鹅足滑囊炎

Lisa

求解：什么是鹅足滑囊炎？锻炼时要注意什么？

曹晓东

鹅足是缝匠肌、股薄肌、半腱肌三块肌肉之腱性部分在胫骨近段内侧的附着点，外形类似鹅足，故称鹅足。在其下与胫骨之间有一滑囊称鹅足腱囊。由于反复应力的作用，如活动过多等，可造成此处产生无菌性炎症，称之为鹅足炎或鹅足腱囊炎。

鹅足滑囊炎的治疗首先应减少或停止引发局部疼痛的动作和活动。局部可进行理疗，症状严重时可行滑液囊封闭疗法。在慢性期可配合中药熏洗和中医理筋手法。顽固不愈者可用小针刀做纵行划割，或手术切除。

曹晓东

粗针挑刺加坎璃砂热敷治疗鹅足腱滑囊炎47例  
郭文青 刘俊红
中医外治杂志 2005年14卷02期     关键词: 鹅足腱滑囊炎; 挑刺; 坎璃砂热敷;     摘要: <篇首> 笔者自1991年7月以来,应用粗针挑刺加坎璃砂热敷治疗鹅足腱滑囊炎47例,取得满意疗效,现报道如下.


传统中医外科膏药贴敷可治疗急慢性滑膜炎。传统中医外科膏药是一种传统黑膏药,.膏药外敷治疗膝关节病，局部渗透力强，药物分子经皮肤吸收参与血液循环，直达病处，并通过皮肤传导至经络、筋骨，激发肌体的调节功能从而增进关节及周围组织的血液循环，保护滑膜，改善营养状态，减少炎症渗出，促进关节液吸收，以解除关节僵硬、水肿、疼痛症状。促进功能恢复而达到治愈目地。既避免了单服止痛药引起胃肠不适的弊端，又无手术治疗痛苦及术后并发症的发生,不影响正常生活.使患者安全、经济、快速的解除病痛。

曹晓东

Pes Anserinus
Muscles of the gluteal and posterior femoral regions. Area of pes anserinus is encircled at bottom. sartorius, gracilis and semitendinosus are labeled at bottom left.

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Lisa

曹晓东 发表于 2011-11-1 22:18
Pes Anserinus
Muscles of the gluteal and posterior femoral regions. Area of pes anserinus is encirc ...

谢谢……非常感谢！好好消化消化

jacky

Patients with pes anserine bursitis need to work on both a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program. This type of program can usually be taught to the patient by an athletic trainer or physical therapist. Patients should understand that, to gain the maximum benefit from this program, they need to stretch their hamstrings frequently during the day, sometimes hourly. The quadriceps strengthening program is recommended in most patients because of other concurrent pathology in the knee.

鹅足滑囊炎患者应该拉伸腘绳肌同时做强化股四头肌的闭链练习。这个方案通常由athletic trainer 和物理治疗师来教授完成，如果病人想或得最大的益处应该一天拉伸腘绳肌多次，经常每隔一小时进行拉伸。由于大多数患者可能会伴发膝盖相应的并发症，股四头肌的强化练习也经常被推荐到康复项目当中。

jacky

Acute Phase急性期
Rehabilitation Program 康复计划
Physical Therapy 物理治疗
Patients with pes anserine bursitis need to work on both a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program. This type of program can usually be taught to the patient by an athletic trainer or physical therapist. Patients should understand that, to gain the maximum benefit from this program, they need to stretch their hamstrings frequently during the day, sometimes hourly. The quadriceps strengthening program is recommended in most patients because of other concurrent pathology in the knee.

鹅足滑囊炎患者应该拉伸腘绳肌同时做强化股四头肌的闭链练习。这个方案通常由athletic trainer 和物理治疗师来教授完成，如果病人想或得最大的益处应该一天拉伸腘绳肌多次，经常每隔一小时进行拉伸。由于大多数患者可能会伴发膝盖相应的并发症，股四头肌的强化练习也经常被推荐到康复项目当中。

A regular program of hamstring stretching and quadriceps strengthening usually results in alleviation of the pain from pes anserine bursitis in approximately 6-8 weeks. Addition of a nonsteroidal anti-inflammatory drug (NSAID) may help to alleviate some of the pain at this time, and an ice massage may help to reduce inflammation. Cutting back or eliminating the offending activities is also important.

一个规律6-8周的腘绳肌的伸展和股四头肌的强化计划会减缓由于鹅足滑囊炎所导致的疼痛。甾体抗炎药(NSAID) 也可以对这段时间的疼痛起到减缓的作用，冰敷按摩可以减少发炎。这段时间内排除一些影响或加重患者病情的活动也很重要。

Recreational Therapy  娱乐疗法

In patients with generalized anterior knee pain, activity modification may be necessary to allow the joint to quiet down and to allow the hamstring tightness to resolve. In most patients, this modification involves minimizing the use of stairs, climbing, or other activities that cause irritation of the joint.

患者经常伴随膝盖前方疼痛，让关节平静下来是腘绳肌紧张消除的活动修正活动很有必要。对于大多数患者来说，这个修正包括，尽量最少的上楼梯，攀爬，或其她刺激关节的活动。




Surgical Intervention  手术介入
The need for surgery is very rare in cases of pes anserine bursitis. Surgery is usually indicated in cases in which an immunocompromised patient has a localized infection that does not resolve with standard antibiotic treatment. Surgical decompression of the bursa may be indicated in such cases.

鹅足滑囊炎很少需要手术介入治疗的。除非像用抗生素治疗使局部感染不能被解决的免疫功能不全的的患者，才动用手术来手术来减缓粘液囊的压力。


Consultations 协商
Recalcitrant cases that do not respond to a program of activity modification and exercise may need a referral to a specialty-trained, sports medicine physician, primary care physician, or orthopedic surgeon for evaluation.

不能相应制定的活动修正计划和运动计划的应该找相应的专家，运动医学医师，医生，或骨科医生来评估。



Other Treatment  其他治疗手段
Local anesthetic (typically lidocaine) and corticosteroid (Celestone) injection directly into the bursa is another treatment option. This should be considered only for refractory cases that have not responded to physical therapy, rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs). No more than 3 injections should be used over a 1-year period, with at least 1 month between injections; however, patients who do not respond to the initial injection rarely respond to repeat treatments.[2] When injecting the bursa, make certain to avoid injecting any of the 3 tendons converging at the pes anserinus because this can intensify the patient’s pain and weaken the tendons.

局部麻醉是另一种选择办法，这个只针对于物理治疗不起作用的情况下，休息，冰敷，非内固醇消炎药(NSAIDs).。每年不能超过三次注射，注射期间最少要间隔一个月。然而，如果病人对首次注射没什么反应，接下来的注射也会反应不大。当像滑液囊注射的时候要注意避免在鹅足滑囊中三块肌腱会聚的地方注射，因为这样会加重患者的疼痛情况和使肌腱变弱。



Recovery Phase  恢复阶段



Rehabilitation Program   康复计划
Physical Therapy  物理治疗
During the rehabilitation program, the patient should incorporate the following measures:

在康复计划中，病人应该配合以下的措施：

Continue with activity modification as necessary.

必要时继续活动的修正计划。

Begin a gradual resumption of activities.

开始逐渐的重新恢复活动。

Continue alternative training for cardiovascular fitness.

继续代替的性血管适能地锻炼。

After regaining full, pain-free motion with good isometric strength, work on improving strength and endurance.

配合适合的等长收缩后，在恢复全关节没有疼痛的的情况下，继续提高力量和耐力。


Medical Issues/Complications 理疗问题/并发症
Pes anserine bursitis is primarily a self-limiting condition, which responds well to an exercise/stretching program.[9] Recalcitrant cases should be referred to a specialist to confirm the diagnosis and to rule out other causes of the patient's pain (eg, proximal tibial plateau fracture).

鹅足滑囊炎是一种主要表现在自我活动受限的症状，对运动及伸展计划都有很好的反应。难应付的情况下应该找相应的专家来诊断和排除其他导致患者疼痛的可能性(eg例如, proximal tibial plateau fracture).

Surgical Intervention 手术治疗

See Treatment, Acute Phase, Surgical Intervention. 参见急性期的手术治疗







Maintenance Phase   保持阶段

Rehabilitation Program  康复计划
Physical Therapy 物理治疗
Continue to work on a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program.

继续拉伸腘绳肌和同事做闭链的股四头肌的强化训练。

jacky

if you need more message ~~如果你需要更多更多相关的信息~~~你可以浏览该网页

http://emedicine.medscape.com/article/90412-overview      希望这些信息可以帮到 你~~{:soso_e112:}

jacky

一下是跟详细的训练方法
Pes Anserine (Knee) Bursitis Rehabilitation Exercises


View image
You can stretch your leg right away by doing the first 3 exercises. Start strengthening your leg by doing the last 4 exercises.

Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise one leg and rest it against the wall next to the door frame. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times and then switch legs and do the exercise again.
Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times and then switch the position of your legs and repeat the exercise 3 times. Do this exercise several times each day.
Quadriceps stretch: Stand an arm's length away from the wall with your injured leg farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall. With your other hand, grasp the ankle of your injured leg and pull your heel toward your buttocks. Don't arch or twist your back. Keep your knees together. Hold this stretch for 15 to 30 seconds.
Hip adductor stretch: Lie on your back, bend your knees, and put your feet flat on the floor. Gently spread your knees apart, stretching the muscles on the inside of your thigh. Hold this for 15 to 30 seconds. Repeat 3 times.
Quad sets: Sitting on the floor with your injured leg straight and your other leg bent, press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10.
Isometric knee flexion: Sitting on the floor with one leg slightly bent, dig the heel of your other leg into the floor and tighten up the back of your thigh muscles. Hold this position for 5 seconds. Do 3 sets of 10.
Heel slide: Sit on a firm surface with your legs straight in front of you. Slowly slide the heel of your injured leg leg toward your buttock by pulling your knee to your chest as you slide. Return to the starting position. Do 3 sets of 10.
Written by Tammy White, MS, PT, and Phyllis Clapis, PT, DHSc, OCS, for RelayHealth.

曹晓东

论坛的力量发挥出来了，呵