Therapeutic Effect of Tendon Bone Setting Technique and Sports Training on Joint Injury.

Purpose: In this study, we observe the therapeutic influence on tendon and bone setting technique, combined with sports training on joint injury.
Methods: Using the random number method, 50 research objects with joint injuries were divided into two groups: treatment group and control group, and each group had 25 cases. The treatment group was combined with sports training with tendon and bone setting technique, and the control group was given intermediate frequency electrotherapy combined with forearm brace fixation. The scores of visual analogue scale (VAS), forearm pronation and postrotation activity, integral electromyogram (iEMG), and research object-rated wrist evaluation (PRWE) were evaluated and compared before and after treatment, and the curative effect observation (blind method was used in the evaluation process) and research object satisfaction were evaluated.
Results: After the treatment, the VAS score of two groups decreased, forearm pronation and pronation activity increased, iEMG value increased, and PRWE scale score decreased (p < 0.05), and compared with the control group, the treatment group's curative effect was better (p < 0.05), and compared with the control group, treatment group's total effective rate was higher (p < 0.05).
Conclusion: The method of tendon and bone setting combined with sports training could effectively reduce the pain of research objects with joint injury, improve the rotation range of the forearm, increase the recruitment of the pronator muscles, and improve the wrist function of the research objects, and the curative effect was better than that of medium frequency electrotherapy combined with forearm brace fixation.

1. Introduction

In the presence of external forces, when the joint suddenly moves to one side and exceeds its normal range of motion, this can cause injury of the joint around the soft tissue such as the joint capsule, ligament, tendon, and so on that will lead to the tear injury, and it is called joint sprain [1, 2]. The parts of the body that are prone to injuries include ankle joints, shoulder joints, elbow joints, hip joints, and radial heads, and joint injuries often occur in athletes [3]. During strenuous exercise, it is highly likely that distal radial joint injury will occur, which refers to the injury of triangular wrist fibrochondral complex that is caused by external forces. The main clinical symptoms of this injury are wrist pain, forearm rotation dysfunction, which is also known as distal radial joint separation, and wrist triangular-dimensional soft bone injury. However, due to the lack of understanding of distal radioulnar joint injury, it is often ignored in clinical practice. If the distal radioulnar joint injury is not timely treated or treated improperly, it can be transferred to chronic distal radioulnar joint injury and eventually form distal radioulnar arthritis, leaving pain and disability, which seriously affects people's daily life activities. At present, surgical treatment is the most common treatment for distal radioulnar joint injury [4-6], and there are few reports about conservative treatment with satisfactory results. Manipulation therapy is the characteristic and advantage of traditional Chinese medicine, and it pays special attention to function exercise in the treatment.

In this paper, we have carried out experimental studies and observation in the clinical work in the undergraduate room, and we used the manipulation of tendons and bones to treat the distal radioulnar joint injury. Additionally, a solid cooperation or integration with the exercise therapy is utilized to enhance the effectiveness of the proposed treatment methods, and we have observed that the effect is remarkable.

The rest of the paper is organized as follows.

In Section 2, the treatment plan and procedures are described in detail along with how the patients are divided into groups and how these patients are treated. Experimental results and observations are presented in Section 3 of the paper where various claims of the proposed approach have been verified. Finally, summary of the proposed work in terms of conclusion is presented.

2. Materials and Methods

2.1. Normal Materials

We selected a total of 50 athletes with distal radial joint injuries, from May 2017 to December 2018, and they were divided into two groups, and each group had 25 research objects. In the treatment group, there were 17 females and 8 males, and their average age was (35.7 ± 12.53) years old and the average course of disease was (10.95 ± 31.75) months; in the control group, there were 12 males and 13 females, and their average age was (36.83 ± 13.54) years and an average course of disease was (9.83 ± 32.45) months. The two groups of research objects completed the relevant treatment, and there was no cases of falling off. Between the two groups, there was no clear as daylight difference (p > 0.05), which was comparable.

Diagnostic criteria: these conform to the Chinese medicine industry standard of the people's Republic of China issued by the State Administration of Traditional Chinese Medicine in 2012 [7].

The wrist had a history of obvious trauma.

The back of the ulnar head was shifted, and the physical examination showed the piano key sign; the joints might be swollen and painful, and the pain was aggravated when the wrist joint rotates.

X-ray examination showed that the space between the lower radioulnar joint was enlarged; MRI examination should be performed if necessary.

Inclusion criteria: the research object met the diagnostic criteria, who could actively receive treatment and obey the doctor's advice. It also included signing an informed consent form.

Exclusion criteria: research objects with shoulder and elbow joint injuries; research objects who have undergone surgery or arthroscopic treatment; research objects with wrist osteoarthritis; research objects with diseases such as tumors and fractures; and those who receive other treatments halfway through.

2.2. Treatment Method

2.2.1. Treatment Group

We use the tendon and bone setting technique and sports training therapy. In the research object's sitting position, the physician would apply some techniques such as rubbing, plucking, and pinching to relax the forearm and carpal muscles of the research object. The pain induration was found at the elbow and wrist flexion, extensor, carpometacarpal junction, and the fifth carpometacarpal joint [8,9]. When the course of disease was too long, the potential pain points were often touched in the distal parts of the meridians such as hand Taiyang, hand Shaoyang, hand Shaoyin, and hand Jueyin, which could further improve the therapeutic effect. For 5–10 minutes, the finger force should be gentle and moderate. Bone setting manipulation: this was combined with the literature for manipulative bone setting therapy [10]. The research object sat upright with the forearm extended in rotatory position. The assistant held the distal forearm in a relative circle and fixed it. Facing the assistant, the doctor should hold the affected wrist with both hands relative to each other and place the thumb on the back of the wrist. (1) The doctor pulled out the wrist and swayed 6-7 times under traction. (2) The doctor bends the wrist of the research object. (3) The doctor extends the wrist back, squeezing it toward the center and poking the thumb down. Basic techniques such as pulling and shaking, returning to squeezing, and pressing were mainly used. When the reduction was successful, or with joint snapping, the research object felt that the wrist discomfort improved. Fixation method: in this method, an open adjustable wrist brace is taken and fixed immediately after the bone setting is finished. Fix it for 4–6 weeks, paying attention to the rest of the wrist and avoiding violent rotation of the wrist and holding heavy objects. If uncomfortable, adjust as appropriate. The specific operation of sports training [11] combined with clinical practice was as follows. (1) Clench training: the research object took the standing position, the feet were the same width as the shoulder, the elbow joint was slightly bent, the palms of both hands were upward, the four fingers were together and extended, and the thumb was abducted. Firstly, the four fingers were bent and clenched, and then the thumb was retracted, and the distal phalanx was tightly fastened to the middle phalanx of the index finger and middle finger. Hold the palms of the fingers tightly without leaving any gaps and keep the wrist straight and neutral. The palms of the fingers clenched the fist, and the muscles contracted continuously for 10 s, and then relaxed and rested for 10 s. 1 group included 10 times, practicing for 3 groups. (2) Palm support training: stand in the same forward position, slightly bend the elbow, make the palms of the two hands face each other, separate the five fingers, and abduct the palms and fingers. Continue to contract the muscles for 10 s, and then relax and rest for 10 s. 1 group included 10 times, practicing for 3 groups. (3) Wrist extension training: taking the right side as an example, the right lunge was facing the wall, the right shoulder was bent forward 90 degrees, the elbow was straightened, the right hand stood up, the fist face was against the wall, and the eye of the fist faced upward. Keep the left upper limb and the left lower limb in the same plane. Twist the trunk to the left, straightening the right leg and moving the center of gravity forward, so that the force acts on the wall through the left upper limb. Continue to exert force for 10 s, and then relax and rest for 10 s. 1 group included 10 times, practicing for 3 groups. The above motion made the force to be less, which did not produce apparent pain with wrist. It was necessary to proceed step by step and exercise according to personal ability.

2.2.2. Control Group

Medium frequency electrotherapy with forearm braces was used for fixation. Computerized intermediate frequency therapeutic apparatus (EcM99-IIA, manufactured by Beijing Royal Health Medical Instrument Co. LTD.) was adopted, local medical alcohol cotton ball disinfection was carried out, the electrodes were placed in front of and behind the ulnar side of the wrist, and the stimulation intensity was best tolerated by the research objects. The single treatment time was 20 minutes, once a day for 4 weeks. After treatment, they were fixed with forearm brace.

2.3. Evaluation Method of Curative Effect

2.3.1. VAS Score

Visual analogue scale (VAS) was used [12], taking a 10 cm straight line and dividing it into 10 equal parts with marking the numbers 0∼10 from the left end to the right end, and 0 meant “painless” and 10 meant “most painful,” and the research object depends on the degree of wrist pain. The method was marked on the straight line, repeat twice, and taking the average value.

2.3.2. Evaluation of Pronation and Supination of Forearm

The range of motion of forearm internal rotation and external rotation was measured before and after treatment with angle ruler. Body position: (i) Sitting position, (ii) upper arm close to rib, (iii) elbow flexion 90 degrees, and (iv) the forearm was neutral and perpendicular to the coronal plane of the body. The axis of the angle ulnar was located at the ulnar styloid, the fixed arm was perpendicular to the ground, and the moving arm was parallel to the palm or dorsal stripes of the wrist joint. Measuring the internal rotation and external rotation of the forearm, the normal range of internal rotation was 0°∼80°/90°, and the normal range of external rotation was 0°∼80°/90°.

2.3.3. Value Evaluation of EMG and iEMG

A 10-channel surface EMG detector (Thought Technology, Canada, Flex Comp Infiniti, operating software Bio Graph Infiniti) was used to collect the surface EMG integral EMG value of research objects during active exercise, and this index was highly correlated with the degree of muscle recruitment. Operation method: the research object, patient, lied in the lying position and medical alcohol cotton ball was locally disinfected and degreased. After the alcohol evaporates, stick the electrode pad to the starting and ending point of the pronator muscle, paying attention to the direction parallel to the muscle fiber. Testing 20 s active exercise: ask the research object to pronate the forearm according to the instructions and measure it 3 times, taking the maximum value for analysis. Before the measurement, propaganda and education should be carried out to inform the research objects of the operation process, so as to make the research objects better cooperate.

2.3.4. PRWE Wrist Joint Research Object Self-Evaluation Scale Evaluation

Evaluate the intensity, frequency, and functional performance of wrist joint pain through 15 items, which could reflect the difficulty of the research object in daily life, work, and entertainment. A score was counted for each item, and the score decreased, which meant that the research object's wrist pain and dysfunction had improved [13]. Recovery: wrist swelling and pain disappeared, and joint activity was normal. Improvement: wrist swelling and pain were reduced, and lower radioulnar joint relaxation improved. Unhealed: no change in joint swelling and pain and lower ulnar and radial joint relaxation.

2.3.5. Evaluation of Research Object Satisfaction

A questionnaire survey was conducted on all research objects using the satisfaction rating scale, and the main content included 28 questions such as psychology, life, emotion, and effect. Each question had five options, namely, very dissatisfied, less satisfied, generally satisfied, more satisfied, and very satisfied, and the corresponding score was 1∼5.

2.4. Statistical Treatment

To perform statistical analysis on the data, SPSS24.0 statistical software was used; for count data, the measurement data were expressed as (x ± s). Chi-square test was performed; for measurement data, t-test was performed; for grade data, nonparametric test was used. p < 0.05 meant that there was no clear as daylight difference.

3. Results of the Experiments

3.1. Comparison of VAS Scores between the Two Groups before and after Treatment

After 4 weeks of treatment, compared with that before the treatment, the two groups' VAS scores were lower, and there was no clear as daylight difference (p < 0.05); compared with the control group, the treatment group was better, and there was no clear as daylight difference(p < 0.05). Before and after treatment, comparison of VAS between the two groups (scores, n = 25, x ± s) is shown in Table 1.

Table 1

Comparison of VAS between the two groups before and after treatment (scores, n = 25, x ± s).

Groups	Before treatment	After treatment	z	p
Treatment group	3.93 ± 1.52	1.93 ± 1.57∗#	−4.864	<0.05
Control group	3.62 ± 1.46	2.851.62∗	−4.733	<0.05
t	0.679	−2.082
p	>0.05	<0.05

∗Compared before treatment, P < 0.05; # compared with control group, P < 0.05.

3.2. Comparison of Motion of Forearm Pronation and Supination between the Two Groups before and after Treatment

After treatment, in the two groups, the motion of forearm pronation and supination was improved, and there was no clear as daylight difference (p < 0.05). Compared with control group, the treatment group's improvement was better, and there was no clear as daylight difference (p < 0.05). Comparison of forearm pronation and post proation activity between the two groups (degree, n = 25, x ± s) is shown in Table 2.

Table 2

Comparison of forearm pronation and post proation activity between the two groups (degree, n = 25, x ± s).

Groups	Time	Forearm pronation	Post proation
Treatment group	Before treatment	79.83 ± 2.91	79.22 ± 4.01
	After treatment	85.49 ± 2.42∗#	86.29 ± 1.52∗#
z/t		−4.729	−10.001
p		<0.05	<0.05
Control group	Before treatment	80.14 ± 3.32	83.82 ± 3.07
	After treatment	82.54 ± 2.71	84.91 ± 2.31
z/t		−4.768	−4.192
p		<0.05	<0.05

∗Compared with this group, P < 0.05; # compared with control group, P < 0.05.

3.3. Comparison of the Surface EMG iEMG Values between the Two Groups before and after Treatment

After 4 weeks, compared with those before the treatment, the two groups' EMG values of the pronator muscles were improved, and there was no clear as daylight difference (p < 0.05). Compared with the control group, treatment group improved, and there was no clear as daylight difference (p < 0.05). Comparison of the two groups on iEMG values before and after treatment (H z, n = 25, x ± s) is shown in Table 3.

Table 3

Comparison of the two groups on iEMG values before and after treatment (H z, n = 25, x ± s).

Groups	Before treatment	After treatment	t	p
Treatment group	19.31 ± 3.60	26.56 ± 2.52∗#	−13.587	<0.05
Control group	19.52 ± 3.40	23.13 ± 3.33∗	−4.782	<0.05
t	-0.183	3.89
p	>0.05	<0.05

∗Compared with this group before treatment, P < 0.05; # compared with control group, P < 0.05.

3.4. Comparison of the Two Groups on PRWE Scale Scores before and after Treatment

After treatment, the two groups' PRWE scale scores were lower, and there was no clear as daylight difference (p < 0.05). Compared with the control group, the treatment group's score reduction was greater, and there was no clear as daylight difference (p < 0.05). Comparison of the two groups on PRWE scale scores before and after treatment (points, n = 25, x ± s) is shown in Table 4.

Table 4

Comparison of the two groups on PRWE scale scores before and after treatment (points, n = 25, x ± s).

Groups	Before treatment	After treatment	t	p
Treatment group	29.13 ± 8.93	9.82 ± 5.62∗#	16.972	<0.05
Control group	28.84 ± 8.83	13.35 ± 5.83∗	9.798	<0.05
t	0.121	−2.591
p	>0.05	<0.05

∗Compared with this group before treatment, P < 0.05; # compared with control group, P < 0.05.

3.5. Comparison of the Two Groups on Therapeutic Effect

After treatment, the treatment group's total effective rate was 92.0%, and the control group's total effective rate was 48.0%; compared with the control group, the total effective rate of the treatment group was significantly higher, and there was no clear as daylight difference (p < 0.05). Comparison of the two groups on therapeutic effect (example) (n) is shown in Table 5.

Table 5

Comparison of the two groups on therapeutic effect (example) (n).

Groups	n	Cure	Improvement	Unhealed	Total effective rate (%)
Treatment group	25	10	13	2	92.0
Control group	25	2	10	13	48.0
Total	50	12	23	15	70.0
x 2	18.151
p	<0.05

# Compared with control group, P < 0.05.

3.6. Comparison of the Two Groups on Satisfaction

The treatment group's satisfaction rate was 88.00%; compared with the control group, this was significantly higher, and it was 68.00%, and there was no clear as daylight difference (p < 0.05). Comparison of the two groups on satisfaction (n = 25) is shown in Table 6.

Table 6

Comparison of the two groups on satisfaction (n = 25).

Groups	Great satisfaction	General satisfaction	Dissatisfaction	Total satisfaction
Treatment group	12(48.00)	10(40.00)	3(12.00)	22(88.00)
Control group	9(36.00)	8(32.00)	8(32.00)	17(68.00)
x 2	1.640	0.431	5.404	5.404
p	>0.05	>0.05	<0.05	<0.05

4. Discussion

For DRUJ injuries, general X-ray examination is likely to miss the diagnosis [14]; when accompanied by a fracture of the forearm, the focus tends to be on fracture management, and DRUJ injury is more likely to be overlooked. Its commonly used conservative treatment includes rest, splint fixation, physiotherapy, and intermittent use of NSAIDs, but the effect is not ideal. DRUJ injury belongs to the category of “Tinnel out of groove, bone dislocation” in Chinese medicine, “tendon out of groove” and “bone dislocation” interact with each other [15, 16]. In the treatment of manipulation, massage and plucking can play a role in loosening tendons and dispersing knots; the bone setting technique can correct the “bone dislocation” existing in DRUJ, and make the “out of groove” ligament, tendon, and so on into the groove reduction. The method of regulating tendons and setting bones is used to treat DRUJ injury. The muscles and bones are treated together, and the specimens are taken into consideration, so as to restore the normal physiological state of “the bone is straight and the tendons are soft.” After the manual treatment, use an open adjustable wrist brace for soft fixation, for 4 to 6 weeks [17]; if the course of the disease is too long, the fixed time can be extended appropriately. Different from the static rigid fixation of small splints, plaster, and brace, the wrist support retains the normal functional activities of the wrist, and the compliance of the research subjects is higher. Sports training can enhance the muscle strength and endurance of the wrist muscles and improve the stability of the DRUJ joint. About 20% of the stability of DRUJ comes from the bony joint surface; the remaining about 80% is mainly provided by the soft tissue around the joint [18], which includes the stable structure inside the joint capsule (triangular fibrocartilage complex, ulnar collateral ligament, etc.) and the stable structure outside the joint capsule (flexor extensor of the forearm, extensor carpi ulnaris tendon sheath, interosseous membrane, pronator, etc.) composition. In this study, the fist clenching training in the sports training program was aimed at the external muscles of the hand and the flexor muscles in the internal muscles of the hand. The main reason was that the clenching action of the hand can make pea bone move far away from the middle line of the forearm, and the ulnar collateral ligament was tense, which could enhance the muscle strength of the thenar muscle and the flexor carpi ulnaris muscle in the internal muscle group of the hand. The palm support training mainly involved the external muscles of the hand and the extensors and abductors in the internal muscles of the hand, so as to enhance the stability of the dorsal side of DRUJ. On the basis of clenching training, wrist training could increase the longitudinal stress stimulation of the forearm and exercise the radial and ulnar interosseous membrane.

5. Conclusion

In this study, the surface EMG system was used to collect the EMG signal of the pronator muscle during the rotation of the lower radioulnar joint, and the iEMG value was used as an objective evaluation index to reflect the changes in the amplitude of the EMG signal of the pronator muscle, thereby indicating its muscle strength and changes in muscle recruitment [8]. After the treatment of the muscles and bones, treatment group's pronator muscle was significantly greater, and there was no clear as daylight difference (p < 0.05). The treatment of DRUJ injury could be immediate effect by the manipulation of muscles and bones, and mainly manifested in pain, significant improvement in mobility and muscle recruitment. However, medium frequency electrotherapy, with limited treatment site and single stimulation amount and mode, could not adjust the disorder of DRUJ. In summary, for distal radioulnar joint injuries, the combination of tendon and bone setting techniques combined with exercise training is superior to intermediate frequency electrotherapy combined with forearm brace fixation in alleviating pain, improving wrist joint mobility, and improving wrist function (p < 0.05), which is worthy of clinical application.