Eighteen-year-old Kobayashi is about to usher in a major test in his life, as an active table tennis player, he accidentally strained the ligament of his right leg while competing for a place in the national competition, and the sudden injury made it impossible for him to participate in the next competition, and winning the national competition, becoming a national athlete, joining the national team, and representing the country is his lifelong dream.
But the sudden injury caused the spirited teenager to fall on the starting point of chasing his dream, and the doctor's preliminary diagnosis and X-ray images of his right leg showed that Kobayashi's injury would take at least three months to recuperate, and it was easy to strain again if he was slightly careless.
Kobayashi knows that the peak of the athlete is only a few years, and the opportunity to participate in the national competition is even more unattainable, and he does not want to give up. Thinking of the experience of seven closed injections in the six-year sports career of Zhang Jike, an idol who is also a table tennis player, Kobayashi began to consult doctors about closed injections.
Those who have paid attention to sports news should have heard the news that many athletes played a closed needle in order not to let the pain affect the state, Xiaolin's idol Zhang Jike completed the shortest time Grand Slam in the history of table tennis by playing a closed needle, and the sports career of famous athletes such as the hexagonal warrior Ma Long, the big devil Zhang Yining, and the national basketball brother Yi Jianlian have had the experience of having to play a closed needle.
The closed needle is rumored to be so divine, can it really "get a needle in the eye"? What are the consequences of a closed injection?
First, can the closed needle "achieve a needle effect"? What is the mechanism of action of the closed needle?
The scientific name of the injection of closed needles is "closed therapy", and closed needles are only one part of the closed therapy. The injection drugs of the closed therapy are generally mixed by local anesthetic drugs and hormone mixtures in an appropriate proportion, and are targeted and special drugs prepared by doctors according to the patient's specific illness, constitution and other factors.
The main role of the closed needle is to relieve local pain in a short period of time, and it can also play a certain anti-inflammatory effect. When the tissues and organs in the human body are damaged or there is inflammation, it will stimulate the nervous system at the site of the lesion, trigger nerve impulses, and the nerve impulses with pain stimulation signals are transmitted to the central nervous system and processed by the cerebral cortex will feedback the pain sensation at the lesion, and at the same time inhibit the movement, feeling and other behaviors of the patient area through the deployment of the central nervous system to avoid the lesion site from being injured again.
The mechanism of action of closed therapy is to block the nerve signaling of the afferent nerve at the lesion site to the central nervous system after the drug is used at the lesion site, and the cerebral cortex does not receive the stimulation signal and does not produce pain sensations, nor does it produce protective inhibition of the lesion site. Patients who inject blocking drugs can resume normal movement for a period of time while losing the pain perception of the injection site of the drug.
The local anesthetics commonly used in clinical preparation of blocking needles are licardoine and procaine, which mainly have the effect of cutting off nerve impulse conduction at the site of lesions. The most common hormonal drugs are glucocorticoids, which account for a small proportion of closed drugs, mainly play an anti-inflammatory role, as well as antiviral, anti-allergic, anti-shock effects, can effectively prevent the spread of damage to other tissues.
According to the injection site and the purpose of injection, the closed therapy is divided into four categories, namely agitation point injection, nerve block, sympathetic nerve block, intra-articular injection, and the corresponding therapy will be selected according to the needs of the patient in clinical application.
(1) Severe pain point injection:
Pain points refer to locally highly sensitive areas present in the muscles that produce painful sensations and can feedback referred pain under the action of the central nervous system.
Stimulated excitation of pain points is clinically manifested as acute or chronic soft tissue pain, muscle spasms, and usually localized point pain can spread to surrounding tissues. Stimulant point injection therapy mainly treats pain and a series of symptoms caused by myofasciitis.
Clinical data show that 93% of pain patients are caused by stimuli of pain points, so closed therapy for pain points is suitable for almost all pain type lesions, mainly as a first-level therapy for relieving myofascial pain and fibromuscular pain.
(2) Nerve block:
Nerve block therapy refers to the direct injection of blocking drugs into the vicinity of the main nerve at the site of the lesion, including drug injection of nerve trunks, plexus, nerve roots, and tissues in or near the sympathetic ganglia.
Nerve block therapy has the characteristics of rapid onset and remarkable effect, and is widely used clinically to relieve neuralgia caused by cervical spondylosis, frozen shoulder and waist fasciitis, tenosynovitis, muscle strain, lumbar leg paralysis, trigeminal neuralgia, and shingles. Nerve injection therapy is a symptomatic therapy adapted to most neuralgia and can also assist anesthetics in their role in paralyzing nerves.
(3) Sympathetic block:
The sympathetic nerve belongs to the autonomic nerve in terms of classification, which is mainly distributed near the heart and other internal organs, and mainly plays a role in regulating the activity of organs in the human body. Sympathetic excitation causes the tissues and organs it innervates to be in a state of excitation, and under normal physiological conditions, the sympathetic nervous system and the parasympathetic nerves that antagonize it together restrict the balance of the body.
However, when the sympathetic nerve dysfunction occurs, it will lead to hyperpsychiatric and cause neuropathic pain, which is common in the head and neck sympathetic nerves, stellate ganglia and upper and middle cervical ganglia, so sympathetic block treatment is also commonly used clinically for symptoms caused by hypermobility of the neck sympathetic ganglia.
(4) Intra-articular injection:
Joint cavity occlusion therapy is mainly aimed at joint lesions such as arthritis, rheumatoid, etc., is a common therapy of orthopedics, the scope of application is not wide but targeted, is the most clinically used closed therapy, commonly used injection drugs are sodium hyaluronate. Sodium hyaluronate injection into the joint cavity plays a mechanical lubrication, buffering, protection, labor pain and anti-inflammatory effect, and is an effective means of clinical treatment of arthritis.
Since the pain relief effect of the closed needle is so good, can all pain-related diseases achieve the purpose of labor pain by injecting the closed needle? Is joint pain and ligament injury suitable for closure injections?
2. What are the conditions suitable for using closed therapy? Is joint pain and ligament injury suitable for closure injections?
Occlusion therapy is not applicable in all cases, and the use of occlusion needles itself has certain side effects, which can cause serious consequences when the injection is improper and the injection process is wrong.
In clinical application, closed therapy will be adopted according to the condition and constitution of the patient only when the patient has five conditions, such as local pain, acute ligaments, joint injuries and fractures, tenosynovitis and fasciitis, cervical spondylosis and frozen shoulder, lumbar disc herniation, and spinal stenosis.
Joint pain and ligament injury are included in these five conditions, and it is possible to inject a blocking needle, but in the specific clinical application, it is necessary to determine whether a closed needle is required for treatment according to the condition.
1) Local pain
The local pain here is mainly local muscle pain, but it is not limited to muscle pain.
In the clinic, pain point closure treatment is regarded as an emergency treatment plan for pain patients, if the patient is treated with severe pain in a certain area, the pain site injection of closed drugs in the form of pain relief is convenient for the next treatment and alleviating the patient's mood, often in the early symptomatic treatment of emergency departments, generally using the principle of "where to beat which".
When the pain site is not concentrated, the most intense part of the pain is judged by the form of body surface compression, and the injection point is selected as close to the nerve as possible and avoids the blood vessels, cartilage, and non-muscle parts.
2) Acute ligament, joint injury, fracture
Ligament injuries, joint injuries, fractures, etc. are sudden injuries, which occur more often in athletes' training, competitions, strenuous exercise in a short period of time, and irregular sports. Such injuries caused by accidents need to be completely healed by one month to half a year of treatment, and special groups such as athletes need to eliminate the pain at the injury in a short period of time to achieve the purpose of restoring normal exercise levels, and closed needles are needed.
For shoulder joints, ankles, knee joints and other parts of the strain and fracture use of closed treatment more, this case will clinically choose intra-articular injection, such as the famous table tennis player Ma Long before the Tokyo Olympics to the old injury recurrence of the knee joint injection injection.
For the general population of people who exercise improperly or have ligament strains, joint injuries and fractures due to various accidents, closed treatment is generally not clinically used in the absence of special circumstances and requirements.
3) tenosynovitis, fasciitis
The tendon sheath refers to the half-moon structure at the joint, which acts as a muscle to fix the tendon, and excessive friction between the tendon and the tendon sheath can cause tenosynovitis. Tendosynovitis tends to occur in the hands and wrists, and is more common in people who need to use hands for a long time, and there are chronic tenosynovitis and acute tenosynovitis. An inflammatory response at the tendon sheath junction can cause congestion, pain, and edema in the surrounding tissues, affecting normal joint activity.
Acute fasciitis attack will show severe pulling pain, at this time the patient can not achieve the purpose of alleviating pain through simple physical therapy treatment, clinically will choose to carry out pain point injection closure therapy at the site of the attack, alleviate the patient's pain is also conducive to the determination and progress of the next treatment plan.
Chronic fasciitis mainly evolved from muscle strain, often occurs in the shoulder and neck area, unlike the acute phase with analgesia as the main purpose, chronic fasciitis treatment focuses on anti-inflammatory. In some clinical cases, occlusion therapy is often used as an adjunct treatment for chronic fasciitis, and the anti-inflammatory and analgesic effect of occlusive drugs can be combined with other drugs to promote myofascial recovery.
4) Cervical spondylosis, frozen shoulder
Cervical spondylosis and frozen shoulder disease patients and occupation also have a certain correlation, in the commonly used computers, mobile phones and other electronic equipment people, often need shoulder and neck force to do repetitive movements of people and elderly groups of people and high incidence.
Cervical spondylosis is a series of diseases caused by degenerative pathological changes in the intervertebral disc, the causes of cervical strain, bone hyperplasia, disc herniation, etc. The cervical spine is a major central nervous system of the human body, and there are very rich neural networks distributed.
Lesions in the cervical spine stimulate the sympathetic nervous system, causing neuralgia, and the best way to slow down neuralgia in patients with acute cervical spondylosis is to use closed therapy for nerve blocking, and clinically the closed drug is usually injected directly into the nerve root.
Frozen shoulder is caused by aseptic inflammation of the soft tissues around the shoulder joint, mainly manifested by pain in the shoulder joint and obstruction of shoulder movement, also known as adhesion shoulder capsules. Frozen shoulder is characterized by paroxysmal nature and manifests itself differently in different patients, with some people experiencing severe pain when nocturnal activity decreases, and some people exhibiting painful symptoms of acute periodontitis of sore shoulder in rainy weather.
Frozen shoulder is a chronic disease, but for patients with unbearable acute pain, most of them will take the clinical treatment of nerve injection blocking needle to relieve pain, and the closed drug will also be injected into the joint cavity in chronic treatment to play an anti-inflammatory, analgesic, lubricating and protective effect.
5) Lumbar disc herniation, spinal stenosis
Lumbar disc herniation is a common disease in spine surgery, mainly manifested as low back pain, sciatica, and cauda equina syndrome, which can also radiate to the lower extremities to compress the nerves of the legs, causing mobility and leg pain.
Lumbar disc herniation refers to the rupture of the fibrous ring of the lumbar disc, the nucleus pulposus to the spinal canal displacement stimulates or compresses the cauda equina nerve or nerve root, causing the affected nerve innervated tissue to produce pain, numbness symptoms, the main treatment of the disease is non-surgical treatment, closed treatment is the primary choice in non-surgical treatment when the disease is more severe.
When used clinically, the drug is usually injected into the epidural space of the spinal canal, and the drug mainly has the effect of relieving pain, reducing swelling and anti-inflammatory, which is called epidural occlusion therapy.
Spinal stenosis refers to a series of diseases caused by various pathological causes of the cone, disc and nerve root canal of the vertebrae caused by the narrowness of the distance, resulting in compression of the spinal cord and nerve roots, the pathogenesis and treatment plan is similar to the herniated disc, and the epidural closure treatment is preferred.
Therefore, joint pain and ligament injury can be closed injections, but what kind of treatment to take varies from person to person, and it is necessary to give priority to the decision of the attending physician.
Many people talk about the discoloration of the closed needle, some people think that it is a "one-shot" antidote to pain, and some people hear that the closed needle will affect the athlete's sports career and refuse to use the closed needle for treatment, thinking that it is a health-threatening poison.
In fact, the closed needle can neither achieve a needle effect, nor is it only to play a short-term analgesic treatment of the palliative, ordinary people need to cooperate with other drugs when using the closed needle clinically, and the drugs in the closed needle in addition to pain relief also have the effect of treating the lesion and targeting it.
The injection of closed needles affects the athlete's athletic career because the hormone drugs in the closed needles affect the body's ability to exercise for a long time, and also lead to athletes after injection being more susceptible to major injuries during exercise.
We ordinary people use closed needles for different purposes than athletes, and the things to worry about are also different; What Kobayashi needs is to be able to forget the pain in a short period of time and get back on the field, and the decline in physical fitness caused by choosing a closed needle is the consequence he must bear. For ordinary patients, after the injection of the closed needle rest and maintenance for a period of time can completely ignore the side effects of the closed needle, it is worth mentioning that the closed needle can not be injected more than four times in a year, and to go to a regular medical institution for spot use.
Bibliography:
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Yang Chengcheng. Danshen closed needle anesthesia under the strong massage treatment of frozen shoulder in 100 cases[J].Guangxi Barefoot Doctor, 1978(11):10-11.
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