracture patients with pathological changes , due to ineffective therapy more often requires the
use of surgical resection of fibrous tissue contractures thickening of purpose. Because of the many problems of surgery,
most patients is not easy to accept. By loosening the needle with a blade , needle blade through direct skin tight fibrous
tissue contracture , closed -type fibrous tissue contracture its mechanical release , in reducing bone fiber tube high-pressure
, they also will not lead to a result of openness scar after surgery brings , to the physiological recovery .
Through the bone fiber tube structure, contents and function analysis, summed prone parts of clinical symptoms , help
physicians in clinical diagnosis , more accurate diagnosis of the site of the disease, improve diagnosis and treatment effects
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The first chapter Basics
A soft tissue injury
In addition to the human bones, organs and other tissues outside the sensory organs are soft tissue. Soft tissue injury
disease refers to the skin, muscles, tendons, tendon sheaths, ligaments, fascia, synovium, synovial, spinal cord, peripheral
nerves, blood vessels and other diseases due to the injury or chronic strain occurred. Pain caused by soft tissue injury are
well known worldwide, but is difficult to cure diseases. In ancient Greece, people have a soft tissue injury awareness, hippo
Socrates once said, "to treat pain as geniuses." Ancient Western visible damage to soft tissue pain caused by attention, and
recognizing the complex and difficult treatment.
The first is Hegmar.Freibeg.ober.Steindier.GrateCopemar, Strong and Japan as the representative of the mountains inland
sea of soft tissue: For chronic soft tissue injury caused pain pathogenesis, early in the twentieth century on the existence of
two different points of view adhesions degeneration is the cause of pain. (Which in 1843 Fororiep that "rheumatism" in
patients with muscle pain induration in 1951, Lewellym and Jones co-wrote "fibrositis" (Fibrositis) a book that fibromyalgia is
pain in the muscles and bones of the most common causes .) The second is the thirties Williem.Mixter, Verbiert fifties
considered as the representative of bone changes (osteoarthritis) is causing the pathogenesis of pain. Since then the former
course of the pathogenesis of soft tissue injury and did not have enough knowledge, reliable screening methods and
treatments have not mastered; non-surgical acute phase heat, physical therapy, massage therapy, such as the partial closure
of up to a certain therapeutic purposes, but the pathological After changing the development of tissue fibrosis and scar
contracture formation to the above treatment can not be treated fundamentally recurrent symptoms. The surgery at the
waist, hip pain part in a wide range of hair, pain alone a prominent lesion surgery release, ignoring the other causes of low
back pain to a lesser extent risk factors, can only alleviate the symptoms of postoperative And no cure, and the relapse rate
is high, so after that, on making back pain or low back pain from the perspective of the treatment of soft tissue coverage less
and less. Research increasingly stagnant, "soft tissue Doctrine" close to being abandoned. Since the latter can make use of X-
ray, myelography, especially seven, eighty years later, the universal application of CT and MRI scans, objectively prove bone
tissue degeneration, disc herniation exist, so that people are more more attention to bone changes, combined with many
scholars in anatomy and physiology, diagnostic techniques and other aspects of the surgical procedure done a lot of
research, so that surgery achieved a certain effect, so the "bone theory" This nerve root compression caused by mechanical
theory of pain caused widespread international attention. From the mid-twentieth century has been in clinical occupy a
major position.
With the continuous development of medicine, there have been many and "bone theory" does not match the phenomenon,
such as clinical: Symptoms and hyperplasia site separation; asymptomatic lumbar disc; many spinal stenosis test results,
from objective indicators radiological point of view, has been more severe spinal cord compression, but the lack of any
clinical manifestations of patients; portion of objective indicators show the spinal cord, nerve roots oppressed patients after
non-surgical treatment, the symptoms under control, but the spinal cord , nerve root compression phenomenon still exists;
many cases still postoperative pain, pain reoperation also found no reason, even if the implementation of spinal fusion
surgery, but also can not relieve persistent pain. Therefore, non-surgical therapy in the last ten years more and more
attention by people. Such as: anesthetic nerve block therapy to treat soft tissue pain; to Feng-day treatment methods
represent promising. Clinically have achieved a certain effect. Early sixties declared sting proposed pathogenesis of soft
tissue damage through a lot of pain in clinical practice known as "aseptic inflammatory lesions." After years of clinical
practice, has become one of the basic theoretical foundation of non-surgical treatment of soft tissue injury.
2 aseptic inflammation is the pathological basis of soft tissue injury
When the body is compromised, the ability to maintain its survival with two, one for self-defense capability, one for repair
capacity. Inflammation is the most basic form of self-defense, which, blood vessels, nerves reaction has a close relationship.
Inflammation and repair often simultaneously.
Inflammation is a nonspecific defense reaction of the body to the damage occurring factors, which aims to eliminate the
limitations or exclusion of foreign pathogenic factor and lethal cell injury when the body is compromised. Inflammation in
the blood vessel during the reaction is most sensitive, the body is stimulated, venules and capillaries change the
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permeability of the wall, so that some of the components within the plasma extravasation, the dilution factor of
inflammation, to reduce or eliminate its destructive power. While pumping blood antibodies, inflammatory mediators,
conditioning factors, such as resistance against Lysozyme matter.
Aseptic inflammatory mediators occupies a very important position in the inflammatory response. Although a variety of
media, from its source can be divided into plasma, such as hormone bradykinin, complement and coagulation - soluble fiber
system; derived cells such as histamine, 5 - hydroxytryptamine, allergic reactions and chronic substance, allergic eosinophilic
leukocyte chemotactic factors, prostaglandins, lysosomes, lymphokines like.
According to current knowledge, almost all of these inflammatory mediators under normal conditions or in the form of a
precursor, or in the inactive form. When the body is damaged or compromised, they can be quickly transformed into a
strong medium vigor, its main role is to influence vasodilator prostaglandins, increased vascular permeability mainly
histamine, 5 - hydroxytryptamine, complement C3a and bradykinin; There leukocyte chemotaxis mainly complement
fragments, C3a, C5a, etc.; cause fever and heat source for endogenous prostaglandins; cause pain mainly bradykinin and
prostaglandins; major cause tissue damage is derived from the neutrophils and macrophages lysosomal enzymes. Although
they played a very strong effect, but the body and quickly generate controlled substances, and timely process to limit media
or excessive reaction, avoid excessive damage.
Pathogenesis of soft tissue injury is damage to the body by some kind of stimulation, resulting in barriers to their
surrounding tissue blood circulation, increased capillary permeability, inflammation, pain caused by substances leaking,
stimulating the surrounding tissue to produce symptoms, the body appeared protective tension, more heavy blood
circulation disorder that metabolites and inflammatory mediators can not be excreted as soon as possible, over time, the
formation of adhesions between organizations, degeneration, fibrosis, and eventually replaced by scar tissue.

3 Clinical application of minimally invasive soft tissue
Minimally invasive soft tissue using some means or methods of organization will loosen stuck together, to restore the
original function. This therapy in many of our subjects had reflected. As in cardiothoracic surgery, chronic constrictive
pericarditis, the pathological changes are visceral and parietal pericardium thickening due to chronic inflammatory changes,
fibrous scar tissue to form a hard, parietal and visceral pericardium sticking to each other, the pericardial cavity disappears ,
cardiac scar tissue to be bound by the long-term, resulting in a series of symptoms. Treatment is surgical excision of
pericardial thickening of fibrous tissue, so that the heart is bound to restore the original function; obstruction of adhesions
in abdominal surgery is the most common complication of abdominal surgery, surgery is required when necessary loosen
adhesions between organizations; bone surgery because of lower extremity fractures long brake, knee injury or
inflammation of the knee sliding device adhesions, contracture, fibrosis caused by stiff knee adhesive shall adopt the knee
loose adhesions solution treatment; tendon adhesions and scar tissue trauma caused by lumbar disc herniation with nerve
root surrounding tissue lysis of adhesions, etc. are required to use different forms of methods to achieve relieve symptoms
caused by the purpose; gluteal muscle contracture is a large rotor upper gluteus medius only point cut part of the muscle
and tendon tension is too high fiber and achieve their goals. As can be seen above, minimally invasive surgical techniques in
disciplines has occupied a certain position. Another clinical physiotherapy, acupuncture, massage, partial closure, nerve
blocks and other non-surgical therapy treatment mechanism is relaxing its local tissue and reach the goal.
4 soft tissue minimally invasive surgery
Minimally invasive surgery is the use of soft tissue along the edge (or no edge) of the needle directly to the lesion, its
organization mechanical release, improving its pathological changes, a treatment to restore the original function of the
organization. Soft tissue is minimally invasive modern medicine, human anatomy, physiology, pathology, biomechanics and
minimally invasive surgical techniques based on sets of traditional medicine acupuncture techniques featured in one of the
modern medical technology. Use direct lesion of the needle blade, the treatments alter the pathological changes in their
muscles, tendons, fascia, ligaments, and other soft tissue synovial restore the normal function of the implicated parts and
reach therapeutic purposes.
First, a lifting mechanism of the high stress fiber: normal development of muscles pulling the bone is important, the size and
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direction of the existing bone morphology and its components are related to stress. Due to continuous repeated static force,
muscle or tendon fibers to make long-term state of tension, acting on the bone surface stress generated by the ending of
"osteoarthritis." Minimally invasive soft tissue can be cut beyond the bone surface or mitigate these high-stress fibers,
change the direction and size of its force in parallel to achieve the purpose of lifting the cause. 2 fiber tube high pressure to
reduce bone: bone fiber tubes, pipes from the bone tissue and the fibers on the rampage, said fibrous tubes. Their bone
structure can be divided into fiber tubes, joints and muscle fiber tube (or tendon) vascular three. It may have associated with
blood vessels and nerves and tendons and other tissues through. Mainly from the protection and the fixed tube tissue. For
some reason caused by increased pressure within the tube when the tube is irritation or compression of the contents
produce symptoms. Minimally invasive soft tissue contractures can release tension by fibrous tissue tube, inner tube to
relieve pressure, to achieve the purpose relieve symptoms.
3. Less pressure within the organization: from trauma or chronic fatigue so that local tissue metabolism disorder caused by
compartment syndrome bone tendons, joint capsule, bursa, or increased pressure within the bone appeared a series of
clinical manifestations, can cut through local tissue lysis needle If the joint capsule, bursa, myofascial's wall to relieve
pressure within the organization, improve blood circulation local organizations to restore local tissue metabolic imbalance
phenomenon, to reduce or relieve symptoms purposes. 4 lifting adhesions between organizations: due to trauma, chronic
fatigue or surgery, did not receive timely treatment, the local adhesion of muscle fiber and its surrounding tissue occurs,
such as: between the muscles and the muscles between the muscle and bone, skin and tissue adhesion between the clinical
symptoms affect normal tissue function appears. By loosening reduce tissue adhesion between, to restore normal
physiological state.
5. Improve local organizations aseptic inflammation: the long-term due to trauma or chronic strain, causing local tissue
blood circulation is blocked, increased capillary permeability, inflammatory pain caused by substances accumulate, forming
a partial aseptic inflammation and pain symptoms. Minimally invasive soft tissue can improve local tissue metabolism and
blood circulation, reduce pain caused by substances produced to promote the absorption of aseptic inflammation. Second,
the indications
Adapt to any part of the body due to the soft tissue injury or chronic strain, and local organizations have organic changes (ie,
the formation of adhesions between the soft tissue, fibrous contracture, the pressure increased, wall thickening and other
pathological changes, invalid or symptoms of repeated non-surgical therapy attack) clinical symptoms caused. 1 neck soft
tissue injury caused by back pain, nerve root of some neck muscles tense as cervical dislocation caused by the emergence of
the vertebral artery and clinical manifestations of sympathetic cervical spondylosis, back of the neck by loosening tight
muscles contracture , coupled with the appropriate traction bonesetting treatment.
2. Third lumbar transverse process syndrome, heel spurs, knee eminence between hyperplasia and other diseases.
3 elbows, ankles pipe, tube feet, carpal tunnel and other entrapment caused by clinical syndrome, migraine headaches,
tenosynovitis, shoulder and neck, lumbar nerve root entrapment in different parts of the surrounding tissue or being
squeezed due to related illness.
4 ganglion cyst, joint caused by increased pressure within the joint pain, synovitis, bursitis, muscle fasciitis caused by various
parts of the body, such as the ischial tuberosity bursitis, calcaneal tuberosity bursitis and so on. 5 by trauma, strain, local
tissue caused by post-operative adhesions, scar. Such as tennis elbow, levator scapula injuries, and medical sequelae of bone
and joint diseases (arthritis, ankylosing spondylitis, gout, osteoarthritis avascular necrosis, fibrous joints stiff limbs, etc.).

Third, contraindications
A fever, infection patients.
2 hemophilia and bleeding tendencies or clotting mechanism.
3 exacerbation of severe visceral lesions, diabetes, mental illness.
4 physical weakness, substandard authors.
5 treatments site infection or redness, swelling, heat, pain, abscess. 6 diagnosis is not clear, cross-sectional anatomical
structures (congenital deformity or after surgery) were the treatments of complex parts, pathological changes and the
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Board. 7 treatments have important parts of neighboring organs and can not be protector.
IV Treatment
Classification of soft tissue: spinal (10%) (discectomy surgery, interventional, RF)? ? ?
A) the manner and needle treatments
A sharp separation: release pin flat blade, helical blade release pin (blade, scissors, periosteal stripping)
Needle acupuncture knife, beryllium needles, pine needles, needle blade, long circular needle, needle spatula, new nine-pin,
water knife, loosen the needle, pick needle, giant crochet, Xiaokuan needle teeth crochet, needle mirror, lily Stubbs barrier,
improved knife
2 blunt dissection: Round release pin, flat head release pin (knife, forceps and fingers separated) dial needles, pine needle
bars, floating-pin, flat head release pin, round needles release
3 needle cannula release: You can select the needle core be sharp or blunt treatments according to different needs
Second) surgery in patients with orthostatic Step 1: Depending on the way the lesion and the treatments can take a different
position to operate. 2 needle positions: lesion treatments and techniques to choose the right part based on, there must be
an important part of the organization in favor clued as the needle point.
Needle 3: Using both fast and slow method, namely the needle into the skin and quickly to relieve pain, when the
subcutaneous needle blade, you need to slow the needle tip can shake around when necessary to stimulate more sensitive
tissue (nerves, blood vessels, etc.) to generate avoidance reflex action to reduce the unnecessary tissue damage.
4-pin edge direction: The different levels of the various parts, in order to avoid important organization in accordance with
the principle of the needle blade and tissue to the direction parallel to the order of the spinal cord, nerve roots, nerve,
artery, vein, muscle fiber.
Three) a longitudinal surgical dredge method: pin edge treatments and tissue fibers parallel to the direction, the adhesion
between the organization and the organization's release, mainly adapted to adhesions organizations. 2 rampant lysis
method: vertical pin edge treatments and tissue fiber parts, cut tight muscle or tendon fibers. Mainly adapted to relieve the
high pressure and high fiber tube bone stress fibrous tissue.
3 cutting method: pin edge of the lesion, selected according to the size of the scar tissue adhesions in different directions
and depth of the line cutting practices in order to reduce the size and extent of tissue adhesion, and promote local lesions
suction change. 4 transparent stripping method: needle up between the organization and the organization, the use of
needle separation of adhesions between the two organizations. This method is mainly suitable for a larger degree of
adhesion area but not severe tissue adhesions (also known as blunt dissection).

5 perforation decompression method: the needle edge of the lesion, the lesion can be punctured or myofascial wall, the wall
can be expanded if necessary, incision, accelerate metabolism and absorption of organizations. This method is used for
intracapsular pressure and aseptic inflammation. D) Notes 1. Soft tissue minimally invasive surgery with the continuous
development of its basic theory and technology research, the role of acupuncture almost to lose their function, and was
replaced by closed surgical technique. Everything so the treatment room should have required the operating room and the
surgeon must master strict surgical aseptic technique.
2 soft tissue from acupuncture, although minimally invasive surgery, but already have a functional surgery, patients who
have skills in addition to acupuncture practices, but also must be familiar with modern medical knowledge of local human
anatomy, physiology, pathology and histology , must have a certain surgical techniques and imaging foundation, especially
orthopedic surgery basic knowledge and techniques.
3 For soft tissue invasive, the treatments in, the doctor in addition to their own have the medical knowledge and surgical
experience, patient treatments parts feel a doctor treatments ways a very important indicator, if required to successfully
complete the surgery, doctors between the patients with essential.
4. Precise soft tissue biggest feature of minimally invasive surgery, treatments that doctors must confirm the diagnosis, clear
the site, a clear pathological changes, specifically the treatments, explicit avoidance method and the adjacent key
organizations to achieve the purpose of the treatments, except otherwise affect its therapeutic effect, will cause
14

unnecessary damage, worse postoperative complications.
5 minimally invasive soft tissue and reduce the high stress fibers
Muscles pulling on the normal development of bones is important. 1892 Julius Wolf (Julius wolff 1836 - 1902 year) made this
classic formulation, forming the famous Wolf's Law: "Every change in bone morphology and function, or just Each function is
a variation on them, inevitably followed to determine the cause of the external morphology of secondary bone change.
these changes are carried out in accordance with the law of the digital. " Bosite (Basset) Wolff's law in modern language will
change as follows: "the existing bone morphology and composition occur automatically Fangxiang settle or replacement
work pressure along their quality based work pressure. The size of the increase or decrease in reflex. "
On the occurrence of lumbar transverse process is highlighted by the pedicle and lamina juncture outward, can be seen from
the transverse abdominal muscle ossification made on the fascia, as the ribbon, thin, round and abdominal wall fit. First to
observe differences in children and adults lumbar transverse lumbar transverse process between the five children of lumbar
transverse process is basically the same, but adult lumbar transverse process, waist three longest, followed by back two,
four, waist a five shortest. Well, from the physiological and anatomical point of view, the third lumbar transverse process,
unlike the first and second lumbar transverse ribs protection, but also from the fourth and fifth lumbar transverse process
has ilium protection. In the tip of the third lumbar transverse process of adhering closely with many activities and trunk
muscles and fascia, especially the middle of the back fascia fibers gradually gathered outside to inside cross into bundles
attached to the tip of the third lumbar transverse . It was palpable in patients using finger-touch fascia and muscle fibers
attached to the tip of the transverse process, feel fibers such as taut bowstring. So according to the law of development of
lumbar transverse process, anatomy and physiology Woiff law, should be considered adult third lumbar transverse process is
too long because of the fascia and muscle attached to the role of high stress fiber tip formed.
Since plantar fascia calcaneal tuberosity, before the line is divided into five beams arrived at the plantar pad. Plantar pad
proximal phalanx firmly fixed on the bottom, and continue with the department periosteum. In normal walking, the body
forward, toe dorsiflexion, plantar proximal phalanx plantar fascia stretch across the metatarsal heads, because this action
plantar fascia easy to make in the beginning part of the stretch excessive stress, then the tendon the beginning part of the
film caused by osteoarthritis, the formation of bone spurs.
How-ever, for such clinical symptoms caused due to high stress fibers, often surgical resection, such as the third lumbar
transverse process syndrome after repeated non-surgical treatment of poor persons, the use of a surgical removal of the
third lumbar transverse process -2cm, in order to reduce high stress fibers and reach the goal. Now release the needle
through the release beyond the tip of the transverse process of high stress fibers, changing the tensile stress beyond the size
and location of the bone surface, reaching the same purpose and effect of surgery.
6 minimally invasive soft tissue and bone fiber tube high-pressure
With the continuous development of soft tissue science, "fibrous tubes" More and more appear in various professional
magazines, people have recognized the "bone fiber tubes" This particular anatomical structure of the human soft tissue
injury there is a very close relationships. Thus structural changes caused by entrapment syndrome is also not uncommon.
Fibrous tunnel tube is composed of bone tissue and was hung on the fiber. It can be through the nerves, blood vessels,
tendons and other tissues. Exists in many parts of the body. Its main function is to fix or change a direction of movement of
the tube contents, so that they take the trajectory at a fixed or moving lines, some fibrous tube also has the role of the
pulley.
First, the organizational structure of fibrous tubes
From the organizational structure of the bone fiber tubes can be divided into the bone fiber tubes, fiber tube joints, muscle
(or tendon) fiber tube categories.
A bone fiber tubes: the bone tissue and the crossing of the fibers. If located in the lumbar facet after the outer portion of the
bone, the upper wall of the mastoid, deputy sudden inferior wall, medial wall of the former vice conflict between milk ditch
outside wall of the mastoid collateral ligament milk vice ditch fiber tube there lumbar medial branch nerve branch through;
under the line of the sternocleidomastoid and trapezius muscle tendon and tendon in the posterior occipital bone
composition, there is a large pillow, the small nerves, blood vessels and the posterior occipital occipital lymph through the
15

tendon Bow bone fiber tube; the thoracic spine side ditch cross fiber to its previous configuration, there thoracic spinal
nerve after thoracic spinal nerve medial branch through the medial branch bone fiber tubes; the greater sciatic foramen and
sacrospinous ligaments, sciatic nerve, hips moving , veins, bone piriformis and sciatic foramen obturator muscle fibers
through the tube and so on.
Two fiber tube joint: the joint and fiber (ligaments) consisting pipe. Such as carpal tunnel: the carpal bones and the
transverse carpal ligament on both sides composed of fibrous bone tunnel deep flexor tendon, flexor hallucis longus tendon
and the median nerve, which refers to the superficial flexor tendon by means; ankle tube: Located below the medial
malleolus of the tibia by the flexor retinaculum, the medial malleolus, talus, calcaneus, triangular ligament and tendon
surrounded organize the order in which they are arranged from front to back through the tendon, flexor digitorum longus
tendon, posterior tibial artery, posterior tibial vein and the posterior tibial tibial nerve, flexor hallucis longus tendon; lumbar
nerve branch bone fiber tube: Located between the lumbar spinal canal after outward, toward the front to the rear, and the
direction perpendicular to the intervertebral tube, the inner sidewall of the lower lumbar facet bone surface and the outer
edge of the transverse process between the upper bound for the transverse ligament between sickle edge, the upper edge
of the lower bound of the transverse process of the lower vertebra, lateral border of the medial border between transverse
ligament, there dorsal branch and with line blood vessels through.
3 muscle or tendon fiber tube (hole): the muscle or tendon fibers fiber tube. Supinator tube: at the top of the back of the
forearm, the supinator shallow depth of two enclosed rear wall of muscle fibers deep near the ending point of the
composition, the anterior wall of muscle fibers shallow or and tendon fibers, within which there is radial nerve Through
deep branch; lateral cutaneous nerve of arm piercing hole: arm lateral cutaneous nerve from the bottom of the radial nerve
in the deltoid point ended flat, wear triceps lateral head to the outside of the arm muscles and triceps brachialis interval
between , on the outside of the arm from the lower third of the septum piercing the deep fascia distributed in the outer side
of the lower arm; peroneal nerve behind the knee walking through the lateral sulcus, peroneus longus and peroneus longus
muscle fibers from the fibular head and neck starting formed arch; atlantooccipital after piercing the fascia hole occipital
nerve atlantooccipital film is like.
Two bone fiber tube contents
Most of the bone through the nerve fiber tube and accompanying vessels: such as foot tube, the dorsal branch fibrous
tubes, elbows, etc. The contents of a single organizer mostly tendon, tendon sheath, such as the palm side of the finger and
phalangeal joint board consisting of palm fiber tube flexor tendon bone through; humeral segment large, small nodules on
the transverse ligament ditch its composition, there Fibrous long head of biceps tendon through the tube; contents of the
more complex, such as carpal bone fiber tube, in addition to nine tendons and a nerve by outside, in some cases, also
lumbrical tube; nerve within the tarsal tunnel , tendons, blood vessels through; occipital bone fiber tubes have nerves, blood
vessels and lymph nodes.
Three special structure of fibrous tube - fibrous septa
In addition to the main tube of fibrous structure composed of fiber tube part also has a memory in the fiber compartment,
its purpose is to isolate the tube within the tissue. If the tube is emitted from the ankle to the deep flexor support surface
with three fibrous septa that form four fascia sheath ankle, pipe contents from different fascia sheath through; within the
intervertebral canal, not only through the nerve root, intervertebral arterial and venous blood vessels and connective tissue
protection, there is also the presence of fibrous septa. In the lower part of the intervertebral canal mouth with a fibrous
septa, even in the intervertebral disc and facet joint capsule, the intervertebral canal mouth into the upper and lower tubes,
the tube through the nerve roots, branches and lumbar intervertebral spinal artery vein the branch, under the down tube
through the intervertebral vein branch, otherwise the upper mouth of the intervertebral canal outside a fibrous septum,
between the intervertebral disc and connected to the transverse and transverse ligament, the mouth is divided into upper
and lower two holes, lumbar nerve through the hole from under the root.
Fourth, clinical research
Through clinical observation, fibrous activities of high frequency content of the tube, pipe joints and bone fiber contents can
lead to complicated by entrapment syndrome. If the palm side of the knuckles by the phalanx volar plate and tough
16

connective tissue (finger flexor tendon sheath) jointly surrounded by bony fibers pipes, through the flexor tendon, and its
function is to protect and support the flexor tendon role in preventing muscle contraction when , a "bow hand" tendon pull
the finger joints. From the viewpoint of biomechanical point of view, the tendon sheath to provide a mechanical sliding
fulcrum, changing the direction of the force, which will help play a tendon sliding effect. Under normal circumstances, the
wall is smooth, the inner tube sliding in the tendons without any resistance. But when local damage, or systemic diseases,
such as: When endocrine disorders, fibrous stenosis, so that the movement of the tendon is limited clinical symptoms,
activity limitation. Common trigger finger, biceps tendinitis and carpal tunnel syndrome, etc, this physiological and
pathological changes in the relevant structures. Fiber tube joints: the human anatomy in many and more common clinical.
People have also had an earlier understanding. Such as carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel
syndrome. Reasons other than fiber tube joint fracture more easily wound injury, the anatomical structure of great
significance. On the one hand bone fiber tube is composed of joints, joint surrounding tissue, increased pressure within the
pipe joints and increased contents, ganglion cyst, etc., can lead to increased pressure within the fiber tube. On the other
hand, if uncoordinated movement in the joints, the shape and volume of the affected bone fiber tube, and secondly, the
tendon fiber tube joints mostly passed. Tendon movement also provides an important factor for the pathological damage of
the pipe. The contents of the tube as the posterior complex fibrous tendinous arch tube, except the occipital inner large and
small nerve and occipital artery, the fiber tube within 2-3 tablets are also present lymph nodes in the normal case, pressure
without any effect, occurs when the body's inner tube systemic diseases, such as influenza, female menstrual and other
reactive lymph nodes can lead to disease, posterior bone fiber tubes due to enlarged lymph nodes, so that increased
pressure within the tube, there occipital small nerve compression clinical manifestations, some patients also appear occipital
artery compression performance, such as the occipital tenderness and so on.
Fifth, the treatment of bone fibrous tunnel syndrome
In the past to use more heat, physical therapy and other methods to partial closure in clinical achieved a certain effect. But
for thickening or fibrous contracture patients with pathological changes, due to ineffective therapy more often requires the
use of surgical resection of fibrous tissue contractures thickening of purpose. Because of the many problems of surgery,
most patients is not easy to accept. By loosening the needle with a blade, needle blade through direct skin tight fibrous
tissue contracture, closed-type fibrous tissue contracture its mechanical release, in reducing bone fiber tube high-pressure,
they also will not lead to a result of openness scar after surgery brings, to the physiological recovery.
Through the bone fiber tube structure, contents and function analysis, summed prone parts of clinical symptoms, help
physicians in clinical diagnosis, more accurate diagnosis of the site of the disease, improve diagnosis and treatment effects.

The second chapter in the monograph
Supraspinatus muscle sheath inflammation on a
Supraspinatus muscle is one of the most easily damaged shoulder muscles, acute exacerbation of symptoms more obvious,
so common in the elderly, more women than men.
Applied anatomy
Supraspinatus muscle is an integral part of the rotator cuff and deltoid has suspended the humerus and assistance outreach
functions, starting in the supraspinatus fossa of the scapula, through the greater tuberosity of the humerus subacromial
beyond the upper, which is closely linked tendon and joint capsule between the acromion and the supraspinatus muscle is
separated by the subacromial bursa, shoulder abduction is the supraspinatus tendon to the humeral head is pressed against
the glenoid fossa, the stability of the humerus, so can the deltoid rotating arm upward. When the abduction of 90 degrees,
below the shoulder bursa fell fully retracted. Nerve supply of the supraspinatus muscle is the scapular nerve, suprascapular
nerve from the brachial plexus, 5-6 by cervical spinal nerves.
Etiology and pathology
Supraspinatus muscle is torn and degenerative rotator cuff muscles most likely to occur when the outreach arm, the
supraspinatus muscle needs to pass through the shoulder, under the narrow gap formed by the humeral head on to the
humeral head and the supraspinatus in a small muscle fiber tubes susceptible to bone squeezing or rubbing damage. On the
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basis of the supraspinatus tendon strain variability, the result of minor trauma or excessive force, or local feel the wind cold
dampness evil, can cause tendonitis, and prone to calcification.
Clinical manifestations
Most showed a slow onset, progressive lateral shoulder pain, pain during exertion obvious shoulder abduction, humeral
greater tuberosity or subacromial tenderness, when the left and right shoulder abduction to 60 degrees autonomy, due to
pain and unable to continue outreach on the move, a "painful arc" phenomenon, when the supraspinatus tendon
calcification, X-ray visible locally calcification. "Pain Arc" is supraspinatus tendinitis peculiar kind of signs is the risk of
shoulder abduction yet reached 60 degrees less pain when passive abduction range to 60-120 degrees, severe pain when on
the move more than 120 degrees, but also reduce the pain and continue on the move autonomously, and thus the range of
60-120 degrees this is called "painful arc."
Tendon rupture associated with acute injury affected the greater tuberosity of the humerus there was tenderness and
swelling associated with varying degrees of front joint, or bruising, pain abduction against resistance positive course for the
elderly, the supraspinatus fossa subsidence, and the emergence of a sense of subacromial snapping.
Chronic injury, slow onset, beginning only shoulder activities, especially outreach activities outside shoulder pain limited, but
after cold or trauma, pain can suddenly increased, severe impact on sleep and daily life, the pain may radiate to the neck
and arm. Long duration may occur disuse muscle atrophy.
Diagnosis and differential diagnosis
Under a subacromial bursitis: mainly for subacromial bursitis pain, tenderness subacromial, but shoulder abduction to 60
degrees, under the original shoulder tenderness obvious or disappear.
2 biceps tenosynovitis: pain, tenderness to the main humeral sulcus, biceps against resistance when the elbow pain
increased.
3 periarthritis: more common in middle-aged about fifty years old, but the pain is not limited to the middle range of the arc,
from the beginning to the entire range of motion activities both pain and local tenderness. Shoulder mobility.
4 nerve root type cervical spondylosis: Symptoms of radiation to the upper limbs, up forearms, fingers, etc., have a history of
cervical disease.
Treatment Ideas
Acute phase or tendon rupture, should be fixed for the short brake and light the way with tendon topical and internal
medicine to relieve pain; For the duration of the long hair of acute or chronic strain, the choice of a closed-type release
supraspinatus adhesions between the tendon and surrounding tissue and reduce local aseptic inflammatory stimuli; after
treatment with topical therapy and functional calcined practice.
Treatment
Position: 1) supine position, limb abduction of 60 degrees
2) patient sitting, slightly bent over, placed on the natural sagging upper thigh
Landmarks: 1cm at the subacromial
Therapeutic range: subacromial supraspinatus muscle sheath at
Tendon and Gang blade parallel to the needle, the needle body and skin subacromial vertical limb, the most obvious
tenderness at the needle, the needle edge of the capsule lesion, the patient may appear obvious soreness localized pain,
stimulating needle blade and lysis of adhesions supraspinatus tendon and surrounding tissue, reducing the bursa pressure,
promote metabolism exclusion, to be self-inductance of patients with subacromial pain relieve soreness or disappear after
the needle, oppression pinhole moment, Band-Aid and topical .
Note: Note the direction of the needle blade to prevent cutting infraspinatus tendon.
Subacromial bursitis under 2
Subacromial bursitis usually caused by trauma or chronic fatigue caused by common people engaged in physical labor. More
due to acute exacerbation of chronic fatigue, patients with more severe pain.
Applied anatomy
Subacromial bursa sac known as the deltoid muscle decline, can be divided into two parts under the acromion and the
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deltoid muscle, subacromial bursa located acromion, coracoacromial ligament between the supraspinatus muscle. Decline in
the upper deltoid deltoid bursa located between the dead and the supraspinatus tendon, capsule after two adults is one
solution, subacromial bursa sac is the body's largest, with profits slip shoulder, reduce friction, easy strained effect. The
bursa in the shoulder abduction can make greater tuberosity freedom of movement in the shoulder, so the activity is very
beneficial for the shoulder, called subacromial joint.
Etiology and pathology
Subacromial bursitis may be caused by direct or indirect trauma, but most of the disease secondary to soft tissue injury and
degenerative changes around the shoulder joint, especially in the bursa at the bottom of the supraspinatus tendon injury,
inflammation, calcium deposition common. Subacromial bursa tissue sandwiched between the acromion and the humeral
head, repeated friction can cause long-term damage, constantly stimulated, synovial hyperplasia, wall thickening, synovial
fluid secretion, tissue adhesion, thus affecting the shoulder abduction, the lift and rotate activities.
Clinical manifestations
The main symptoms of subacromial bursitis shoulder pain, limited mobility and limitations of tenderness.
Pain can be gradually increased to at night particularly at night, can be painful wake up, when the shoulder joint pain
increased, especially abduction and external rotation of the pain were located deep in the shoulder and may involve dead
outside the deltoid muscle, but also to the scapular neck, hands, etc. radiation, and when swollen bursa fluid, can cause
expansion of the shoulder profile, and the leading edge in the deltoid muscle mass to form a circular ridge, also available in
the deltoid region of the shoulder tenderness occur within range, to reduce pain, patients often make the shoulder adductor
in the rotated position. With the proliferation of synovial thickening of the wall, the tissue adhesions, shoulder activity
decreased, late shows shoulder muscle atrophy.
Diagnosis
A shoulder strain or partial history of trauma often
The following two shoulder continuity dull, increased activity, when the most obvious shoulder abduction
3 tenderness in the shoulder, shoulder, large nodules, etc., often with the rotation of the humerus and displacement.
4 shoulder shape than the bulging, exists in the outer end of the shoulder tenderness, a sense of volatility
5 shoulder abduction test positive, subacromial pain is positive, active or passive abduction.
6 X-ray examination: no abnormal changes in general, and sometimes see the shadow round the shoulders of increased
density, swelling of the bursa of late calcification shadow of the supraspinatus muscle.
7 Early shoulder swelling, pain refused to press, especially night pain, local swelling palpable sense of volatility. Seen in the
late shoulder soreness, pain worsened after exertion, chills thermophilic, lassitude, palpable mass of soft.
Differential Diagnosis
A shoulder joint tuberculosis: the latter local pain, often accompanied by fever, night sweats, weight loss, anemia, shoulder
muscle atrophy, multi-functional activity limitation, erythrocyte sedimentation rate, decreased hemoglobin, X-ray shows
bone destruction, joint space change narrow.
Treatment Ideas
Acute phase with a neck strap wrist rest for 3-7 days, after mitigation techniques can be used, acupuncture therapy.
Treatment
Position: 1) side in the treatment of bed, put on the side of natural limb
2) patient sitting, slightly bent over, placed on the natural sagging upper thigh
Landmarks: 3cm at that subacromial bursa subacromial projection area
Therapeutic range: subacromial wall
Needle blade parallel with the supraspinatus tendon, the needle body and skin vertical limb subacromial bursa tenderness
most obvious at the needle, the needle edge of the capsule lesion, the patient may appear obvious soreness localized pain,
with needle blade punctured subacromial sliding wall thickening, reducing the bursa pressure, promote metabolism
exclusion, to be patient since subacromial alleviate pain or soreness after the disappearance of the needle, oppression
pinhole moment, Band-Aid and topical .
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Note: Note the direction of the needle blade to prevent cutting infraspinatus tendon.
3 biceps tendon sheath release
Biceps tendon tenosynovitis due to friction in the intrathecal long been strained degeneration occurs, adhesions, tendon
sliding function so that barriers to disease, can affect the upper limb extracts and outreach functions, slow onset, and more
found 50-year-old female patient.
Applied anatomy
Biceps tendon is a tendon round, starting at the shoulder glenoid tubercle, passing shoulder capsule, after piercing the
joints, along the fiber conduit between the sulcus and transverse humeral ligament formed by beyond the radial tuberosity
and biceps fascia, the fascia is a wide tendons, fascia mixed with the inside of the forearm. Biceps tendon in the shoulder
adduction, internal rotation when slid between the top of the pipe in the fiber and transverse humeral ligament sulcus
formed in the outer show, when it slid beneath the flexion and external rotation, due to the biceps between the long head
tendon and muscle sulcus unique anatomical relationship, so for biceps tenosynovitis predilection sites.
Etiology and pathology
Many and degenerative changes related to the long-standing biceps tendon friction when the upper limb activity biceps to
complete the slide up and down in the ditch between the humerus bone fiber tube, long-term wear coupled with large
external force to the humerus , small nodules sulcus transverse ligament contracture, the impact of the long head of biceps
tendon movement, partial aseptic inflammation causes pain, long-term stimulation of visceral thickening of the tendon
sheath contracture, relatively narrow, tendon sheath activities within limited and disease.
Clinical manifestations
A shoulder early in the disease, there may be pain and joint mobility, pain, mainly located in the front of the shoulder,
humeral tubercle sulcus to the most obvious, with the development of the course, the symptoms can aggravate the pain
may involve the attachment of the deltoid and biceps head muscle belly, pain patients can wake up at night.
2 Extension arm biceps were tenderness, especially within the first partial shoulder at about 3cm below the humerus big
small nodules sulcus, limitations shallow tenderness, hold the upper limb in patients with common hand in flexion to avoid
arm rotating activities increase the pain.
3 straight after upper limb flexion and shoulder extension, elbow forearm pronation obstacles, and aggravate symptoms.
Diagnosis
A common in the elderly
2 no obvious incentive to shoulder pain, exacerbation of pain may radiate along the front side of the upper arm to the
elbow, elbow weakness.
3 front part of the upper arm shoulder may have swelling, tenderness, shoulder abduction and rotation, elbow flexion
significantly weakened;
4 causes chronic fatigue, patients may have mild shoulder pain may retain elbow function.
5 X-ray examination, generally no abnormal findings;
Differential Diagnosis
1 periarthritis: same age, and had shoulder pain, limited mobility, but the disease is usually between the shoulder
tenderness tubercle sulcus, and with elbow weakened, but was frozen shoulder tenderness around the elbow function is not
significantly affected.
Treatment Ideas
Acute phase required braking, the prevalence of early local therapy feasible for cross fibers sulcus at the tense, closed-type
contracture release method of treatment can be used.
Treatment
Position: supine, natural limb put on side;
Landmarks: the bottom of the front shoulder biased about 3cm, humeral tubercle sulcus;
Therapeutic range: humerus big, small nodules sulcus contracture tension in the transverse ligament;
Humerus big, small nodules most obvious tenderness at the needle, the needle body and the skin vertically, the tip of the
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shoulder transverse ligament, and tendon needle blade parallel to the vertical transverse ligament and shoulder, cut tight
shoulder contracture transverse ligament under the needle there is a sense of frustration that the stop, self contracture of
the transverse ligament tension after the release of the needle, hemostasis few minutes, Band-Aid topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise. With local therapy can accelerate the absorption of inflammation during treatment.
Note: Pin release tension contracture shoulder blade transverse ligament can, so as not to penetrate too deeply mistaken
biceps tendon.
4 supinator syndrome
Supinator syndrome refers to the deep branch of the radial nerve after entering the spin arch tendon is entrapment, Nerves
arising muscle weakness or muscle paralysis symptoms. Clinically more common, also known as the dorsal forearm
interosseous nerve entrapment syndrome, supination bow tendon entrapment syndrome.
Applied anatomy
Brachioradialis radial nerve in the upper and lower joints between approximately 3cm, into superficial branch and deep
branch, superficial branch to sensory fibers, mainly located in the dorsal radial side of the distal forearm. Deep branch of the
muscular branches, mainly dominated supinator, extensor digitorum, extensor carpi ulnaris, abductor hallucis longus,
extensor pollicis brevis, extensor hallucis longus and extensor inherent forefinger.
Supinator starting at epicondyle of the humerus, ulna upper part of the outer edge of the supinator crest, bundle out, the
front ends of the radial 1-3, bundle of superficial and deep layers, the proximal edge of the deep tendon organization, was
Arcuate, called supination tendon bow. Thickness and gap difference accommodate the tendon bow nerve larger deep
branch of the radial nerve after crossing the bow into supination tendon muscle mass, muscle bundle between the shades
down.
Etiology and pathology
Much more than elbow rotation activities, especially the use of forearm rotation movement repeatedly for professionals,
because after repeated stretching of muscle damage caused muscle degeneration spin, spin tendon bow hypertrophy, direct
compression of dorsal interosseous nerve produce symptoms . Here elbow disease or injury, such as rheumatoid arthritis,
inflammatory swelling, Monteggia fracture, radial head fracture or dislocation, as well as local soft tissue damage, scar
adhesions or compression screw after it formed tendon bow mouth and so that can cause.
Due to accommodate limited supination tendon bow nerve gap between the dorsal forearm nerves only a few leeway here.
When chronic fatigue so supination bow tendon thickening or partial tumor oppression, so that between the dorsal forearm
tendon arch nerve compression in the small spin narrowed, compressed nerve pallor, becomes flat, tenderness, in arch
tendon can be left with pressure trace, the following epineurium bow tendon edema and fibrosis, the general did not
change the beam axis, the general health contracture tension loose bow untied after lesions reversed restore nerve
function. For long-term nerve entrapment is the phenomenon arch tendon, nerve proximal variable thick, were pseudo-
neuroma-like changes.
Clinical manifestations
The incidence of posterior interosseous nerve palsy and more slowly, mainly for muscle innervated muscle weakening or
paralysis. The disease is characterized by: means not hanging vertical wrist, muscle paralysis and feel normal. Early localized
to the proximal dorsal forearm persistent pain, no radiation feeling a little pain in the forearm activity eased, but increased
at rest, often at night the pain woke history. Tender points in the radial head dorsolateral apparently found that the
equivalent of between supination tendon bow oppression bone surface projection of the dorsal nerve, deep pressure can
cause increased pain remote, or touch the cord-like mass . In the elbow position for extended middle finger after forearm
supination resistance test or when resistance test, can induce pain below the lateral humeral intensified. Late visible
forearm extensor group atrophy.
EMG showed extensor hallucis, extensor muscles have varying degrees of tremor, slowed nerve conduction velocity. X-ray
examination can be no exception.
Diagnosis
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A slow onset, more common in young adults and manual laborers
2 hanging means without vertical wrist, forearm muscle paralysis and feel normal, slightly ease the pain during activity, but
increased at rest, often at night the pain woke history.
3 radial head dorsolateral limitations tenderness, deep pressure can cause distal limb pain intensified;
4 elbow position for extended middle finger after forearm supination resistance test or resistance test was positive;
5 long duration visible forearm extensor group atrophy.
Differential Diagnosis
1 humeral ankle inflammation: the humeral epicondylitis pain and tenderness on the outside of the ankle in the humerus,
relatively limited. Department of supinator syndrome among forearm interosseous nerve involvement, pain along the radial
nerve to the upper arm and forearm radiation, tenderness located proximal dorsal forearm rotation after dorsal arch
tendon, forearm supination elbow pain, and humerus When pronation of the forearm elbow epicondylitis pain significantly.
In addition, elbow finger against resistance test helps diagnose the ankle extensor hallucis humeral inflammation without
functional limitations with the metacarpophalangeal joint dysfunction.
Treatment Ideas
Acute phase required braking to non-surgical therapy to prevent excessive rotation of the forearm for action, and processed
for different causes, due to the tight spin bow tendon contracture release thicken feasible closed-type treatments carried
out with local treatment.
Treatment
Position: supine position, flat on the side ipsilateral upper extremity, palms up, so that the elbow flat on the bed.
Landmarks: lateral condyle of the radial head below the top of the humerus, which supination tendon arch.
Therapeutic range: tension, contracture, thickening of the tendon bow supination.
Above the lateral condyle of the radial head beneath the outer most obvious tenderness at the needle, the needle body and
the skin vertically, needle blade parallel with the deep branch of the radial nerve, and tendon bow vertical spin, spin up
when the needle blade bow tendon when , the patient may feel pain and discomfort locally, by the way up and down the lift
and thrust thickening of the tendon contracture release bow, bow tendon unlock every song there is a sense of frustration
after mentioning the needle until patients feel a sense of relieve local pain and self-healer After the bow tendon contracture
tension ease out of the needle, hemostasis few minutes, Band-Aid topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise. With local therapy can accelerate the absorption of inflammation during treatment.
Note: the needle blade release tension bow tendon contracture can spin, too deep to avoid mistakenly stabbed the radial
nerve. Treatment of patients with partial response should be closely observed when patients have localized tingling and pain
in the phenomenon of radioactivity to the remote, you should immediately adjust the needle blade to avoid hurt local
nerves and blood vessels.
The total condylar extensor tendon on the humeral loosening 5
Epicondylitis, also known as "tennis elbow" on the outside of the humerus, the epicondyle of the humerus extensor tendon
of the total chronic muscle injury fasciitis, more common in women aged 30-50, the most common chronic diseases elbow
injury .
Applied anatomy
Humeral epicondyle is the outside of the humerus bone of non-articular part of the uplift, is the starting point of the
common extensor tendon, easily accessible at the time of elbow flexion, extension when you fall into a depression, this
depression that lies brachioradialis joints, depression After the inside of the elbow muscle, the outer side of each of the
radial extensors.
Humeral epicondyle extensor tendon is dead, the main role of the wrist extensor stretch their tendons in the formation of
the annular ligament flat plate-like common extensor tendon tendon, in addition there are tiny blood vessels, nerves
through the beginning part of the total tendon and brachioradialis joints, annular ligament in close contact, supinator also
attached to the epicondyle of the humerus, and its role in bringing the innervation of forearm supination, above the neck
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muscles are subject issued by 5-8. From the radial collateral ligament from the epicondyle of the humerus, the fiber blend
down and annular ligament, elbow muscles also play on the condyle of the humerus, the elbow of the main extensor,
Brachioradialis starting from the outer ridge epicondyle of the humerus on 1/3, 5-6 innervation by the neck, the main role of
the elbow.
Etiology and pathology
Cause of many repeated with the forearm, long-term or excessive wrist extensor, extensor and forearm rotation movement.
Epicondyle of the humerus attached to the common extensor tendon , is the highest parts of the extensor group of stress ,
when the upper limb extensor carpi do , extensor and forearm pronation movement , easy to attach to the fascia tendon
epicondyle of the humerus by pulling , falling can cause cumulative damage.
Also located on the extensor tendon of the small total depth of neurovascular bundles , from deep extensor tendon
rampage through the base and then through the deep fascia to the skin, when the Department fasciitis occurs when the
muscle strain , local swelling , surrounded inflammatory cell infiltration , can stimulate nerve bundles strangulation causes
pain , tenderness often located in its blood vessels, nerves and tendons beam passes through the fascia of the Department,
if the cut this neurovascular bundle fascia and tendon or relieve myofascial tension may relieve local pain .
Clinical manifestations
Humeral epicondylitis majority of adults , male to female ratio of 3:1 , the right of common, the patient complained of
lateral elbow pain, weakness, pain gradually increased.
The disease induced by improper force suddenly , most slow onset and gradually appear outside of the elbow soreness
discomfort, pain can be presented outside of the forearm , do twist towels , sweeping, side pot pour such action when the
pain got worse , suffering from hand can not be forced , even hold things landing. Forearm pronation disorders , severe
impact on life , the humeral epicondyle total dead extensor tendon , ligament and brachioradialis ring joint space limitations
at shallow tenderness. Wrist extensor tension test positive , forearm extensor tendon traction test positive , the ipsilateral
elbow extension, wrist flexion, forearm supination do when the lateral epicondyle pain . Severe night pain , about 1/ 3 of
patients may be pain to the upper arm , forearm and wrist radiation , the impact of physical activities , but generally
asymptomatic at rest .
Diagnosis
A greater intensity of labor prevalent in young adults and housewives ,
2 mainly for the Ministry of limitations elbow epicondyle of the humerus pain, persistent pain may radiate to the forearm ,
wrist or upper arm pain at night obviously , can not end heavy , serious side glass or sweeping both cause pain.
3 to epicondyle of the humerus centered obvious pain , annular ligament or joint brachioradialis often obvious tenderness.
4 do against resistance of wrist dorsiflexion and forearm supination movements can cause pain in the affected area ;
5 mils (Mill) test was positive : the ipsilateral elbow slightly bent , hands fist wrist palmar flexion strength , do forearm
pronation , elbow extension activities can cause pain at the lateral epicondyle of the humerus .
6X -ray, can sometimes be seen in the lateral epicondyle of the humerus calcification shadows.
Differential Diagnosis
Brachioradialis synovial bursitis : The disease in addition to local tenderness , before elbow pronation, supination limited ,
pronation causes severe pain , epicondylitis slightly its position double humerus pain , tenderness over the lateral epicondyle
of the humerus mild inflammation , swelling tenderness locally , the needle can be sucked out effusion.
Treatment Ideas
Early use more topical anti-inflammatory painkillers, physiotherapy or acupuncture treatment, or for a long duration can be
closed permanently by type release extensor tendon in total adhesion epicondyle of the humerus and cut small
neurovascular bundle .
Treatment
Position: the patient sitting, elbow flexion , flat on the treatment table
Landmarks : epicondyle of the humerus sensitive tenderness ;
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Treatment : 1 ) epicondyle of the humerus of the common extensor tendon adhesions at the point of ending ; release 2 )
separation of the small radial nerve neurovascular bundle ;
In the extensor tendon in a total dead epicondyle of the humerus most obvious tenderness , skin vertical needle into the
needle, the needle blade and tendon fibers parallel , the needle of the bone surface , the patient may have significant
soreness local pain , the total release extensor tendon adhesions and external humeral condyle bone surface between the
patient to be self-inductance of local soreness pain relief, healer total inductance extensor tendon adhesions eased after the
needle , hemostasis few minutes, Band-Aid topical.
2 neurovascular bundles were located in the annular ligament entrapment and brachioradialis joint gap , vertical limb needle
body and skin , the needle blade parallel to the annular ligament and joint space , needle and joint space of the muscle belly
, looking for sensitive reaction points and loose adhesion between the fibers and Jieji or cut pressure sensitive neurovascular
bundle . Subject to local soreness pain lessened or disappeared after the needle to stop bleeding , Band-Aid topical.
Note: must identify the parts of the tender points .
6 pronator teres release ( volar forearm interosseous nerve entrapment syndrome )
Pronator teres syndrome corrections department located in the nerve in the forearm pronator teres plane after entrapment
, muscle movement dysfunction appears dominated by the median nerve .
Applied anatomy
Median nerve from the elbow to the forearm is in the nest biceps aponeurosis through the next arch tendon and pronator
teres between the humeral head and foot bones into the forearm across posed , and then through means superficial flexor
fiber bow border between the superficial flexor and finger flexor finger deep down into the carpal tunnel . Clinically median
nerve entrapment between easily subjected biceps aponeurosis , pronator teres and superficial flexor tendon bow bow and
forearm flexors and deep fascia , the main point of entrapment round pronator tendon bow and finger superficial flexor
tendon arch .
Etiology and pathology
Department of pronator teres syndrome caused by a variety of reasons , so acute injury scar formation , fibrosis and chronic
fatigue to make a bow tendon becomes hard and tough , or abnormal fibrous bands, as well as local tumor, forearm
fractures can be compression of the median nerve , another arm spin current time , the muscle tendon tissue or fibrous
band tension can also be compression of the median nerve.
After the acute injury so the palm side of the forearm directly affected by external injury, did not receive immediate
treatment, so that where soft tissue fibrosis or tendon tissue contracture and tough .
The crowd repeated forearm rotation job can lead to severe chronic fatigue pronator teres , long-term hard elbow , wrist,
finger and forearm rotation force , making the forearm flexors repeated involvement and injury, followed by tendon tissue
becomes too tough or showed fibrosis, caused by the median nerve in the forearm from the proximal pressure.
Median nerve is vulnerable to oppression in the following three areas:
( 1 ) the front side of the distal humerus bone fiber tube ;
( 2 ) the lower edge of the biceps fascia ( muscle fiber bundles fibrosis ) ;
Between ( 3 ) pronator teres borders of two ( pronator teres syndrome ) .

Clinical manifestations
Forearm strain may have a history or history of trauma to varying degrees , can occur at any age, proximal forearm pain in
patients with early onset of major clinical symptoms of persistent pain , intermittent increase, change or limb pain when
resting concerned , there night pain woke history , patients often can not hold a pencil or with your thumb and forefinger to
eat with chopsticks Xiecai late pain can be reduced or alleviated, but there may be muscle atrophy and decline in the median
nerve muscle . Front elbow fossa 2-4 centimeters , may have limitations tenderness, palpable long duration hard feeling or
cords induration, tenderness can cause distal radiating pain , before the time when anti- pronation and elbow flexion wrist
pain worse .
EMG suggestive of nerve conduction velocity .
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Diagnosis
1 ) can be any age , is more common in the group engaged in manual operation ;
2 ) proximal forearm pain, intermittent increase, change or limb pain when resting concerned , there is pain at night woke
history ; 3 ) lower front elbow fossa 2-4 centimeters , may have limitations tenderness, long duration may hard hitting streak
flu or induration .
Differential Diagnosis
1 carpal tunnel syndrome : Although clinical symptoms were manifestations of median nerve compression phenomenon, but
tenderness pronator teres syndrome more in the forearm pronator teres surface projection area , and carpal tunnel
syndrome in the wrist transverse ligament ;
2 thoracic outlet syndrome : thoracic outlet syndrome mainly as a whole brachial plexus compression phenomenon ;
3 humeral epicondylitis : humeral epicondylitis of tender points were located on the periphery of humeral condyle .
Treatment Ideas
Early should reduce excessive rotation of the forearm and wrist flexion movement clothes , and with local therapy and
topical treatment of traditional Chinese medicine , long duration or local induration , streak -like changes , to adopt a closed
-type contracture release tension in pronator teres reduce the phenomenon on the median nerve .
Treatment
Position: the patient sitting, elbow flexion , flat on the treatment table ;
Landmarks : the lower front elbow fossa 2-4 cm ( pronator teres lower edge ) at the limitations of tenderness ,
Therapeutic range : nervous, contracture pronator teres ;
Front elbow fossa around 2-4 cm , round pronator muscle belly Office ;
Epicondyle of the humerus below the radial head tenderness over the outside of the most obvious place to find sensitive ,
hardened strip of the needle , and the needle perpendicular to the skin , the needle blade parallel to the radial nerve fibers
in the middle , when the needle edge of tension contracture short when the pronator teres muscle abdominal pain patients
may have localized acid and feeling , by the way up and down the lift and thrust contracture release hardened round
pronator muscle fibers and tendon bow , to be localized pain patients feel a sense of relief, the doctor from after abdominal
tendon contracture tension ease out of the needle , hemostasis few minutes, Band-Aid topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
Note: When the needle blade tension release contracture round pronator muscle belly , the patient should be closely
observed local reactions , when patients have localized tingling and pain in the phenomenon of radioactivity to the remote ,
you should adjust the needle blade immediately to avoid stabbed local nerves and blood vessels .
7 radial styloid stenosis of the tendon sheath release
Ministry of radial styloid and have long thumb abductor hallucis brevis tendon sheath common in everyday life and work in
the Ministry of radial styloid tendon in the tendon sheath friction and repeated after a long injury , synovial showing edema,
proliferative and other inflammatory changes , causing the tendon sheath wall thickening , adhesions or stenosis , said
narrow radial styloid tenosynovitis .
Applied anatomy
In the Ministry of radial styloid bone with a narrow shallow ditch , covered with dorsal wrist ligaments above , forming a
fibrous sheath , hallucis longus tendon and exhibition jointly by pollicis brevis tendon sheath folded after this were limited to
a certain angle near the thumb and the first metacarpal phalangeal .
Fibrous sheath of two layers, the outer layer of fibrous sheath , inner synovial membrane , synovial membrane is divided
into visceral and parietal , parietal lining the inner surface of the fibrous sheath , the tendon reflexed covered that is visceral
, also known epitenon , dirty parietal blind sac formed at both ends , during which contains a small amount of synovial fluid ,
lubrication and plays a role in maintaining tendon activity.
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Etiology and pathology
Show hallucis longus tendon and a short thumb extensor tendon in place through the radial styloid covered by a ligament
and tendon sheath has synovial lining , due to the relatively narrow tendon sheath , coupled with a larger thumb activity,
easy indirect friction , causing strain or cause trauma , inflammation of the tendon sheath damage can occur , so that the
tendons , tendon sheaths and produce corresponding symptoms were edema, thickening , luminal narrowing, tendons slide
difficulties in the tube.
Fist action causes repeated friction between the tendon , irritation and inflammation, irritation and inflammation in the
acute phase causes swelling induced fibrosis in chronic phase , in both cases the fibers of the sheath may be narrow and
cause pain when muscles .
Clinical manifestations
The onset of the disease is slow, the radial side of the wrist pain, discreet , fatigue, pain increased in some patients the pain
can be hand or forearm to conduction, so that the thumb weak , and because of a variety of actions wrist or thumb
abduction , flexion such action and intensified. Inspection at the radial styloid mild swelling , local tenderness , palpable
thicken the tendon sheath , harden. So that when the resistance to extension and outreach thumb pain increased , patients
thumb flexion , the thumb and the other fingers around the wrist ulnar deviation ( Stan Fink 's ear test ) checks can cause
nasopharyngeal fossa pain. Tenosynovitis is nasopharyngeal fossa ( through the scaphoid area close to the long thumb
abductor tendon , thumb brevis tendon and thumb extensor tendon length ) at unwittingly exacerbate pain , another fist
action during lateral forearm away side pain can be intensified.
Diagnosis
1 more common in middle-aged women.
2 no obvious incentive to slow onset to the radial side of the wrist joint chief complaint of pain , wrist aggravate the
symptoms of various actions ;
Three local tenderness at the radial styloid obvious pain associated with increased resistance to stretch your thumb
abduction ;
4 X line may be no obvious abnormalities.
Differential Diagnosis
Between carpal joints staggered joint : a narrow radial styloid tenosynovitis usually no trauma, pain, swelling at the site of
the radial styloid , carpal joints staggered joint was injured area trauma induced carpal bone joints swelling, pain, which is
common for the wrist movement is limited .
Treatment Ideas
Acute phase of severe pain , can be fixed brake , local therapy , and topical medicine, reduce inflammation , for long
duration , affecting work and life, radial styloid sheath thick wall , local uplift is higher, repeatedly made feasible closed -type
tenolysis .
Treatment
Position: the patient sitting, put a fist in the treatment of the ipsilateral wrist table, wrist underlay pillow .
Landmarks : the tip of the radial styloid depression before , that fibrous sheath projection area ;
Therapeutic range : contracture tension thickened radial styloid process of the fiber sheath ;
Depression, the most obvious tenderness at the needle , the needle body and skin hanging in front of the radial styloid tip ,
the tip of the radial styloid process of the fibrous sheath , the needle blade and tendon parallel , perpendicular to the fiber
sheath , when patients feel a significant local when soreness pain , tension reached the tip proved , contracture , thickening
of the fibrous sheath tube that carries release treatment, each needle next release to be a sense of frustration that the stop,
local reactions decreased when patients and doctors who self-inductance contracture after the release of the transverse
ligament tension needle , hemostasis few minutes, Band-Aid topical.
General treatment once a week , after the third day of viable local heat and accelerate the absorption of inflammation .
Precautions
Treatment should be noted that the degree of treatment and needle blade direction , so as not to cut the tendon and
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overtreatment.
8 transverse carpal ligament release
Carpal tunnel syndrome, also known as the median nerve crush syndrome. Is your fingers numb fatigue syndrome mainly
due to the compression of the median nerve in the carpal tunnel caused .
Applied anatomy
Carpal tunnel system a lack of elasticity of bone fibrous tunnel concave bottom , the hard overlying the radial carpal and
volar carpal ligament structure, roof supported by a tough flexor band structure, carpal tunnel section oval, can
accommodate a finger , there are means superficial and deep flexor hallucis longus and flexor tendons , etc. 9 arteriovenous
median nerve and nourishes through . Flexor retinaculum ( transverse carpal ligament ) is about 1.5-2.0cm wide, 2.5-3.0cm,
thickness of the central portion of 2.0cm, the Ministry and the near and far sides of thick 1mm. Ulnar attached to the peas
and hamate bone , can be divided into two radial shallow attached to the navicular tuberosity and trapezium bone nodules,
deep inner lip attached to the trapezium grooves , superficial, deep layers and most lines have flexor carpi radialis tendon
and tendon synovial fluid .
Etiology and pathology
Any reduction in the volume so that the carpal tunnel , carpal tunnel contents increased in the number of reasons can lead
to compression of the median nerve , which produces neurological dysfunction, caused by trauma wrist sprain, fracture,
dislocation can cause thickening of the transverse carpal ligament so narrow carpal tunnel , compression of the median
nerve. Chronic fatigue wrist , metacarpophalangeal and wrist activities, flexor tendons and the median nerve and transverse
carpal ligament long back and forth friction ; cause tendons, synovial edema, hyperplasia or fibrosis increases the volume
compression of the median nerve, some patients have history of rheumatoid arthritis or rheumatism , and endocrine
disorders can also be induced by compression of the median nerve within the carpal tunnel ganglion cyst , lipoma,
earthworm -like finger flexors and abdominal muscles into the carpal tunnel is too long , so that the contents of an increase
in the carpal tunnel , also may compress the median nerve .
Clinical manifestations
The main clinical manifestations of the median nerve at the transverse carpal ligament is entrapment , suffering from the
radial side of the hand feeling 3 and a half finger abnormalities, numbness or tingling , exacerbating the night , sometimes
waking pain , pain when the temperature increased significantly , activity, or walk away after the loss. Detailed history ,
occupation , type of work can often prompt causes. Transverse carpal ligament tenderness , and can lead to symptoms,
suffering from diminished grip strength , grip objects or situations occasionally missed the end of the matter , the patient
may have chills cold season , cyanosis , difficulty moving the fingers , the thumb abductor poor, there are severe thenar
muscle atrophy, shiny skin , nail thickening , suffering refers to symptoms such as neurotrophic disorders.
Special clinical signs:
Percussion test positive : tapping the carpal tunnel in the middle part of the median nerve ( flexor carpi between the tendon
) , the median nerve in patients who have radioactive shock cloth -like fingers tingling .
Wrist flexion test was positive : the patient elbows resting on the table, the forearm vertical with the desktop , two wrist
palmar flexion , when the median nerve compression at the proximal edge of the transverse carpal ligament , the symptoms
became worse after 40 seconds is positive ; sweating test positive : to suffer at the hand of each finger pressure to work with
the ninhydrin test strips can be found in the median nerve distribution sweaty fingers reduction ( in case of ninhydrin sweat
purple , sweating more , darker color ) .
Tourniquet test was positive : Application blood pressure table , balloon inflated to between systolic and diastolic blood
pressure, congestive heart so that the injured arm , one minute troubles hand symptoms worse.
Diagnosis
1 more common in women under 50 ;
2 injured arm radial three and a half fingers paresthesia, numbness or tingling , aggravated at night , and sometimes the pain
woke ;
3 patients weakened grip strength , grip objects or situations when things occasionally missed the end , may have chills,
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cyanosis, finger movement inconvenience history ;
4 carpal tunnel middle tenderness , and may appear remote aggravation of symptoms ;
5 wrist flexion test, the percussion test, the cuff test positive.
Differential Diagnosis
A cervical disease : cervical disease is more common in the elderly disease , clinical manifestations of cervical spondylosis
radiculopathy with symptoms easily confused with peripheral nerve compression , C5, 6,7 nerve root compression appears
radial side of the hand numbness , pain, sensory loss , but should not appear thenar muscle atrophy, may be associated with
neck discomfort , cervical X-ray, EMG help to identify the two.
2 pronator teres syndrome : generally no pain at night woke history , there are proximal forearm pain and tenderness, flexor
muscle , forearm rotation decreased muscle strength , EMG help differentiate between the two.
3 Polyneuritis : Distribution of diabetic nerve damage appears as hand , foot glove , sock-like sensory loss , mainly due to
damage to the nerve endings , sports injury is not obvious.
4 on the other should be in the type of thoracic outlet syndrome , the median nerve tumor , shoulder-hand syndrome phase
identification.
Treatment Ideas
Severe pain , you can give to a fixed brake , symptoms can be lifted fixed , local therapy , heat , etc., because for fractures,
dislocations and other symptoms caused by increased content of symptomatic treatment is required , closed -type release
due mainly adapted to the transverse carpal ligament contracture, thickening caused by carpal tunnel syndrome.
Treatment
Position: the patient sitting, wrists flat on the treatment table , wrist underlay pillow ;
Landmarks : the patient hard fist wrist flexion , wrist palmar may have three longitudinal ridges on the skin , carpal tunnel
wrist band is located between the three tendons .
Therapeutic range : tension, contracture ] , thickening of the transverse carpal ligament ;
In the transverse carpal ligament partial ulnar midpoint of the needle , and the needle perpendicular to the skin , the needle
blade is parallel with the tendon , and vertical transverse carpal ligament , the tip of the transverse carpal ligament , the
patient may have a significant wrist pain sensation, pin blade along the transverse carpal ligament contracture tension
longitudinal ligament cut , cut each time the ligament , there is a sense of frustration that is under the needle stop , self
contracture of the transverse ligament tension after the release of the needle , hemostasis few minutes, Band-Aid topical.
General treatment once a week , after the next local feasible heat, physical therapy and other treatments to promote the
absorption of inflammation . In addition to the symptoms, subject to carpal tunnel tenderness disappears side to cure .
Note: Note that a sense of frustration needle position and intraoperative needle blade , piercing too deep to prevent
accidental injury of the median nerve and other tendon.
9 flexor tendon sheath release stenotic
Refers to the flexor tenosynovitis can occur at any fingers, thumb called " tenosynovitis flexor hallucis longus ," also known
as " snapping thumb ." In other finger flexor tendon tenosynovitis was , saying " snapping finger " or " trigger finger ." The
incidence of the disease in more than a thumb , a minority of patients the incidence of multiple fingers , more women than
men , higher incidence in the elderly , but there are also those children with congenital tenosynovitis .
Applied anatomy
Metacarpal neck and the metacarpophalangeal joint ligaments shallow trench with a narrow sheath rigid fibrous tubes ,
synovial sheath layer , the flexor pollicis longus can slide back and forth substantially the rest of each finger flexor tendon
sheath is also constraints on its metacarpal bones and phalanges . Flexor tendon sheath surrounding the superficial flexor
tendon and the deep flexor tendon , the tendon sheath fibers from the outer sheath and the inner composition of synovial
sheath , tendon fiber plays protect and lubricate the tendon sheath to avoid friction effect.
Etiology and pathology
Finger flexion often make flexor tendon and bone fiber tubes repeated friction , or long-term force grip hard, bony fiber tube
by a hard object and metacarpal bones of both extrusion, local congestion , edema, followed by fiber tube degeneration,
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stenosis , flexor tendon surface and consequent pressure tapering at both ends was swollen like fenugreek , hinder sliding
tendon , when swollen tendon through the narrow tunnel , the occurrence of the action and the sound bouncing who , it
said , snapping thumb or finger . Swelling of the tendon when not through the narrow tunnel , the fingers can not flex ,
claiming to be blocked.
Clinical manifestations
Slow onset of the disease , the initial risk refers to wake up stiff , pain, limb flexion difficult activity after elimination, there
snapping and pain after waking activity gradually disappear after 1-2 hours , the last morning when suffering that pain, can
not flex the day, there atresia, snapping and pain , joint pain in the fingers and not in the metacarpophalangeal joints . Check
the palm side of the finger , the metacarpal head tenderness , and reach a size of soybean nodules , press this nodules,
patients suffering from finger flexion nodules can be felt here below , otherwise a nodule on the move , and felt snapping
thus issued.
Diagnosis
1 is more common in women handicraft workers and families , slow onset gradually increased, limited finger movement only
in the early morning or after work tired , the palm side of the metacarpophalangeal joint of the limitations of pain, heat-
loving chills .
2 If the middle and late stages , the tendon sheath hypertrophy, finger flexion function disorders, snapping , a " trigger "
phenomenon, then severely hampered finger flexion and extension , a " lockout " phenomenon, in external help, only
flexion and extension .
3 Check the metacarpal bones , palmar palpable nodules, tenderness in the finger flexor , this nodule in playing dynamic.

Treatment Ideas
Early viable local therapy and suffering from hand hot water soak method for promoting local inflammation absorption
occurs when a patient refers to the phenomenon of snapping or latching need closure type release tension, contracture
flexor tendon sheath.
Treatment
Position: the patient sitting, suffering from palm up flat on the treatment table ;
Landmarks : risk refers to the palm side of the metacarpophalangeal joint is the projection of the flexor tendon sheath ;
Therapeutic range : narrow finger flexor tendon sheath suffering ;
Risk refers to the palm side of the metacarpophalangeal joint of the needle , the needle body and the skin vertically , the tip
of the tendon sheath layer , the needle blade is parallel with the tendon , and the tendon sheath vertical incision narrow
sheath fiber , so there is a sense of frustration that is under the needle to stop , cut when partial cutting sound can be heard
clearly , self contracture of the transverse ligament tension after the release of the needle , hemostasis few minutes, Band-
Aid topical. Then too passive dorsiflexion of the metacarpophalangeal joint palm several times to help relax the late release
of the tendon sheath .
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . During treatment with topical therapy and suffering from hand hot bubble and functional training can accelerate
the absorption of inflammation .
Note:
A needle blade will narrow to release the tendon sheath , the blade can not be too many needles piercing deep within the
tendon , causing iatrogenic tendon rupture ;
Do not deviate from the 2-pin blade sheath middle fingers to avoid injuries to the nerves and blood vessels on both sides ,
3 narrow tendon sheath can change shape to form fenugreek , subcutaneous palpable sense of multiple sclerosis, and can
not be mistaken for scar nodules, with a knife to cut.
10 ischial tuberosity decline capsular release
Ischial tuberosity bursitis is a common disorder , also known as "weaving hip " or " ischial tuberosity cysts " and more
engaged in sedentary work occurs in the elderly, especially the more frail elderly, More common in women , it is also known
29

as the " old lady hip tumor ." Also be due to damage caused by bursitis acute changes .
Applied anatomy
Ischial tuberosity bursa is located deep to the gluteus maximus , gluteus maximus between the ischial tuberosity and
synovial tissue of the bladder is a gap , it 's the inner wall of the synovium , synovial capsule a little .
Etiology and pathology
Ischial tuberosity bursitis chronic injury more common , due to the ischial tuberosity bursa long been oppressed and friction
, congestion and edema synovial hyperplasia, fibrous wall thickening , intracapsular mucus secretion, reducing the
absorption caused by a small number of hip Dayton contusion caused .
Clinical manifestations
Multi stumbled lumps or pain or discomfort when found , discovered a lump touch exist , ischial tuberosity bursa becomes
inflamed , the local swelling, tenderness , in the deeper portion of the ischial tuberosity can touch the edge of the oval
clearer the mass and the ischial tuberosity portion with adhesions , most patients have cushion -like feel , some patients feel
sitting tenderness, not seated serious sit down , when the bursa fluid perennial Needless, no tenderness , or lateral position
in Zhouxi bit , buttocks ischial tuberosity seen at 4-15cm in diameter size ranging from high surface such as cystic height of
about 3-4cm, the base can not move , touch unclear ischial tuberosity , the surface skin friction pressure was due to long-
term brown or rough texture .
Diagnosis
The incidence of working more with long sitting , the elderly, especially those related to health than thin.
Ischial tuberosity tenderness is the only positive signs of the disease ;
Pain occurs immediately when the patient chair , disappeared immediately when starting .
Ischial tuberosity local anesthesia in patients after sitting on a hard chair , without discomfort, can be confirmed.
Differential Diagnosis
The disease must be differentiated with piriformis syndrome , which is hip pain , tenderness in the piriformis projection area
, ischial tuberosity no pain , and thigh internal rotation , external rotation , stretching exercise can aggravate the sciatic
nerve pain, and radiating pain occurs .
Treatment Ideas
Acute phase should be properly bed rest , avoid sitting hard bench can be used to alleviate the symptoms , such as local heat
treatment closure , soft stool to sit for long duration feasible partial release sliding wall thickening , intracapsular pressure to
change in order to reduce the local pathological changes for long duration and localized tumor is too large too thick wall are
required surgical resection downstream bursa .
Treatment
Position: on the ipsilateral side in patients desirable , tuck your hands in the chest ;
Landmarks : about 1cm below the ischial tuberosity for the projection of the ischial tuberosity bursa ;
Therapeutic range : ischial tuberosity sliding wall ;
About 1cm below the ischial tuberosity , the most obvious tenderness at the needle , and the needle perpendicular to the
skin , the needle edge of the slide wall portion of the patient may feel a clear sense of local pain, doctors who self-
inductance of the organization under the needle hard and difficult to stab in, lift and thrust up and down the wall cut way to
reduce hypertension and changes in aseptic inflammation intracapsular local organizations. Due to the ischial tuberosity
bursa wide range of wall and thick, does not absorb, thus need be layered graded release, longer course of treatment , but
treatment can relieve local symptoms and reduce each mass range.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
Precautions
Tuck your hands on the chest of the lateral position on the gluteus maximus can mention the decline in favor of the ischial
tuberosity sac exposed.
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11 gluteus greater trochanter bursa release
Trochanter bursitis mostly due to trauma , chronic fatigue , inflammation or by the chemical , physical stimulation, causing
excessive exudate , or cause incomplete adhesion, resulting in clinical symptoms , or may be purulent synovitis tuberculous
inflammation.
Applied anatomy
Gluteus maximus in hip behind a piece of muscle hypertrophy , and upright postures , starting at the outside of the ilium ,
the iliac crest 1 /4 at the back of the sacrum near the iliac , coccyx side and back fascia. TDC is located behind the femur the
greater trochanter , femur thick and iliotibial fascia lata , gluteus maximus dominated by the inferior gluteal nerve , muscle
fibers from the starting point down outside, forming part of the rear ends of the femur gluteal tendon thick lines , outside
the tendon between the vastus lateralis muscle of a large bursa , a larger muscle tendon bursa between the medial femoral
after . conducive gluteal diastolic , systolic motion , this bursa are uncertain or additional bursa .
Etiology and pathology
In life it is in the gluteus maximus and trochanter continued to rub against each other long , so in order to adapt to the local
friction and oppression , greater trochanter bursa occur secondary to connective tissue , and produce chronic inflammation,
this inflammation are no bacterial inflammation, the early days of intracapsular serous exudate increases , the formation of
the limitations of swelling , lack of sliding wall thickening , exudate malabsorption, a chronic mass, greater trochanter
bursitis usually no obvious trauma .
Clinical manifestations
When the disease may have a fullness and a large portion of the rear rotor depression disappeared , local tenderness , pain
was run, jump or walk for a long time , in order to alleviate pain, often in limb flexion , abduction , and external rotation
position, such as the passive rotation increased pain , hip flexion and extension activities are not restricted .
Diagnosis
The outer side of hip pain and discomfort , especially in the long run, jump or walk obvious ;
Often in limb flexion , abduction, external rotation position, to make the buttock muscles relax relieve pain.
Large parts of fullness and the rear rotor depression disappeared , local tenderness , severe cases can reach sac sexy ;
The passive limb rotation can cause pain , hip flexion and extension activities are not restricted
X -ray examination often negative , calcified plaque visible minority duration of the elderly .
Differential Diagnosis
The disease is required and the greater trochanter bursitis pyogenic and tubercular phase identification , trochanteric bursa
can cause acute suppurative or tuberculous infection, acute infection if not obvious , you might as tuberculosis infection ,
according to their local and clinically systemic inflammatory symptoms be identified .
Treatment Ideas
Acute phase should be properly bed rest, can be used to ease the symptoms techniques, drugs, closed treatment, the
infection should be early incision and drainage of purulent , tuberculous bursitis TB drugs must be controlled in addition to
the downstream section of the bursa surgery , for due chronic fatigue caused by long-term , and long treatment , due to the
large rotor wall thickening , increased intracapsular pressure to adopt a closed -type release therapy.
Treatment
Position: lateral position, affected side up ;
Landmarks : the greater trochanter trochanter bursa is inside the projection area .
Therapeutic range : greater trochanter sliding wall
In the medial femoral trochanter bursa , that the most obvious tenderness at the needle , the needle body and the skin
vertically , parallel to the fibers of the gluteus maximus needle blade and needle edge of the slide wall portion of the patient
may feel a sense of local obvious pain, the doctor from sense stitch under hard and difficult to penetrate , lift and thrust up
and down the wall cut way to reduce hypertension and changes in aseptic inflammation intracapsular local organizations.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
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Precautions
Wider area of the greater trochanter bursa , treatment should pay attention to possible treatment clear.
12 popliteal muscle release
Popliteal muscle in one of the most clinically easily damaged muscle , but many people are not paying attention , no age
limit , the clinical symptoms were not squat down stairs difficult , long duration leg pain , stiff, there nighttime pain woke
phenomenon .
Applied anatomy
Popliteus muscle flat , small triangular muscle, gastrocnemius located deep to the upper end of the rear upper end of the
tibia , with a smaller outer upper muscle tendons starting 3.0cm from the femoral condyles , in addition to the effect from
the popliteal arcuate fascicle ligament , lateral meniscus of the knee joint capsule adjacent the outer edge and bottom
oblique muscle fibers , the femoral biceps tendon , popliteal line up over the tibia bone surface between the fibular
collateral ligament and lateral meniscus , tibial nerve nerve , close to the middle of the back of the popliteal muscle popliteal
vessels and tibial nerve . In addition to making the role of the popliteal muscle tibial internal rotation , external rotation of
the femur outside , play an important role in maintaining the stability of the knee , when fully extended knee started
buckling, popliteal muscle is generally considered the start of muscle , and when the external femoral rotation knee flexion,
the most obvious popliteal muscle activity to assist the arcuate popliteal ligament prevents forward dislocation of the femur
.
Etiology and pathology
Was in the final straight and knee flexion movement began in highly non-linear movement, that Sinatra, accompanied by a
significant rotational movement stretched the main movement, this movement mainly depends on the coupling quadriceps
completed rotation ( padlock ) movement , they rely on the popliteal muscle contraction to release buckle lock mechanism.
When the stairs when climbing knee flexion major, then the leg is fixed , thigh extensor process in foreign spin , popliteal
muscle easily damaged due to excessive force , popliteal muscle is torn , osmotic swelling out , because the muscle is deep ,
with the exception of knee flexion and extension appears limited , in general, do not cause obvious symptoms localized ,
with the continuous development of the disease , popliteal muscle fibers thicken and fibrosis affects the tibial nerve from
the nerve by the emergence of dominated parts of irritation .
Clinical manifestations
Mainly in the squat or knee pain up , some patients can only squat stool for many years , very painful , in the upstairs,
climbing can also occur when the knee pain, most of the chronic injury manifested as blunt pain, acute damage is severe or
more severe pain or involve tearing like pain, knee pain and more to the Ministry of the site or the outer side of the knee
pain, pain due to deep tissue positioning is not as clear as the skin, such as involving the popliteal muscle behind the tibial
nerve , the pain may radiate to the back of the calf and heel . Muscle injury in the following three parts tenderness and more
obvious: a popliteal muscle in the back of the tibia muscle belly ; popliteal angle after two lateral meniscus and the joint
capsule and tendon between the muscle crypt ; 3 popliteal muscle in the femoral condyle foreign starting point.
Diagnosis
1 more common in middle-aged women , with a clear history of trauma or strain ;
2 patients with knee pain when crouching or together ;
3 popliteal muscle behind tibial muscle belly obvious tenderness , multi- medial collateral ligament injury and coexistence ;
4 legs fixed , can aggravate symptoms of external rotation leg , long duration group may have the calf muscle tension , pain
may radiate to the back of the calf and heel .
5X -ray examination is often negative.
Differential Diagnosis
Calf muscle injury, heel spurs and heel fat pad inflammation phase do not .
Treatment Ideas
Acute injury should be fixed brake , local application of traditional Chinese medicine to promote absorption , until symptoms
tendon therapy with local practices ; For long duration , popliteal muscle strain evident , palpable abdominal muscles hard
32

streaks are required to release the line closed -type treatment , and with local therapy .
Treatment
Position: prone position , ankle cushions , exposed knee popliteal and rear leg , and to the knee slightly bent ;
Landmarks : 3cm lower medial popliteal popliteal muscle that is the only point in the tibia ;
Therapeutic range : popliteal muscle and fascia tissue in the tibial muscle belly point contracture tension bone ended .
Needle blade and leg parallel vertical limb needle body and skin in the popliteal muscle and fascia tissue in tibial muscle belly
point contracture tension bone ended , that tenderness for the most obvious progress , turned the direction of the needle
when the needle blade edge near the bone surface , the needle with the popliteal muscle fibers parallel to the blade , lift
and thrust between the upper and lower abdominal adhesions law Jieji pine needles push the blade along the bone surface
adhesion lysis method and tibial muscle surface . When the needle edge of the popliteal muscle contracture tension in the
muscle belly , patients may have localized soreness obvious pain , soreness under the needle to be self-inductance of pain in
patients with reduced or disappeared after the needle , oppression pinhole moment, Band-Aid topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
Precautions
Note that the needle blade direction , especially when the muscle belly release, should pay attention to the tibial nerve and
blood vessels in its surface .
13 knee medial collateral ligament release
Knee medial collateral ligament is an important organization to protect the knee stable injury more common , if not timely
diagnosis and treatment of knee ligament damage , loss of opportunity for early repair , often left varying degrees of knee
instability, instability easily repeated knee injuries , resulting in thigh muscle atrophy and traumatic arthritis.
Applied anatomy
Located inside the medial collateral ligament of the knee , it is important ligament structure to maintain the stability of the
knee , the ligament flat wide triangular base forward , tip back , under the classification of the anterior longitudinal portion
and a rear portion of the ramp oblique , front vertical portion of the medial femoral condyle starting on the downward
oblique medial tibia beyond the edge of the ramp after the Ministry backwards from the front edge of the vertical portion of
the next , beyond the edge of the medial tibial joints and attached to the medial meniscus inner edge , since the lower
oblique portion of the front edge of the vertical portion of the rear oblique , beyond the edge of the edge of the tibial
condyle and medial meniscus in the knee fully extended, the medial collateral ligament of the most intense , can prevent
knee any activity valgus and leg rotation , while half knee flexion, lateral collateral ligament relaxation , knee instability,
there is a certain maneuver calf activities easily damaged.
Etiology and pathology
Knee ligament injuries , most occurred in the inside of the normal knee , about 5-10 degrees of valgus , lateral knee hit by
the impact of strong violence or pressure , so that excessive valgus and medial knee injury collateral ligament , so some or all
of fracture , but also because of knee flexion at the time , the calf suddenly abduction, external rotation , or fixed in the foot
when suddenly thigh adduction , internal rotation occur medial knee ligament injury, medial collateral ligament of the deep
fibers connected with the medial meniscus , so in the deep fiber breakage , it is possible to simultaneously produce medial
meniscus tear, even concurrent cruciate ligament tear, called a knee injury clinical triad . After the lateral collateral ligament
tear, the stability of the knee weakened, if not treated properly , then the broken fiber retraction, scarring connection ,
causing ligament Chi Zhang weakness, knee dysfunction .
Clinical manifestations
Generally have a significant history of trauma, knee injured side local pain, swelling, and sometimes bruising, can not fully
straighten the knee . Tenderness obviously ligament damage , while the medial collateral ligament injury, tenderness often
on the lower edge of the medial condyle or tibial condyle in femur stress test side , knee extension , the examiner hand
holding the ankle injured limb , and the other inside or outside of a palm thenar withstand lap portion, strong leg adduction
or abduction , as part of the medial collateral ligament injury, damage due to involved , because ligament injury causes pain
33

involved when adduction abduction , such as complete and tear , there are abnormal adduction activity .
Diagnosis
1 more common in the elderly, there is strain history ;
2 medial knee pain , even visible swelling, particularly when the leg eversion ;
3 medial tenderness , often on the medial femoral condyle or tibial condyle of the lower edge of the common ;
4 knee lateral stress test was positive , to impose local anesthesia at the inside of tenderness , the symptoms can be
alleviated ;
5 valgus stress -bit X -ray shows medial gap widened .
Differential Diagnosis
A cruciate ligament injury : severe pain , knee swelling significantly , drawer test was positive.
2 meniscus : joint space limitations at the pain , when interlocking joints snapping, grinding tests , Jimmy 's sign positive.
Treatment Ideas
Acute phase of a partially torn knee ligament , should be fixed brake to facilitate wound healing , complete rupture , should
prompt surgical repair for chronic fatigue or injury caused by tearing of scar formation after a closed -type release treatment
are required . And with local therapy and TCM herbs .
Treatment
Position: the patient supine, thigh limb abduction 40 degrees , knee pillow outside , exposed and fixed medial knee ;
Landmarks : medial collateral ligament is triangular ;
Therapeutic range : collateral ligaments in the knee contracture and ligament fibers and bone adhesion ; find obvious
tenderness and hard streaks medial collateral ligament in the knee area of the needle , and the needle perpendicular to the
skin , the needle blade parallel with the lateral collateral ligament fibers when the needle blade sticking up contracture
ligament fibers , the patient may feel pain unbearable local doctors who adopt the way up and down the lift and thrust
strained ligament fibers will contracture release , the use of bone surface to push the needle blade cut the ligament fibers
and release techniques bone surface adhesion . When the sense of pain in patients with reduced self-inductance of the
needle under doctor contracture organization a sense of relaxation after the needle , oppression few minutes, Band-Aid
topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
Precautions
Postoperative hemostasis required number of points, so as not to affect the efficacy of bleeding .
14 knee ligament release
Knee ligament , also known as anterior cruciate ligament , divided into anterior and posterior cruciate ligaments, and knee
ligament it , patellar tendon , knee flexion muscles, joint capsule together to maintain the stability of the joint.
Applied anatomy
Anterior cruciate ligament in the knee starting from the front of the tibial eminence , backwards, on the inner surface of the
outer ends of the femoral condyle , from the rear of the posterior cruciate ligament from the tibial eminence among the
former crossed cross medial ligament , forward , on the outer ends of the medial femoral condyle , posterior cruciate
ligament anterior cruciate ligament over the thick , its strength is 2 times the anterior cruciate ligament of the knee ,
whether straight or bent , front and rear cruciate ligament showed a state of tension, the anterior cruciate ligament can be
prevent forward movement of the tibia and external rotation , posterior cruciate ligament prevents the tibia moves
backward , ligament plays an important role in stabilizing the knee joint sports .
Etiology and pathology
Cruciate ligament knee deep, knee posterior cruciate ligament is the most powerful ligament , anterior cruciate ligament
strength and only half , thus , before the cruciate ligament injury more common, simple cruciate ligament injury is rare,
many accompanied by collateral ligament and meniscus damage. Anterior cruciate ligament rupture and more powerful
knee hyperextension injury or the result of outreach , in a non- weight-bearing strength can occur before a simple
34

hyperextension cruciate ligament injury before flexion cruciate ligament injury can occur , anterior cruciate ligament rupture
occurred in the attachment of the femoral condyle , posterior cruciate ligament rupture by knee position tibia combat
violence before the latter , so that the leg segment due to a sudden setback , or violence in the knee hyperextended lead
after cruciate ligament rupture , posterior cruciate ligament the site of the fracture in the femoral condyles and more
attached to the Ministry .
Clinical manifestations
Knee obvious history of trauma , may have tearing knee injured , injured knee pain, swelling sense , joint instability ,
movement disorder, check joint swelling, joint tenderness outside unclear , such as swelling spread to the popliteal fossa
and legs, drawer test was positive : knees 90 degrees, fixed femur , upper leg checked by both hands , pull forward or push
back the tibia. Such as anterior cruciate ligament rupture , tibia forward abnormal activity ; such as posterior cruciate
ligament rupture , tibia backwards abnormal activity .
Diagnosis
A history of knee injuries .
2 injured consciously or tearing sound in the relevant section of tearing , severe pain, dysfunction.
3 drawer test was positive.
Treatment Ideas
Pure before or after cruciate ligament insufficiency fracture , available around Plaster fixed ; For after cruciate ligament
rupture , should be promptly treated with surgery ; knee ligament injury late cross , the relevant section of flexion and
extension function is limited , should adopt a closed -type song solution adhesions, restore knee function .
Treatment
Position: the patient supine, elevate the limb below the knee pillow , so that the limb knee flexion at nearly 90 degrees and
fixed.
Landmarks : the tibiofemoral knee joint on both sides of the depression ( joint space )
Therapeutic range : knee tibial crest ending at the intersection ligament ;
Select knee clearance into the needle, and the needle perpendicular to the skin , the needle blade parallel with the joint
space , reached after intra-articular , change the direction of the needle body , so that between the tip along eminence ,
entered when the tip of the knee intercondylar ridge , the patient partial acid can feel a sense of unbearable pain , the
doctor uses the way up and down the lift and thrust to stimulate the tendon tissue beyond the intercondylar crest on local
patients to alleviate the sense of pain upon needle , oppression few minutes, Band-Aid topical.
General treatment once a week until local symptoms and tenderness disappeared completely feasible function after
exercise . With local therapy can accelerate the absorption of inflammation during treatment.
Precautions
Due to the deeper parts , are required to use longer needles for treatment , while the general intra-articular injection of
local anesthetic should not be , the treatment response in patients with more pronounced , patients do ideological work
required before treatment with better with treatment.
15 knee synovitis
Knee trauma -induced aseptic synovial inflammation, known as knee synovitis .
Applied anatomy
Synovial joints in the knee is the largest joint in the area , apart from intra-articular distal femur , tibia and patella cartilage
platform , most of the rest are covered by synovium . Full of blood vessels in the synovium , rich blood supply , synovial cells
secrete synovial fluid, articular cartilage can be kept lubricated to reduce friction , and can spread the heat generated when
the joint activity .
Etiology and pathology
Depending on the size and long-term strain violent stimuli can be divided into acute synovitis and chronic synovitis .
Acute synovitis usually caused by a direct blow to the violence . Contusion , trauma, periarticular fractures, surgical
stimulation , joint sprain . Synovial injured after the main reaction in two ways: 1 ) synovial vasodilatation : plasma, blood
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cells, red blood cells and giant cells into the synovial fluid extravasation , fibrin deposition, 2 ) active synovial cell hyperplasia
, and produce large amounts of synovial fluid , too much fluid in the joints, can increase intra-articular pressure , stimulate
the nerve endings so the pain got worse , reflex muscle spasm. And synovial fluid containing white blood cells, red blood
cells, bilirubin , fat, fiber and protein mucin , so that synovial hypertrophy , fibrosis, causing joint adhesions, cartilage
atrophy, affecting joints .
Synovitis chronic injury to exudation mainly from acute traumatic synovitis general rule turned into a loss , or other chronic
fatigue caused by chronic fatigue occurs in the elderly, obese or over knee weight-bearing joints of people with chronic
inflammatory damage caused by synovial effusion , joint effusion, is a Chinese " arthralgia " range , and more from the wind
cold dampness from three gas hybrid , the general dampness by many, or obese people, moisture bet on joint disease.
Clinical manifestations
After knee trauma or strain , joint gradually swelling, pain , limited mobility , pain with a lighter sense of pain in the knee in
full extension or flexion more obvious sense of pain , knee adverse events , limp , tenderness point is not fixed, skin
temperature can be increased , according to the sense of volatility, floating patella test positive , such as fluid a long time
may have quadriceps atrophy, synovial hypertrophy obvious sense , joint puncture fluid can be bloody , pink or yellow
bacterial culture was negative.
Have a history of chronic synovitis or joint pain, fatigue , knee swelling, fullness discomfort, difficulty squatting , or up and
down stairs pain, increased fatigue , rest after mitigation , skin temperature is normal, floating patella test positive , long
duration then shares four muscular atrophy , synovial wall thickening , thick touch of a tough feeling, joint instability , limited
mobility, joint puncture can be drawn clear yellowish exudate , the surface without fat droplets .
X -ray film is generally no more changes in bone , joint effusion long shadow visible swelling of the joint capsule distension .
Joint degenerative changes seen in the elderly or intra-articular loose bodies .
Diagnosis
A history of trauma or strain history , found in different ages ;
2 knee swelling, pain , limited mobility, hi hi still not moving ;
No significant tenderness around three knee puncture can be removed yellowish exudate ;
4 floating patella test positive ;
5 X -ray film is generally no more changes in bone , joint effusion, more than those gaps can be widened .
Differential Diagnosis
A pigmented villonodular synovitis : more often in middle-aged men than women , the majority of knee trauma , joint
swelling, when light weight , longer course, limited joint mobility is not obvious, and sometimes skin temperature slightly
higher duration of the elderly palpable sense of synovial hypertrophy , usually no systemic symptoms , body temperature is
not high , normal blood , bloody joint puncture may be withdrawn or brown cloudy liquid.
2 synovial tuberculosis : diffuse swelling of the joints , synovial hypertrophy, fusiform appearance , few joint effusion , pain,
joint mobility , fever, weight loss, anorexia and other symptoms , ESR fast , X-ray visible universal joints loose bone , joint
puncture can be removed beige cloudy liquid.
Treatment Ideas
Early brake should rest mainly to reduce the generation and promotion of fluid absorption , more than those for joint
effusion , joint effusion in the net can be pumped and injected Diprospan . When the latter occurs when chronic synovitis
and joint knee contracture tension surrounding tissue , you need to promote the local release of synovial absorption and
functional exercise. For obvious synovial hyperplasia feasible arthroscopic synovectomy .
Treatment
Position: supine , suffering from knee booster pillow, so that the knee flexion in the range of 45 degrees ;
Landmarks : the knee patella , and patellar articular cavity.
Therapeutic range: the knee patella, patellar and intra-articular synovial;
On the knee patella, patellar and joint space under the needle, the needle body and the skin perpendicular to the needle up
36

and down the edge of the synovial mention interpolation procedure, stimulate blood circulation within the synovium,
synovial to promote absorption, treatment process, patients may have localized pain unbearable feeling, a sense of pain
when the needle to reduce patient, oppression few minutes, Band-Aid topical.
General treatment once a week, due to the proliferation of synovial wider area, should be graded sub-site for treatment. If
after local therapy can help with the absorption of inflammation.
Precautions
Note identification and other diseases.
16 peroneal nerve fiber tubes release
Peroneal nerve entrapment syndrome is a common peroneal nerve at the fibular neck compression caused by a series of
symptoms, is the more common form of lower extremity peripheral nerve entrapment syndrome.
Applied anatomy
Peroneal nerve originate in the lumbar total of 4,5 and 1,2 sacral nerve in the thigh segment branch issued only a short head
of the biceps femoris, popliteal and after lumbar nerve separated downstream on the outside of the popliteal fossa, a small
place in the level of the fibular head across the gastrocnemius and soleus muscles, and then down into the outer side of the
fibula bone jugular groove and the peroneus longus muscle fiber bow deep fascia and bone fiber tube composed of peroneal
nerve through this tube into the leg, in the tube of the deep peroneal nerve branch, the dominant tibialis anterior, extensor
digitorum longus, and the third fibula, thumb extensor plantar brevis and the first dorsal metatarsal between two muscle;
peroneal branch: to musculocutaneous nerve, dominated fibula long and short muscle, cutaneous branch company back
foot feeling, back support joints and tibialis anterior muscle control.
Etiology and Pathology
Due to the common peroneal nerve in the peroneus longus fiber tube during its elastic limit has maximum exposure before
the fracture load is far better than other parts, in acute and chronic injury, easy to make bone fiber tube hypertension and
oppression of the common peroneal nerve, in addition , local compression factors fibula head and neck tumors or cysts,
sitting cross-legged alien oppression have long, extreme flexion position, squatting too long, the fibular neck fractures also
cause stenosis, or bleeding form fibrosis, Philippians Total nerve damage, improper bedridden patient position, also can
cause the common peroneal nerve injury.
Clinical manifestations
Performance in the foot and lower leg lateral pain, the pain increased passive foot inversion, muscle weakness, ankle and
toe flexion weakness, valgus activities weakness, paralysis until, foot varus deformity was sagging, tenderness fibular head,
leg and lateral dorsal sensory disturbances or sensory loss, and sometimes local palpable mass. Fibular neck Tienl positive
signs, symptoms are severe, occur foot drop, the need to exalt the knee, hip, foot thrown upward.
Diagnosis
1 small head of the lesions in trauma or other fibula;
2 leg extensor weakened or incomplete paralysis;
All three dorsal region feel deletion, in particular the fifth toe feeling;
4 fibular head office tenderness, can lead to lower limb symptoms get worse;
5 fibular neck Tienl positive sign.
Differential Diagnosis
A lumbar disc herniation: In addition to the outside of the leg symptoms in patients with a history of lower back, lumbar
spine CT or MRI showed a prominent phenomenon of lumbar intervertebral disc 4,5. Straight leg raising test was positive;
2 sciatica: In addition to the small leg symptoms, hip piriformis tenderness, piriformis test positive.
Treatment Ideas
For local lesions such as: fibular head and neck tumors or cysts, or fibular neck fractures, peroneal nerve compression
syndrome respond to treatment-induced; For acute and chronic damage to the bone fiber tube pressure is increased to
produce symptoms The model can be closed soft tissue release and bone peroneal nerve fiber tubes, and with local therapy
and other methods of treatment.
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Treatment
Position: ipsilateral side up body;
Landmarks: the head of the fibula below the upper lateral fibular neck, the Charcot-Marie-ending point, avoiding the
common peroneal nerve release;
Therapeutic range: contracture tension bone peroneal nerve fiber tubes;
Below the fibular head, the lateral fibular neck top, the most obvious tenderness at the needle, the needle blade angle of 45
degrees with the lower leg, which is parallel with the peroneal nerve fibers, and the peroneal nerve fiber tubes
perpendicular to the bone, the needle when the edge of the bone fiber tube Patients may have significant localized soreness
pain, slow down the lift and thrust needle blade, about promoting bone lysis peroneal nerve fiber tube tension and
contracture, the standby pin inductance soreness pain patients reduce or disappear after the needle , oppression pinhole
moment, Band-Aid topical.
General treatment once a week until the lower limb symptoms and tenderness disappeared after feasible functional
exercise. With local therapy can accelerate the absorption of inflammation during treatment.
Precautions
Therapy should be closely observed in patients with partial response, if local anesthesia appears to lower extremity pain or
radiation localized tingling occurs, they should immediately adjust the direction of the needle blade, mistakenly stabbed
excessive nerves or blood vessels.
17 from the front ligament release (ankle sprain)
Ankle sprain is prone to injury in daily life, because the ankle bones, ligaments and muscles of the foot features turn-based
clinical practice within the common essence of ankle sprain is ligament damage, mainly from Philippi former common
ligament injury.
Applied anatomy
The main ligaments around the ankle has medial collateral ligament, lateral collateral ligament and the inferior tibiofibular
ligament, medial collateral ligament, also known as the deltoid ligament, starting in the medial malleolus, from top to
bottom fanned attached to the foot of the scaphoid, talus inside before the next ligament and the calcaneus with the boat
set out from the sudden, is a strong ligament, easy to damage, starting from the lateral collateral ligament and lateral
malleolus, beyond the anterolateral talar peroneal ligament from the front, and ends with fibular ligament calcaneus to the
outside, beyond the posterolateral talus from peroneal ligament; inferior tibiofibular syndesmosis ligament ligament, also
known as the interosseous ligament between the tibia and fibula, and is important to maintain a stable ankle ligaments.
Etiology and pathology
Usually caused by a sudden step when walking or running on uneven ground, or up and down stairs, walking pathway
accidentally stumble, cycling, football and other sports in a fall, or walking, running, jumping riding on uneven ground when
the resulting inversion ankle plantar flexion ground, so that the lateral collateral ligament suffered too much traction tension
injury occurs, turn the metatarsal injury, Philippians easy to damage from the outside of the front ligament injury when the
simple turn, can easily damage fibular ligament with the outside.
Clinical manifestations
A clear history of ankle sprains, ankle swelling after injury, damage light only local swelling, limping gait, not force a foot
injury, the pain intensified activities. When varus injury, significantly below the pre-lateral tenderness, if you are going to
turn for action in the foot, the pain before the bottom of the lateral malleolus. X-ray films without fracture characteristics,
can make a diagnosis.
Diagnosis
An obvious history of trauma;
2 acute phase of ankle swelling, limping gait, chronic swelling reduced, but still causes pain when forced to the ground;
3 before the bottom of the lateral malleolus tenderness;
When turning movements within 4 feet for, before the bottom of the lateral pain.
5 ankle and lateral X-ray to exclude fracture and dislocation.
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Differential Diagnosis
An ankle fracture, dislocation: local tenderness, may have deformities, bone fricative, etc., X-ray fracture dislocation
syndrome.
2 calcaneal fractures: swelling, tenderness of the calcaneus parts, X-ray has a calcaneal fracture characteristics.
Treatment Ideas
Ankle sprain early immobilization should make the necessary caution manual therapy, local topical medicine or physical
therapy may promote the repair of injury, are required to complete rupture of the ligament repair surgery, chronic ligament
contracture from the front and with the surrounding tissue adhesion , viable ligament and scar lysis
Treatment
Position: supine, the limb rotation, knee bolsters, fixed foot,
Landmarks: lateral depression under the square, between the talus and fibula
Therapeutic range: contracture, tight and deep front from the joint capsule and ligament tissue;
Depression between the talus and fibula at the front from the peroneal ligament needle, needle blade parallel with the
ligament fibers, needles from the edge of the front ligament, the patient may have significant soreness local pain, upper and
lower lift and thrust surgical loose ligament adhesions between the solution and contracture, if the patient also has deep
joint capsule contracture, needle edge of the deep tissues of patients also have partial sour feeling pain, soreness under the
needle to be self-inductance of pain in patients with reduced or disappeared after the needle, the needle oppression Hole
moment, Band-Aid topical.
General treatment once a week until the lower limb symptoms and tenderness disappeared behind the cure. With local
therapy or soak water can accelerate the absorption of inflammation during treatment.
Precautions
Occlusive release is the best method of treatment of such disorders.
18 tarsal tunnel syndrome
Tarsal tunnel syndrome (tunel syndrome) is the posterior tibial nerve and posterior tibial tendon in the tarsal tunnel
syndrome resulting from compression. Occurs in young adults, more common in men, the majority of those who engage in
manual labor or sports.
Applied anatomy
Ankle tube is inside ankle bone fibrous tunnel. About 2-2.5cm. At the tip of the medial malleolus from the top, down the
back ends of the calcaneus medial periosteal flexor support band, namely splitting ligament. Possession of the posterior
tibial tendon ankle, toe flexor tendon, posterior tibial vessels, posterior tibial nerve and flexor hallucis longus tendon.
Around the tendon sheath, nerves and blood vessels and tendons between the interval and a small amount of fat fibrous
connective tissue. Through the posterior tibial nerve behind the medial malleolus, the flexor 1-2 with support band issued
the following expenses, supply medial skin.
Etiology and pathology
Mostly ankle sprain, malunion. Chronic fatigue or local produce tenosynovitis. Or because of foot valgus deformity, and even
split the ligament tension increased, deepened the nerve, the posterior tibial tendon. For various reasons mentioned above
can cause tendon sheath edema, hyperemia, sheath wall thickening, luminal narrowing relative nerve tunnel syndrome
arising after ankle oppression tube tibia.
Clinical manifestations
Light often walking, after long standing or tired, uncomfortable feeling below the medial malleolus, local tenderness. The
heavier the inside bottom of the foot and the heel appears paresthesia or numbness, ankle pipe section has a fusiform mass,
knocking pressure can cause significant pain radiate to the foot, the toes can have shiny skin, hairs fall off, less sweat and
other plants signs of neurological disorders, may have intrinsic foot muscles atrophy. After checking below the medial
malleolus tenderness, or to the bottom of the foot channeling hemp tingling. When foot dorsiflexion eversion symptoms. x-
ray examination is sometimes visible from the inside of the calcaneal spur formation.
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Diagnosis
More than one person in young adults.
2 often sprain history or standing, waiting lines through ankle strain history. History are generally longer.
3 early after ankle pain occurs beneath the discomfort, and the rest related. Duration of the elderly, the inside of the heel
and the bottom of the foot may appear numb feeling.
4 tenderness beneath the medial malleolus to the bottom of the foot after channeling hemp or tingling.
When 5 foot dorsiflexion eversion symptoms.
6X-ray examination is sometimes visible from the inside of the calcaneal spur formation.
Differential Diagnosis
A medial ankle ligament sprain: typical foot eversion sprain history, swelling, severe pain, tenderness is more common in the
former site of the medial malleolus below. Ankle limited heavier. But no nerve compression symptoms, general
identification difficult.
2 inner ankle tenosynovitis: strain or sprain can cause repeated minor tenosynovitis, pain below the medial malleolus,
swelling, difficulties in walking, but the symptoms were mild and no foot numbness and autonomic dysfunction
phenomenon.
Treatment Ideas
Under normal circumstances may be using techniques, medications, acupuncture, closed treatment, if after 1-2 months after
treatment has no effect, or aggravated symptoms showed progressive type release treatment can be closed.
Treatment
Position: supine, slightly limb knee flexion and valgus, lateral knee pillow, fixed ankle and exposed to the inside of the ankle
joint.
Landmarks: the lower edge of the medial malleolus and the calcaneus final margin draw a straight line, the end of the
calcaneus medial malleolus and the leading edge of the leading edge of a straight line drawn between the two lines that sub-
surface projection of the ankle tube.
Therapeutic range: tension, division ligament contracture;
Partial ulnar collateral ligament in splitting the midpoint of the needle, the needle body perpendicular to the skin, the needle
blade parallel with the nerves and tendons, ligaments and split vertically, the tip of the split ligament, the patient may have
significant ankle pain sensation, the needle along the edge split longitudinal ligament ligament contracture tension cut, cut
each time the ligament, there is a sense of frustration that is under the needle stop, self contracture tension ligaments after
the release of the needle, hemostasis few minutes, Band-Aid topical.
General treatment once a week, after the next local feasible heat, physical therapy and other treatments to promote the
absorption of inflammation. In addition to the symptoms, subject to carpal tunnel tenderness disappears side to cure.
Precautions
Note that a sense of frustration needle position and intraoperative needle edge to prevent accidental injury penetrate too
deep tibial nerve and its accompanying blood vessels and tendons.
Achilles fell 19 capsular release
Achilles bursitis occur in the next 40-60 years of age in the elderly, usually caused by damage due to chronic fatigue.
Applied anatomy
Achilles is the body's most powerful tendon, calf triceps extension organization, attached to the calcaneal tuberosity, in the
triceps contraction has bent legs, put the heel and ankle fixed and prevent leaning forward and so on, is walking bouncing
the main tendon, tendon sheath around the two outer sheath is formed by the deep fascia of the leg, the directly attached
to the tendon sheath, similar to the structure of the synovial sheath, when the ankle flexion and extension when Achilles
account, mutual friction between the outer sheath and exercise, Achilles Lan Zhou Yan refers to inflammatory changes in the
tissue around the Achilles tendon (fat, fascia, tendon slipped sac) due to being caused by trauma or chronic fatigue.
Etiology and pathology
A direct violence injuries, Achilles tendon suddenly exposed to direct external impact, extrusion, frustrated, resulting in the
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Achilles tendon itself and the surrounding edema, and other inflammatory changes.
2 indirect violence injury, the human body bouncing, anxious to run, due to triceps too much force, the rapid muscle
contractions, causing Achilles tendon tear, sprains, and even cause inflammatory changes around the Achilles tendon
congestion, edema.
3 Chronic labor injury: a long-term Achilles tendon and surrounding tissue friction and repeated Achilles tendon injury, can
cause aseptic inflammation around the Achilles tendon.
Clinical manifestations
Acute injuries you can see around the Achilles tendon swelling, tenderness, ankle flexion can cause pain, sometimes
palpable crepitus for plantar flexion against resistance test increased pain, improper early treatment can cause hardening
around the Achilles tendon, ankle joint range of motion is limited by the range of motion becomes pain, the pain may be
reduced, but the ankle joint activities inconvenient, I find difficult up and down stairs, X-ray may be found around the
Achilles tendon calcification degeneration.
Diagnosis
An obvious history of ankle injury;
2 ankle flexion can cause pain;
3 Achilles obvious tenderness on both sides, long duration.
Treatment Ideas
Early local therapy should be used, soak in hot water, acupuncture and other methods, the proliferation of long duration or
bursa bursa release can be closed with obvious method of treatment.
Treatment
Position: the patient side, the lower limb, healthy limb knee slightly bent and placed on the front side of the body. Or prone
ankle dorsal pillow and fixed ankle.
Landmarks: between the Achilles tendon and the tibia both sides of depression;
Therapeutic range: under Achilles tendon bursa tissue hyperplasia;
Both sides of the needle in the depression between the Achilles tendon and the tibia, and the needle perpendicular to the
skin, the needle blade and Achilles tendon fibers parallel to the edge of the needle after surgical bursa do to stimulate
proliferation of synovial tissue up and down the lift and thrust to promote its absorption, the course of treatment the
patient may have local pain unbearable feeling, a sense of pain when the needle to reduce patient, oppression few minutes,
Band-Aid topical.
General treatment once a week, if after local therapy can help with the absorption of inflammation.
Precautions
Note identification and other diseases.
20 Foot Pain
Calcanodynia mainly refers to the underside of the calcaneus due to pain caused by chronic injury, difficulty walking based
illnesses. Occur in the 40-60 year-old Chinese medicine is generally believed that overwork, kidney deficiency can cause heel
pain, indicating little old bad blood, decreased activity, can occur with pain, clinically over 60 years old, with pain are rare .
Applied anatomy
The heel is a major part of the body weight, the analysis from the anatomy, with the lower part of the skin is the thickest
part of the body, due to subcutaneous fat dense and developed, called the fat pad. Since plantar fascia plantar calcaneal
tubercle, stretched forward along the bone surface and attached to the five toes fat pad and then stop at the periosteum,
the role is to maintain the longitudinal arch of the foot and plantar flexor tendon participation in activities; lateral plantar
issued a nerve in front of a small nerve to the flexor digitorum brevis and the plantar fascia and periosteum issuing branch to
the outside at the beginning of the calcaneal tuberosity of the calcaneus around the leading edge, nervous right through
from the deep surface of the plantar fascia.
Etiology and pathology
In normal walking, the body forward, toe dorsiflexion, plantar proximal phalanx plantar fascia stretch across the metatarsal
41

heads, this action causes plantar fascia in the beginning part of being pulled over, some of the plantar fascia is generated
High stress fibers, due to the ongoing plantar fascia starting high stress fibers are constantly being torn and repaired, the
beginning part of the body to enhance the strength, and calcium deposition, calcification and ossification, causing bone
hyperplasia, and from calcaneal tubercle extended forward, eventually forming bone assassination, its tip buried in plantar
plantar fascia. When bone assassination generally do not cause symptoms, but when the plantar fascia in high stress fibers
were torn again, local hemorrhage, edema, exudate, inflammatory cells immersed in blood circulation, metabolism and pain
caused by the accumulation of material, aseptic inflammation generating, clinical symptoms. Also during this pathology if
stimulation or repression from the deep surface of the plantar fascia in front of the nerve passes through, it will also cause
pain in the foot at the bottom, showing the phenomenon of heel pain.
Clinical manifestations
More common in middle-aged female patients, standing or walking, pain below the calcaneus, the pain may spread along
the plantar medial calcaneal forward to, especially after the morning, or after the break when the pain started to walk more
obvious pain after a period of inactivity Instead, relief, tenderness in the heel slightly negative focus plantar fascia at the
front. X-ray film in the calcaneus calcaneal attachment of the plantar fascia may have calcification, ossification flat and small,
sharp spines consistent with plantar tendon forward direction, but also whether the spur of the performance, the
pathological changes are mostly local aseptic inflammation and front fascia irritation or compression of nerves.
Diagnosis
1 more common in the elderly, may be no obvious history of trauma;
2 standing or walking, with lower pain, especially in the early morning or after resting at the start of walking obvious;
3 plantar fascia slightly ahead tenderness.
4 X-ray film showed a calcaneal attachment of the plantar fascia calcification.
Differential Diagnosis
1 Plantar fasciitis: under the heel of the sole has a sense of tension or passive stretching of the plantar fascia pain
aggravated, X-ray visible arch flattens.
2 calcaneal osteomyelitis: Although the symptoms with pain, but local pain, swelling and other symptoms of acute infection,
accompanied by severe systemic symptoms such as high fever, laboratory and X-ray can confirm the diagnosis.
3 calcaneus Tuberculosis: The disease occurs in young people, local symptoms, swelling larger range, poor general condition,
fever, night sweats, fatigue, weakness, loss of appetite, laboratory and X-ray examination can be identified.
Treatment Ideas
The disease is usually hot bubble foot treatments and other methods to in the course of a long time, repeatedly made by the
local release of the calcaneus can be high stress fibers, fibrous tissue or discharge under the plantar fascia contracture
tension, relieve nerve to front stimulation and oppression.
Treatment
Position: prone position, ankle pillow, so that the foot is exposed slightly upward.
Landmarks: the heel bottom 1/3 of the calcaneus leading edge of the plantar fascia dead;
Treatment Range 1) beyond the leading edge of high stress calcaneus plantar fascia fibers; 2) calcaneal dead deep plantar
fascia, the soft tissue irritation or compression of nerves in front;
In the bottom of the heel 1/3 of the calcaneus plantar fascia dead front, that is the most obvious tenderness at the needle,
the needle blade parallel with the plantar fascia, the needle edge of the plantar fascia ended, when patients have a
significant local when the sense of pain, turned the blade edge needle lines perpendicular to the plantar fascia, using
interpolation techniques to mention cutting down tight contracture plantar fascia, the plantar fascia surgical applicable
pathological changes caused by high stress fibers calcaneal spur; for Pathological changes in front of nerve entrapment can
pin down to edge along the plantar calcaneal bone surface, the passage about the use of surgical procedures, tissue
contracture release in front of nerve stimulation and squeeze the soft tissue; under the needle to be patient inductance acid
sense of pain decreased or disappeared after the needle, oppression pinhole moment, Band-Aid topical.
General treatment once a week, during treatment with topical treatments can accelerate the absorption of inflammation.
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Precautions
1 with pain pathology results can be obtained by X-ray analysis, X-ray renderer for obvious heel spurs, heel pain can be
considered multi-disease and high stress related to the plantar fascia, when the X-ray renderer without heel spur, but the
symptoms Performance and heel pain is the same, and more can be considered to be in front of nerve irritation or
entrapment due;
2 for the front nerve release surgery surgical needs attention, and not available up and down the lift and thrust of surgical
treatment to prevent damage in front of nerves, causing muscle atrophy dominated.
Common limbs attached tender points:
Limbs, tenderness point features: symptoms and signs (tender points) basic pathology and treatment site at the same site.
Therefore, the diagnosis is relatively simple, the pathological changes in the other four limbs mostly bursa, synovitis, starting
and ending points of muscle strain, ligament strain and bone fiber tubes or structural changes caused by increased pressure
within the nerves, blood vessels or tendons entrapment syndrome, treatment parts of the superficial, the surrounding tissue
is relatively less important, the treatments method requirements are not high, more suitable for beginners. Limbs on the
basis of common parts tenderness renowned surgeon Professor soft tissue sting declared the proposed combination with
other experts on clinical practice and summarized for your reference:
Upper part of the first section
A shoulder tenderness common parts
1. Tenderness in the upper corner of the scapula point: levator scapula attached to the lower end of the upper corner of the
scapula and the scapular spine edge of the inside of the top of the root. When levator scapula strain, there may be pain in
the top of the scapula; levator scapula attached to the upper end of the 1-4 transverse cervical, occipital and more will
appear next to the pain clinic, and to the front of the transmission, leads to the temple pain. Patients with bilateral severe
symptoms addition to the above signs, the seat reading, watching movies, etc. are often difficult to adhere to a few minutes.
More severe, often using both hands hold the lower jaw to support the weight of the head.
Inspection methods: patient sitting, the examiner stood behind, holding down the left and right sides, respectively, with a
double thumb tip and medial upper corner of the scapula levator scapula attachment for pressing slide up and down from
the inside out, you can look up tenderness.
2. Scapular spine edge tenderness: small and large rhomboid muscle rhomboid muscle are attached to the scapula spine
edge. The former is attached to the middle, that is the root of the scapular spine inside edge; latter in the next paragraph,
that the scapular spine and the lower edge of the Gungan angle. This two muscle attachment, especially when small
rhomboid muscle strain, and more will appear on the back pain.
Inspection methods: the patient sitting to the right side, for example, the examiner left standing on the patient, the patient's
right shoulder blade and hold the right hand; left hand placed on the same side of the shoulder before foreign to brake; then
press and hold the tip of the right thumb spine edge, fingertips and hold the axillary margin of 2-5. If the size of the lesions
appear rhomboid muscle attachment, when the tip of the thumb to slide the top down along the spine edge when pressed,
can Richard tenderness.
3. Scapula supraspinatus muscle tenderness: the supraspinatus muscle at the end attached to the supraspinatus fossa. Gang
discomfort soreness can occur on the supraspinatus fossa of the scapula when the muscle fatigue, severe cases will be
affected shoulder and arm drooping unbearable heaviness. Because this muscle is attached to the outer ends of the greater
tuberosity of the humerus above (ie pressure trace on the greater tuberosity), so when the autonomy of the shoulder
abduction to 90 , and the emergence of signs will increase foreign shoulder pain. The supraspinatus supraspinatus fossa
attachment will lead to neck and shoulder strain junction heavy discomfort or pain.
Inspection methods: patient sitting to the right side, for example, to check who stand on the right patient, with the right
thumb tip and hold the supraspinatus fossa on the right vertical surface of this bone for muscle attachment at the slide
pressed to Richard tenderness.
4. Trapezius (scapular - shoulder - collarbone) tender point: This muscle under the outer end of the attachment from the
edge of scapular from the inside edge of the shoulder within the outer edge of the outer segment go to the upper edge of
43

the clavicle. Muscle strain occurs when a heavy shoulder, discomfort and pain as well as pain in the upper back of the neck
outside, hanging tight feeling, contralateral neck flexion is limited to the outer upper and shoulder pain aggravated on the
move for involvement and physical fatigue and other portable signs. Unilateral or heavy side (on both sides of the severity of
signs of very poor persons) over the trapezius severe contracture, the disease causes cervical spine flexion and shoulder tilt
the head to the contralateral external rotation. Patients often hold the palm side of the cheek disease required to maintain
balance; individual extremely severe cases, when the trapezius muscle contractures resulting in extreme flexion cervical
spine and shoulder to health to the sick (light) side of extreme external rotation can be forced under throated contact with
the skin healthy shoulder supraspinatus Department (this position is not normal people do). When the examiner corrected
the head and neck and then forced to let go, head and neck will immediately return to its original position deformity. Signs
of loosening after the implementation of the trapezius muscle is completely discharged. The segment also trapezius muscle
contracture stable or one of the important risk factors clonic torticollis.
Inspection methods: the supraspinatus above the scapula attachment position on the tender point examination, the
examiner will thumb tip toward the edge of the scapular spine, the upper edge of the acromion and clavicle edge of the
outer segment, from the outside inward, respectively, for muscle attachment Slide pressed to Richard tenderness.
5. Scapula infraspinatus muscle tenderness: This muscle is attached to the inside of most of the infraspinatus fossa bone
surface, accounting for the entire supraspinatus fossa area under the 2/3. Scapular attached at the top edge of the side
attached to the outer edge of the scapula spine, foreign attachment against the teres minor, under the foreign community in
teres attachment (between each of these three muscle fiber fascia interval) , which formed on the outer end of a tendon
attached to the rear of the humeral greater tuberosity (ie large nodules pressure trace). When infraspinatus muscle strain,
shoulder discomfort and pain occurs, symptoms may involve the upper arm to the rear.
Inspection methods: the patient sitting to the right side, for example, to check who stand on the front right side of the
patient and the patient face; shoulder with your right hand and hold the brake department; or first with the affected arm to
lift his right forearm, while maintaining significant ipsilateral arm Press and hold down on the right palm with greater risk of
shoulder position at right angles to the brake. In both locations to hold back with his left scapula spine margin of 2-5 finger,
thumb tip according to nest in the infraspinatus. When the thumb pointed needles this infraspinatus muscle attachment for
sliding pressed to Richard tenderness. Infraspinatus muscle attachment area of the scapula large, so tender points (District)
area is also wider, should be carefully examined all the attachment, can not simply engage in, but the most sensitive
tenderness generally infraspinatus fossa site.
6. Teres minor and teres scapula tenderness: the end of the teres minor is attached to the bone surface near the edge of the
scapula axillary outside the top of the infraspinatus muscle located outside, above the teres major and triceps long head end
attachment Under the party, during which each fascia separated; outer end to form a tendon attached to the humeral
tuberosity crest. The end of the teres major is attached to the back of the shoulder blade area near the lower corner of the
oval, the inside of the infraspinatus muscle on the side of teres minor, also have separate fiber fascia; outer end to form a
short tendon attached to the humeral tuberosity ( together with the latissimus dorsi tendon).
Inspection methods: the patient sitting to the right side, for example, to check who stand on the right side of the patient, in
the aforementioned first two positions for the tender point examination teres minor shoulder blade, hold down the spine
that left-handed fingertip 2-5 edge, when the teres minor attachment sharp left thumb sliding along the back edge of the
axillary pressed Richard tenderness can be attached at the teres minor. Then check in the same position, the examiner will
move back down to the tip of the thumb l / 3 sections under the scapula, located teres attachment for sliding pressed to
Richard tenderness at the attachment point teres.
7. Deltoid (clavicle - acromion - scapular) tender point: This muscular upper end of the front l / 3 attached to the outside of
the front of the clavicle 1/3, and 1/3 is attached to the outer edge of the acromion, the l / 3 scapular attached to the outer
segment; its lower end by the three parts of the muscle fibers merged into a tendon attached to the outside of the middle
deltoid tuberosity of the humerus. Aseptic inflammatory lesions musculoskeletal attachment, it will lead to anterior shoulder
pain, foreign pain, pain in the rear or lateral arm pain.
Check: Check with the thumb tip in the muscle attachment point for the upper end of the slide is pressed, the Richard
44

tenderness.
8. Triceps long head of the glenoid lip tenderness: This muscle long head attached to the glenoid lip. The occurrence of
muscle attachment aseptic inflammatory lesions, it can lead to axillary pain, shoulder pain and back pain ahead, will also
affect the shoulder abduction, and sometimes leads to upper conduction down signs.
Inspection method: to the right shoulder, for example, the examiner standing on the right patient, the examiner will be
placed in the outer limb elevation elbow muscles relax after it (with the "scapula teres minor and teres major tender points"
Check one kinds of location), and then press and hold the left thumb tip glenoid lip muscle attachment. When the slide is
pressed, the Richard tenderness.
9. Subscapularis subscapularis fossa tenderness: This intramuscular end attached to the entire surface of the subscapularis
fossa of the scapula bone rib surface; outer end of the melt into a tendon attached to the humerus small nodules.
Intramuscular end aseptic inflammatory lesions of bone attachment, it can lead to the armpit, or upper chest pain or
conducting concurrent signs, will also affect the shoulder abduction. But whoever has this sensitivity tenderness tenderness
associated with susceptibility scapula muscle attachment point group of three at the back. When surgery can eliminate the
former and the latter died while away on its own without surgery. This explains the subscapularis fossa tenderness
subscapularis muscle remains attached at the secondary conduction pain.
Inspection methods: the patient supine, upper limb abduction upward, outward rotation of the lower angle of the scapula
parties to facilitate inspection by deep inside tip of the thumb to hold down the subscapularis fossa. When pressed to slide
Richard tenderness.
10. Scapula coracoid tenderness: the beak beak protruding above the shoulder ligaments and coracoclavicular ligament
attachment; beneath the beak brachialis, biceps short head and the pectoralis minor muscle attachment. Coracoid soft
tissue attachment of primary aseptic inflammatory lesions appear alone in front of the shoulder pain caused by clinically
very rare; vast majority are ipsilateral infraspinatus muscle, teres major and teres minor damage to the back of the shoulder
blade attachment to the shoulder soft tissue damage secondary to pain or pain conduction above all muscle attachment of
the proximal humerus in front.
Inspection methods: patient sitting to the right side, for example, who stood on the right to check the patient, hold down
the soft tissue attachment coracoid with right hand fingers, after the investigation was highly sensitive tender points on the
fingertip grip is fixed, The original pressure remained unchanged; then use the tip of his left thumb against the infraspinatus
muscle (including sequentially for the size of the teres) for pressing the shoulder blades slide attachment, three different
situations may occur:
Second, check the upper arm tenderness
1. Supraspinatus muscle tenderness humerus: This muscle attached to the pressure trace on the greater tuberosity of the
humerus above the greater tuberosity. When will cause shoulder heaviness aseptic inflammatory lesions, pain and limitation
of shoulder pain outside more prominent in the shoulder abduction.
Inspection methods: the patient sitting, limb sagging, the examiner thumb tip is pressed against the slide for the greater
tuberosity of the humerus pressure trace of muscle attachment, which is available on tenderness.
2. Infraspinatus muscle tenderness and teres minor humerus humerus tender point: muscle attached to the outer end of the
former rear of the greater tuberosity pressure trace; latter muscle attached to the outer ends of the rear of the humeral
greater tuberosity small minimum pressure trace. When aseptic inflammatory lesions, both of which will appear behind the
shoulder and upper extremity pain, referred pain.
Inspection methods: the examiner thumb tip against the rear of the humeral greater tuberosity pressure trace or small rear
lowest pressure trace, respectively, for sliding pressed, can look up their tenderness.
3. Triceps lateral head of the humerus tender point: This muscle attached to the rear of the upper end of the humerus 1/3
point. Will cause the upper arm pain and upper limb pain when conducting aseptic inflammatory lesions.
Inspection methods: for the examiner's thumb tip is pressed against the sliding muscle attachment on the rear of the
humerus l / 3 segment, which is available on tenderness.
4. Subscapularis muscle tenderness humerus: This muscle is attached to the outer end of the humeral tuberosity. Front will
45

cause pain and shoulder pain in the upper limbs when conducting aseptic inflammatory lesions.
Inspection methods: for the examiner's thumb tip is pressed against the sliding humeral tuberosity muscle attachment, you
can look up tenderness.
5. Teres major and latissimus dorsi humerus humerus tenderness tenderness: the former is attached to the front of the
humeral tuberosity ridge; latter is attached to the front of the humerus between the inside edge of the ditch. Both are very
close to or merging. When aseptic inflammatory lesions can cause pain in the front of the shoulder and upper extremity pain
conduction.
Inspection methods: the examiner's thumb tip is pressed against the sliding respectively, for both muscle attachment, which
is available on tenderness.
6. Pectoralis major humerus tenderness: This muscle is attached to the outer ends of the greater tuberosity of the humerus
in front of the ridge, and the two longitudinal rows of skeletal muscle attachment. Cause shoulder pain as well as the front
arm or chest pain when conducting aseptic inflammatory lesions.
Inspection methods: for the examiner's thumb tip is pressed against the front of the humerus slide 1/3 greater tuberosity
crest muscle attachment, which is available on tenderness.
7. Humerus deltoid tenderness: This muscle is attached to the lower end of the humerus near the midpoint of the deltoid
tuberosity foreign. Cause shoulder pain and upper lateral conduction of pain when aseptic inflammatory lesions, pain
aggravated obvious limitations when suffering from shoulder abduction.
Inspection methods: the examiner's thumb against the tip of the deltoid tuberosity of the humerus as a slide pressed to
Richard tenderness.
8. Humeral condyle on the ulnar nerve sulcus tenderness and tenderness: the former for the forearm flexors (refer
superficial flexor, refers to the deep flexor muscle flexor carpi ulnar, radial flexor carpi and pronator teres, etc.) the upper
end of the bone attachment. When aseptic inflammatory lesions, can cause elbow pain conduction within the square and
along the pain or discomfort flexors strike. Ulnar nerve behind the inner condyle of the trench by the ulnar nerve,
connective tissue attachment when the flexors aseptic inflammatory lesions suffer ditch and covered the ulnar nerve and
ulnar fibrous sheath surrounding the nerve sheath, its chemical When sexual stimulation on the outer sheath of peripheral
nerve endings, causing pain and limitations branch dominated region along the ulnar nerve conduction pain; If the hydrocele
secondary degeneration contracture, and produced a strong stimulation of chronic mechanical compression of the ulnar
nerve dry, it will cause numbness, paralysis or muscle atrophy and other signs.
Inspection methods: suffering a right angle elbow flexion position, the examiner's thumb tip in the medial epicondyle for
muscle attachment for sliding pressed to Richard tenderness. When combined "secondary ulnar nerve surrounding tissue
inflammation," who, in the ulnar nerve sulcus sliding and pressing its ulnar nerve entrapment under dry on its fibrous
sheath, can identify the limitations of pain and ulnar nerve conduction irritation signs (pain, numbness) significantly
increased.
9. Epicondyle of the humerus and distal humerus tenderness radial flexor of the elbow bursa tenderness: the former for the
forearm extensors (extensor carpi long, short extensor carpi, extensor digitorum muscle, extensor carpi ulnaris and
supinator) attached at the upper end of the bone. When aseptic inflammatory lesions, can cause pain and along the outer
elbow extensor group toward the conduction of pain or discomfort, disease called primary author of elbow lateral soft tissue
damage (formerly known as "humeral epicondylitis") . But in many cases of neck and arm pain, because infraspinatus
muscle, teres major and teres minor shoulder blade attachment of the anterior scalene muscle damage or attachment of the
first rib damage, conduction in lateral elbow dysmenorrhea long unhealed, epicondyle muscle attachment has been formed
aseptic inflammation secondary lesions in the humerus.
Check: Check the slide pressing with the thumb tip were epicondyle of the humerus and elbow flexor side of the outer edge
of the distal humerus capsular attachment, respectively Richard tenderness. Lateral elbow soft tissue damage is often
accompanied by some of the radial ring ligament tenderness.
Third, the forearm and hand tenderness point inspection
1. Olecranon tenderness: Triceps remote attached to the olecranon. When the lesion, causing the tip of elbow pain.
46

Inspection methods: the examiner olecranon tip of the thumb along the edge of the distal attachment slide triceps presses,
can Richard tenderness.
2. Radial annular ligament tenderness: the outer periphery of the radial neck tightly surrounded by the annular ligament.
This ligament aseptic inflammatory lesions, can cause lateral elbow pain. Individual morbidity are rare, often associated with
soft tissue damage exist outside of the elbow.
Inspection methods: suffering a right angle elbow flexion position, the examiner hand palm and finger 2-5 and hold the tip of
elbow medial elbow, and use ipsilateral thumb tip for radial neck of the annular ligament as a slide pressed, the other hand
holding the combination of moderate ipsilateral forearm pronation and supination, so that mechanical stimulation increased
pressure between the annular ligament and radial neck, will Richard aggravate pain tenderness.
3. Forearm extensor group fascia tenderness: the forearm extensor group, primarily aseptic adipose tissue inflammatory
lesions on the extensor carpi fascia, and its chemical stimulation of the dorsal forearm caused by a wide area in the nerve
endings pain. Disease diagnosis forearm extensor group called the name of the author fascia injury (formerly known as
"rolling boulder muscular sheath inflammation" or "crepitus fasciitis").
Inspection methods: the examiner fingertips pressed shallow lesions fascia extensor group, not only Richard tenderness, and
crepitus can touch too.
4. Radial styloid tenderness: the Ministry of radial styloid bone has a shallow trench, and tendon sheath composed of a pipe.
Short thumb extensor hallucis longus tendon and tendon development pipeline thus passed into the dorsal thumb. Many
patients in this sub-total tendon sheath tendon sheath may occur, the two tendons separated. This tendon sheath and
tendon inflammation around aseptic synovial lesions, can cause painful limitations; refractory cases will contracture due to
degeneration of the tendon sheath thickening in the tendon of the limitations of pressure areas form a narrow lead thumb
flexion dysfunction, the author called the radial styloid stenosis sheath damage (formerly known as "narrow radial styloid
tenosynovitis").
Inspection methods: the examiner's hand holding the middle of the forearm limb; another hand holding suffering from
carpal metacarpal below the tip of the thumb and hold the Department and the Department of the radial styloid process can
be a tangible cartilage or bone stiffness and size similar to soybeans lumps (thickening caused by degeneration of the tendon
sheath), when pressed on the slide, you can look up tenderness.
5. Dorsal ulnar bone tenderness point: there is a deep attachment portion of the dorsal fascia and carpal ligament. When
aseptic inflammatory lesions appears dorsal ulnar bone pain.
Inspection methods: the examiner's hand holding the middle of the forearm limb; another hand holding suffering from
carpal metacarpal below the ministry, with the thumb tip is pressed against the sliding foot bones for the dorsal, the Richard
tenderness.
6. Ulnar styloid tenderness point: where the Department of wrist joint capsule and synovial attachment, which has stepped
outside of the wrist ulnar collateral ligament. Aseptic synovial inflammatory lesions of this attachment, it will cause ulnar
wrist pain; wrist can not bend the foot roll, otherwise it will aggravate signs; pain leads to more passive foot flexion. Disease
in the past were misdiagnosed as "triangular articular disc rupture" or "triangular plate of cartilage damage", and now the
author of soft tissue release surgery to the ulnar styloid clear diagnosis of synovial damage. Because there was no nerve
endings in the cartilage, even if broken will not cause pain.
Check: Check with the thumb tip fitted in bone and soft tissue clearance triangle between the ulnar styloid, slide pressing
the ulnar styloid tip attached synovium, can Richard tenderness.
7. Dorsal metacarpal bone or head-shaped dorsal protuberance tenderness: wrist back 2 or 3 dorsal metacarpal base and
head shape of the distal dorsal predilection limitations bony bulge. Some absolutely no signs; some of its peripheral soft
tissue or ligament attachment aseptic inflammatory lesions, and often have the limitations of pain.
Inspection methods: slide pressed on it, you can look up tenderness.
8. First metacarpal tubercle tenderness: Department of lateral tubercle long thumb abductor muscle attachment of the base
of the first metacarpal. When aseptic inflammatory lesions caused radial wrist and thumb pain, exercise less force in the
diagnosis often associated with "radial styloid tenosynovitis" confused. I diagnosed with this disease long thumb abductor
47

first metacarpal tubercle attachment damage.
Inspection methods: the examiner thumb tip against the base of the first metacarpal for sliding lateral tubercle pressed to
Richard tenderness.
9. Transverse carpal ligament tenderness: transverse carpal ligament that supports the flexor band, very strong, starting
from the radial tuberosity trapezium and scaphoid tubercle, beyond the ulnar bone hamate hook and peas. This composition
of carpal tunnel carpal ligament and the flexor tendons and median nerve within the constraints of this pipeline. This occurs
on both sides of the bone ligament attachment aseptic inflammatory lesions can cause pain limitations; If the transverse
carpal ligament contracture secondary degeneration itself is extremely serious, then this is too strong a chronic mechanical
stimulation may oppress flexor tendon and the median nerve dysfunction and signs of nerve compression occurs. The
disease formerly known as "carpal tunnel syndrome", and now I name the volar carpal transverse ligament damage, referred
to as the transverse carpal ligament damage.
Inspection methods: the examiner pointed at the size of the palm side of the wrist between the transverse ligament thenar
radial side of the thumb and the trapezium bone nodules and scaphoid tubercle and the hamate hook attachment of the
ulnar bone and peas, namely for Slide the push to Richard tenderness.
10. Pea bone tenderness: This volar ulnar flexor carpi attachment. When pain occurs limitations aseptic inflammatory
lesions.
Check: Check with the thumb tip is pressed against the palm of your hand for sliding peas volar ulnar muscle attachment,
which is available on tenderness.
11. Flexor tendon sheath tender point: Each of the palmar metacarpal bones has a shallow trench, and tendon sheath
composed of a pipe. First metacarpal head of the flexor hallucis longus tendon and metacarpal 2-5 superficial and deep
flexor tendon of the finger were passed by the respective pipeline. This tendon sheath and the outer periphery of aseptic
inflammation of synovial lesions can cause pain limitations; If contracture and thickening of the tendon sheath
degeneration, pressure will be on the site of the formation of the limitations of a narrow tendon affected finger flexion
function, passive leads to "rattle" sound when flexion. I called the flexor tendon disease stenotic sheath damage (formerly
"flexor tendon stenosing tenosynovitis" or "snapping finger").
Inspection methods: suffering wrist palm up, fingers the whole straight; examiner hand holding suffering wrist, the other
hand clenched 4-5 refers to the entire risk refers to, and then to the tip of the thumb on the same side of the palmar
metacarpal neck for sliding pressed to Richard tenderness and tangible soybean-sized lumps in the skin, hard and cartilage
similar to degeneration caused by thickening of the tendon sheath contracture.
Section II, part of the lower limbs
First, hip, hip, thigh, pubic symphysis tenderness inspection
Risk factors and head, Xiang Jing, back, shoulder pain, as also divided into primary and secondary two.
1. Iliotibial band tender point: This is not part of the iliac tenderness middle of the tibia beam, but is located at the junction
of iliotibial band and the gluteus maximus and gluteus myofascial three. When aseptic inflammatory lesions will appear
outside of hip pain or hip pain. In cases of hip pain or low back pain were less subcutaneous adipose tissue, check there is
often a palpable taut tendons of streaks. "Extra-articular snapping hip" is a result of the degeneration of cord contracture,
greater trochanter denaturation iliotibial band contracture deep level sliding under uncoordinated, while snapping occurs.
Inspection methods: the patient prone, check first with both hands on the 2nd and 3rd finger separately identify iliac spine
at the front left and right sides, respectively and two thumb tip in the anterior superior iliac spine at the back of the hip to be
shallow about Hengzhang Pressure can be Richard tenderness.
2. Cutaneous nerve tenderness: Section l, 2 and 3 after lumbar nerve branches within the lateral cutaneous branch from the
outside through the lower sacral spine muscle, leaves from the back of the piercing inside the top of the fascia iliac crest
segment, located in the hip subcutaneous adipose tissue. This three nerve referred cutaneous nerve. When the outer sheath
of the nerve endings branch aseptic inflammation of soft tissue lesions by the chemical stimulation occurs hip pain, back
pain or typical "radioactive sciatica." These signs can not cut off the nerve branch, but only release damaging the
surrounding fat tissue lesions discharged, thus confirming its tingling factor is the fatty tissue lesions, is not that nerve
48

branch itself. Only when the chronic cases of cutaneous nerve branch, when mechanical stimulation by acute inflammation
surrounding adipose tissue degeneration contracture, and the combined nerve pain can occur signs of oppression itself.
Inspection methods: the patient prone, location check iliotibial band tenderness on the thumb side toward the examiner
gluteal muscle area, at the iliac crest 2-3 Wang pointed that the external branch of cutaneous nerve, charged and the branch
distribution area, from outside to inside, respectively, as superficial sliding pressed to Richard tenderness. After the branch
distribution area near the outer parts of the partial hip line, its tenderness should be attached to the posterior superior iliac
spine tenderness gluteus maximus has been identified.
3. Posterior superior iliac spine and iliac wing out inside tenderness: the gluteus maximus upper end attached to the
posterior superior iliac spine to the outer edge of the line of hip; central iliac wing attached to the outside to the inside, and
the inner edge of the attachment of the gluteus medius junction; sacrococcygeal bone attached to the lower back. When
these three bone attachment of the gluteus maximus aseptic inflammation suffering from disease, hip pain, and there will
be a typical "radioactive sciatica."
Inspection methods: the patient prone, the examiner thumb tip first in the posterior superior iliac spine department for
superficial sliding compressions, two different situations may occur: If the Department of attachment of the gluteus
maximus bone damage that occurs in the line of the hip tenderness; If supported by the Department of stimulating
pathogenic inflammation of fat around the internal cutaneous nerve, the tender point on the line near the hip on the side of
a nerve branch outside the site. Then the thumb-side down, pressing for deep slide for the gluteus maximus iliac wing bone
attached to the inside of the outside, when aseptic inflammatory lesions that Richard tenderness. Gluteus maximus end
point tenderness over the relevant attachment sacrum back another introduction.
4. Tensor fascia lata muscle tenderness: tensor fascia lata muscle attached to the anterior superior iliac spine on the outside
of the outer edge of the iliac wing and the outer rear. When aseptic inflammatory lesions, can cause lateral hip pain,
sedentary stood so often prominent signs; pain but also to the outside of the lower limbs conduction, hemp is one of the
main lateral leg pain diseased parts; and thigh soft tissue damage as suffering limb cutting toenails action can not be in the
seat.
Inspection Methods: Patients side in the hard board bed, suffering from hip upward, the examiner standing behind the
patient's hip, abdominal wall against the patient's buttocks with one hand and the muscles completely relax and straighten
the lower limb passive lift, keeping the hip joint in a position of extreme hyperextension and abduction on or above the
patient in the position will be affected knee flexion angle of 90 degrees, placed on the shoulders of those checks can ensure
tensor fascia lata on the thigh abduction , gluteus medius, gluteus minimus and piriformis so completely relaxed; thumb tip
perpendicular to the other hand for the anterior superior iliac spine and the outer rear outer edge of this muscle attachment
(especially hip little muscle attachment) pressed for deep slide . To Richard tenderness.
5. Gluteus minimus muscle tenderness: gluteus minimus muscle iliac wing attached to the outside of the outer hip, located
under foreign gluteal muscle attachment, the upper rear and share tensor fascia lata muscle attachment at the upper part of
the rectus muscle attachment of the acetabulum.
Inspection methods: the patient side, the excessive hip abduction and extension position above checks tensor fascia lata
muscle tenderness points above the greater trochanter of the examiner's thumb tip with the other hand in the femur
together, under the direction of inward for deep slide pressing against the outside of the iliac wing. If the muscle attachment
aseptic inflammatory lesions that Richard tenderness.
6. Gluteal muscle tenderness: gluteal muscle attached to the top of the iliac wing outside, located below the iliac crest, the
gluteus maximus and the upper end attached to the inside of the outer and inner side gluteus minimus muscle at the lower
angle of the greater sciatic notch Qi edges.
Inspection method: check the position are above tensor fascia lata muscle tenderness point, the examiner's thumb tip with
the other hand to the outside of the hip below the iliac crest of the hip muscle attachment for sliding pressed. When if
aseptic inflammatory lesions can be part of Richard tenderness. As for intramuscular gluteal tender point and the bottom
side in the prone position should be checked on the other in order to clearly see the following "sciatic notch trailing edge
(and the trailing edge), the edge (and within the margin) (formerly the upper edge of the rim and the greater sciatic
49

foramen) tender points and the exit of the sciatic nerve under the piriformis tenderness "said.
7. After the large sciatic notch edge at the outlet under the edge of the sciatic nerve and piriformis tenderness tenderness:
the greater sciatic notch is located in the middle of the hip, the trailing edge (and the trailing edge), the edge (and within the
margin of) the periosteum is gluteal muscle iliac wing is connected to the outside part of the periosteum. Piriformis
attachment surface from the sacral pelvic starting out rampant piercing through the greater sciatic foramen below the
greater sciatic notch, the distal tendon of the beam to form a bar attached to the greater trochanter. Also from the front of
the sciatic nerve in the piriformis hole leads, and in the piriformis exports, extending to the lower limbs. If the edge of the
greater sciatic notch (and the trailing edge), the edge (and within the margin) under the periosteum and around the sciatic
nerve piriformis exports aseptic inflammatory lesions of connective tissue, both can cause hip pain and not typical "sciatica."
Inspection methods: the patient prone. The former inspector in the middle of the hip forward with the thumb tip upward
pressure greater sciatic notch deep edge, the edge and the trailing edge, the edge of the bone surface for longitudinal sliding
presses; latter examiner thumb tip from the greater sciatic notch Check the location of tenderness point moves down about
one finger width at the cross, that is, under the piriformis about the exit of the little finger touches the sciatic crude for
sliding along the vertical direction transverse pressed. Two can find a respective tender points.
8. Inferior gluteal nerve tenderness: the outer edge of the sacroiliac joint, located on the rear below the lower iliac spine, as
gluteal nerve into the gluteus maximus place. If this branch of the connective tissue around the nerve secondary to aseptic
inflammatory lesions, can cause hip pain or concurrent atypical "sciatica." Under bilateral gluteal nerve conduction inward
pain can also be collected in the sacral, and bilateral sciatic notch tenderness inward conduction leads to the clinical
manifestations of pain as sacral pain.
Check: Check with the thumb pointed inward and forward direction, crossing the superficial nerve branch for longitudinal
sliding pressed, palpable pain of fine cords, is inferior gluteal nerve tenderness.
9. Superior gluteal nerve tenderness: Located above the outside at the exit of the sciatic nerve under the piriformis, which is
at about the midpoint of iliotibial-line under the sciatic nerve piriformis tenderness and tenderness at the exit point. If this
branch of the connective tissue around the nerve secondary to aseptic inflammatory lesions, also have hip pain or
concurrent atypical "sciatica."
Inspection methods: the patient prone, the examiner's thumb tip superior gluteal nerve deep pressure parts for sliding
across the nerve branch pressed to Richard tenderness.
10. Sacrococcygeal dorsal tenderness: here is the lower end of the gluteus maximus bone attachment. Outside the iliac wing
its aseptic inflammatory lesions often end with this muscle damage in central medial attachment appear together, but also
the lower part of the femoral attachment of the gluteal tuberosity aseptic inflammatory lesions occur in conjunction with
the outer end of this muscle will cause sacrococcygeal pain, hip pain or concurrent atypical "sciatica"; severe cases can also
cause anal perineal discomfort, sagging or pain, the patient can stand and multi lends not sit.
Inspection methods: the patient prone, check with the thumb pressed against the sliding tip for sacrococcygeal dorsal
attachment of the gluteus maximus, which is available on tenderness. Talking about here is sacrococcygeal dorsal primary
tenderness, and bilateral hip to soft tissue damage in the clinical greater sciatic notch or secondary tenderness inferior
gluteal nerve conduction inward pooled sacral pain at some identification .
11. Thigh tenderness: also known as adductors share the ischial pubic rami and tender points, including in the obturator
muscle attachment, check into:
(1) support the pubic - pubic tubercle - under the pubic branch tenderness: Share adductors muscles attached to the pubic
pubis on the branch (pubic hair); long adductor muscle attached to the bottom and the pubic symphysis pubis tubercle;
shares Thin and short adductor muscle attached to the inferior pubic branch; adductor muscle attached to the lower branch
until the ischial pubic and ischial tuberosity.
Inspection methods: the patient supine, the two lower limbs hip and knee flexion, two foot on two legs will automatically be
relatively tight abduction, the examiner first branch on the left and right pubic bone with two thumb tip and pubic tubercle
were muscle Slide attachment for pressing, then around the next until near the ischial pubic branch of muscle attachment
for sliding presses can look up all the tenderness.
50

(2) ischial support - the outer surface of the ischial tuberosity tenderness point: there is a large upper adductor muscle
attachment. When the lesion leads to the bottom hip pain, ischial tuberosity pain or concurrent atypical "sciatica" sedentary
will benefit the ischial tuberosity pain-shaped protrusions.
Inspection methods: patient supine, suffering from hip peg-leg, the thigh is on the moderate flexion and abduction relax the
muscles, the examiner hand brake fixed ipsilateral thigh, the other hand thumb against the tip of the ischial tuberosity and
ischial outer side of the outer branch adductor muscle attachment (including closed-cell adhesion in the muscles) can be
pressed to make a sliding Richard tenderness.
12 rectus muscle cone and the pubic symphysis tenderness: This two muscles are attached to the upper edge of the pubic
symphysis, including both sides, including the pubic tubercle, parallel to the linea alba. Pyramidal muscle is a small triangular
muscle, located in front of the rectus abdominis attachment, and is surrounded by the rectus fascia.
Inspection methods: the patient supine, the examiner for the slide with the thumb pressed against the tip of the two sides of
the muscle attachment of the pubic symphysis and pubic tubercle on the edge of the bone surface, which is available on
tenderness.
13 ischial pubic next branch and the side branch of tenderness: also known as suprapubic tenderness. There is
ischiocavernosus and deep transverse perineal muscle and other attachment. Thigh soft tissue pain severe cases occur
secondary damage these musculoskeletal attachment, causing genital pain, vaginal pain and female sexual pain unite signs.
Their clinical manifestations and ipsilateral thigh soft tissue damage to the ischial pubic branch and side branch conduction
pain basically the same.
Inspection methods: the examiner's finger at the end of the two thigh muscle attachment surface for the inside of the bone
under the ischial pubic branch and branch, from the inside out to make a sliding push, you can look up tenderness. Female
patients converted vaginal examination, the tender point will be more clear.
14 the anterior superior iliac spine tenderness: the rectus femoris attachment to straight head. When aseptic inflammatory
lesions, will be in front of the hip discomfort or pain, you can transfer to occur above the knee.
Inspection methods: the patient supine, both legs straight, check with the thumb tip in the anterior superior iliac spine
beneath a horizontal sliding finger widths for deep pressed to Richard tenderness. Silver needle acupuncture has a
significant effect. Can lower spine muscle attachment at the anterior superior iliac acupuncture more clearly discover the
tenderness.
Second, thighs tender point examination
1. Femoral trochanter gluteal tender point: the lower part of the outer end of the gluteus maximus gluteal tuberosity
attached to the femur. Iliac wing aseptic inflammatory lesions outside the inner end of this muscle attachment, etc., the
outer end of the attachment will be the same lesions appear. In addition to the limitations caused by pain, are also
complicated by atypical lower extremity "radiating pain."
Inspection methods: the patient prone, legs straight, the examiner's thumb tip for gluteal femoral trochanter parts for the
rear sliding pressed to Richard tenderness.
2. Femoral front, inside or outside of tenderness point: in front of the femoral shaft side muscle attached to the middle of a
stock; medial attachment has vastus medialis and vastus intermedius muscle; outside are attached and vastus intermedius
vastus lateralis muscle and the rear attachment The large adductor muscle and biceps femoris short head. These muscle
attachment and belongs to the same side of the periosteum aseptic inflammatory lesions, there may be limitations of pain,
numbness, or concurrent odd sensation, severe need to wear leather pants to keep warm on a hot day.
Check: Check with the thumb against the tip of each soft tissue femoral attachment of the front, medial, lateral or rear, top-
down slide pressed to Richard tenderness.
3. The medial femoral tenderness: adductor muscle distal medial head of the gastrocnemius, medial collateral ligament and
medial capsule were attached to the medial epicondyle of the femur. On the thigh soft tissue damage is concerned, when it
formed the adductor tubercle of femur distal attachment of the damage to the conduction of pain, will involve the four soft
tissue attachment.
Inspection methods: the patient supine, limb straight. Examiner hand thumb tip against the inside of the knee or below the
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front portion of the gap is pressed, the pain leads to keep the pressure constant; then another hand thumb against the tip of
the medial femoral condyle soft tissue attachment (especially the inner adductor tubercle ) is pressed, the medial epicondyle
leads to severe pain, 4. Lateral femoral epicondyle tenderness: iliotibial band remote, lateral collateral ligament, the lateral
head of the gastrocnemius, plantaris muscle, muscle and lateral knee popliteal cyst attached to the lateral femoral condyle.
When the proximal iliac crest iliotibial band attachment (including its outer lateral hip deep iliac wing attachment gluteus
minimus muscle, etc.) damage to the conduction of pain in the distal femoral condyle formed on the attachment of soft
tissue damage.
Inspection methods: the patient supine, limb straight. Examiner hand thumb tip is pressed against the outside of the knee
joint space, keep the pressure constant pain after extraction, then the other hand thumb against the tip of the lateral
femoral epicondyle pressing soft tissue attachment leads to severe lateral epicondyle pain, make the outside of the knee
clearance tenderness disappear.
Third, the tender point examination of the knee
1. Medial or lateral clearance tenderness: the inner and outer sides of the knee meniscus because they do not have the
sensory nerve endings in the cartilage lesions appeared impossible even cause pain. When aseptic synovial inflammatory
lesions and attachment of the inner and outer edge of the meniscus closely connected, it will lead to knee pain inside or
outside of the gap.
Inspection methods: the patient supine, the examiner's thumb tip by hand inside or outside the clearance gap tenderness
for sliding down the side of the knee, and the other hand holding the patient leg, change its position by the extension into
flexion, more clearly where the meniscus anatomical location of the joint space, then leads to the inside or outside of the
knee pain, you can look up throughout the tenderness, but this tenderness is not affected condyle conduction soft tissue
damage tender points on the femoral condyle or outside.
2. Rough tenderness patellar tip: Before infrapatellar fat pad attached to the upper edge of the entire patellar tip rough,
involving l / 2 section of the edge of the patella. When aseptic inflammatory lesions, can lead to pain below the knee. Check
goes down when the patella, patellar often found above will be severe soft tissue tenderness.
Inspection methods: the patient supine, knees straight, lower limb muscles relax completely. Where the examiner habits
with the right thumb-operated check whether the left or right knee, all standing on the right side of the patient, easy to
operate. The patient to relax the leg muscles, check first with the left hand thumb and forefinger and hold the upper end
and push the bottom edge of the patella, patellar tip forward tilt so; then on the thumb of his right hand palm facing
fingertips for patella the lower rear of the patellar tip rough surface, including 1/2 section of the edge of the patella, from
back to front and slide pressing for rampant from the bottom up, which is available on tenderness.
Four, leg and foot tender point examination
1. Tibial tuberosity tenderness: the patellar ligament is attached to the lower end of the tibial tuberosity. Aseptic
inflammatory lesions of the tendon attachment, it will cause pain limitations. Onset of soft tissue damage alone is rare, often
associated with tibial tuberosity epiphysis avascular necrosis (Os-good Schlatter disease) coexist.
Check: Check the slide with the thumb tip is pressed tibial tuberosity of the patellar ligament, which is available on
tenderness.
2. Tibial shaft inside or outside tenderness: tibial shaft medial surface attachment are all the periosteum; the lateral tibial
shaft 1/3 bone surface attachment has tibialis anterior muscle, lower 2/5 above the bone surface attached to the
periosteum; tibial shaft between the outer edge of the bone are connected by edges of the interosseous membrane
between the bone and fibular shaft attached to the inside.
Check: Check with the thumb tip tibial shaft inside or outside of the bone and soft tissue attachment surface, top-down slide
pressing lesions larger area, you can look up tender point (area).
3. Fibular shaft inside or outside of tenderness: interosseous fibula backbone of the inside edge of a interosseous membrane
attachment, through the interosseous edge of this film and the tibial shaft outside is connected; intermediate fibula
backbone of the medial surface of the lower side segment has hallucis longus attachment, its upper and lower segments
each with periosteal bone surface; fibula bone surface lateral backbone have extensor digitorum longus, and peroneus
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brevis peroneus longus muscle attachment, under the l / 4 section of periosteal bone surface.
Inspection methods: the examiner thumb tip were soft tissue attachment inside or outside the backbone for the fibula bone
surface, top-down sliding push these lesions larger area, you can look up the tender point (area).
4. Tenderness in the front of the ankle joint capsule point: when the ankle joint front side and the lateral joint capsule
attached to the front side of the fibula appear under aseptic inflammatory lesions tibia, causing pain in the front of the
ankle.
Inspection methods: the examiner for the tip of the thumb in front of the ankle joint with effect from ankle joint articular
surface of the square until the fibular malleolus joint capsule along the lower surface of the tibial attachment slide pressed
to Richard tenderness.
5. After the tender point below the medial malleolus: posterior tibial tendon sheath tibial malleolus through the ditch, with
its outside surrounded by flexor support. When the flexor tendon sheath supporting bone and attachment with acute or
chronic strain injury aftermath of the formation of aseptic inflammatory lesions, pain can occur below the medial malleolus,
known as the primary soft tissue below the ankle injury.
Check: Check with the thumb tip embedded malleolus ditch, from behind the medial malleolus, until the bottom of the slide
for pushing ahead, you can look up tenderness.
6. After lateral tenderness below: peroneus longus and peroneus brevis tendon sheath after fibular malleolus below the
total by being on the outside of the peroneal muscles, the support band surrounded. If this support band and total bone
attachment of the tendon sheath due to acute injury or chronic strain formed aftermath aseptic inflammatory lesions, pain
can occur below the lateral malleolus.
Check: Check with the thumb at the bottom of the lateral malleolus tip pressed against the sliding support for the band and
total tendon sheath, which is available on tenderness.
7. Tarsal sinus tenderness point: outside the front of the ankle under a piece of the tarsal sinus fat pad attached to the bones
and ligaments around the sinus. When aseptic inflammatory lesions will appear under the front of the ankle pain, affect
walking. After severe cases often associated with soft tissue damage beneath the lateral condyle, and gradually developed
into a "spastic flat plantar foot."
Check: Check-depth by sliding the thumb tip is pressed against the tarsal sinus fat, which is available on tenderness.
8. Navicular tuberosity tenderness: the posterior tibial muscle attached to the navicular tuberosity. After aseptic
inflammatory lesions of the muscle attachment, the pain will occur, known as primary tibial attachment of muscle damage
navicular tuberosity. If the Department of the medial malleolus and soft tissue damage in the navicular tuberosity below the
conduction of pain, you can ditch the medial malleolus entrapment leads to pain when leaving the navicular tuberosity
tenderness disappears.
Inspection: Check for sharp slide by pressing against the muscle attachment navicular tuberosity of the tibia with the thumb,
which is available on tenderness.
9. Achilles heel bursa nodules, with Achilles tendon sheath and former fat pad (that is, after the ankle fat pad) tender point:
Achilles heel nodules attached to; achilles tendon sheath surrounded by the outer periphery; Achilles fat pad in front of a
stick attached, and the ankle joint capsule phase interval. This four-or one of them due to excessive use or trauma sequelae,
presence of a primary lesion or aseptic inflammation infrapatellar fat pad damage due to back pain, the continuing impact of
the downward conduction, forming secondary in the above three non- When bacterial inflammatory lesions, also will appear
behind the ankle pain. Achilles tendon attachment with nodules may be complicated by damage to the occasional "nodules
with bursitis."
Inspection methods: the examiner until their attachment for sliding with nodules pressed gotta be investigated nodules,
bursa and tendon sheath with tender points along the Achilles tendon with a thumb tip back side. As Achilles fat pad before
checking tenderness, the patient supine or prone position may be, but it should be kept lower limb straight, you can relax
over the Achilles tendon in the ankle plantar flexion position, the tip of the thumb and then with front tendon outside
(inside) side of the ankle joint capsule and deep pressure pointing fat pad lesions may be Richard tenderness. Achilles fat
pad before and after the damage often coexist beneath the lateral soft tissue damage.
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10. With the end of tenderness: there is calcaneal attachment of the plantar fascia. There are more associated with the end
of pain plantar fascia calcaneal attachment of osteophytes (commonly known as "the calcaneus bone tingling"). Considered
with the traditional concept of osteophytes from the bottom due to this pain, tenderness mainly at the same site with the
site of osteophytes at the bottom and confused. I verified through long-term clinical practice, it is now the end of pain,
damage to the patellar fat pad back down after the conduction of pain or lateral soft tissue damage down below the
conduction of pain with pooled in the bottom of the clinical manifestations.
Inspection methods: the former assistant to make after the first pressing with the thumb tip leads to severe pain with the
end to keep the pressure constant, then check with the thumb tip is pressed rough patellar tip leads to severe pain in the
patellar fat pad leaving immediately disappear with the end of tenderness; later who, as described above does not work,
switch to double-check by pressing the tip of the thumb were grooves and lateral malleolus total ankle tendon sheath
underneath intense pain leads to, you can make disappear with the end of tenderness; If you are rough or relax inside and
outside the patellar tip Ankle oppression, then with the end of tenderness immediately reproduce.
11. Dry the outside metatarsal tender points: inside and outside of the fifth metatarsal is attached to the first metatarsal l
periosteum; inner and outer metatarsal 2-4 is attached dorsal interosseous muscle. Chance of aseptic inflammation of soft
tissue lesions in these attachment of small, generally with femoral medial or lateral soft tissue damage and the tibia and
fibula medial or lateral soft tissue damage occur simultaneously, can also cause forefoot pain, numbness or cold feeling odd.
Check: Check with the thumb pressed against the tip for sliding inside or outside of each metatarsal, which is available on
tenderness.