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Blood flow to the extensor carpi radialis brevis muscle following adrenaline infusion in patients with lateral epicondylitis.
Dept of Physiology and Pharmacology, Karolinska Institutet. Dept of Hand Surgery, Södersjukhuset. .
Dept of Radiology, Södersjukhuset Stockholm.
Dept of Orthopedics and Hand Surgery, Sahlgrenska University Hospital.
Dept of Molecular Medicine and Surgery, Section of Clinical Physiology, Karolinska Institutet. Dept of Clinical Physiology Karolinska University Hospital.
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2011 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 36, no 12, 1974-80 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Based on previous evidence of muscle fiber injury and decreased blood flow in the extensor carpi radialis brevis (ECRB) muscle in lateral epicondylitis (LE), we hypothesized that there would also be an abnormal (vasoconstrictive) vascular response to adrenaline in the ECRB muscle in LE.

METHODS: In a case-control study, we measured skeletal muscle blood flow in 8 patients with LE and in 8 healthy controls in response to a 30-minute intravenous infusion of adrenaline. We used local clearance of technetium-99m in the main portion of the ECRB muscle to calculate muscle blood flow.

RESULTS: In support of the hypothesis, the blood flow response to the adrenaline infusion was markedly different in the 2 study groups. Whereas the continuous decrease in technetium-99m clearance rate over time was interrupted by the adrenaline-induced vasodilatory effect in the control group, we detected no such effect in the patient group.

CONCLUSIONS: In the ECRB muscle in LE, there is a shift in the balance of vasodilatory and vasoconstrictory influences of adrenaline, leading to vasoconstriction during low-dose adrenaline infusion. The adverse adrenaline effect is similar to what was previously observed after minor muscle injury. Whether the vasoregulatory change, by causing relative muscle ischemia, represents the primary etiology in LE or results from muscle injury cannot be determined, but it is likely to contribute to the development and continuation of chronic muscle pain in LE. New ways of thinking about the condition may be required, and pharmacological treatment might be an option to improve the blood supply and avoid further damage to the affected ECRB muscle-tendon unit.

Place, publisher, year, edition, pages
2011. Vol. 36, no 12, 1974-80 p.
National Category
Research subject
Physiology; Orthopaedics
URN: urn:nbn:se:uu:diva-169653DOI: 10.1016/j.jhsa.2011.08.028PubMedID: 22015074OAI: oai:DiVA.org:uu-169653DiVA: diva2:507479
Available from: 2012-03-05 Created: 2012-03-05 Last updated: 2012-03-06
In thesis
1. Blood Flow in Human Skeletal Muscle: The Effect of Adrenaline and the Influence of a Small Muscle Injury
Open this publication in new window or tab >>Blood Flow in Human Skeletal Muscle: The Effect of Adrenaline and the Influence of a Small Muscle Injury
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A variety of vasoregulatory systems are involved in the complex control of blood flow inhuman skeletal muscle. The interaction between these systems where one system canoverride or modify the other makes blood flow regulation complicated. Determinations ofmuscle blood flow can thus be challenging especially when considering the shortcomingsand limitations of the available measurement methods. This thesis focuses on two differenttopics of which both are dependent on sympathetic tone.

First, the common use of venous occlusion plethysmography (VOP) with only one straingauge attached per limb is a method with obvious pitfalls. The inherent problems with thissimplification of the original VOP method are highlighted in Study I-II where small variationsin sympathetic tone and venous pressure proved to have a considerable influence on theresults. The basic circumstance to this variability is the curvo-linear pressure/volumerelationship in the veins and the fact that redistribution of blood can occur betweenindividual limb segments. The results clearly demonstrate that events taking place underone strain gauge cannot be strictly duplicated in adjacent portions of the limb.

Secondly, recent reports have indicated that a minor muscle trauma might change the localblood flow response to adrenaline. Two studies were conducted to test if an acute smallmuscle injury (Study III) and chronic muscle damage (Study IV) influences the normal bloodflow effect of adrenaline. In support of the hypothesis we found that the microdialysiscatheter-induced muscle injury in Study III caused a significant vasoconstriction during an i.v.adrenaline infusion, as measured with 133Xenon clearance next to the catheter, whereas nosignificant change in blood flow was seen with adrenaline-infusion in the absence of thecatheter (conventional 133Xe administration). The adverse adrenaline effect is likely to berelated to the degree of invasiveness. Hence, it would be expected that any type of invasivemeasuring device causing a muscle injury could possibly provoke a similar reaction. Thisfinding has a general physiological implication, but has also implications for the use ofinvasive techniques to study blood flow regulation in skeletal muscle.Previous studies of tennis elbow (TE) have reported signs of diffuse muscle damage anddecreased blood flow in the affected extensor carpi radialis brevis (ECRB) muscle. Weconducted a case-control study (IV) to test the hypothesis that the muscle damage in the ECRBin TE alters the blood flow response to adrenaline in a vasoconstrictory direction. Muscleblood flow was determined with local clearance of 99mTechnetium during an i.v. infusion ofadrenaline. In support of the hypothesis, the blood flow reaction to adrenaline was markedlydifferent in the two study groups. Whereas the infusion did not significantly influence99mTechnetium-clearance in the ECRB of controls there was a significantly decreased clearancein the patients. The altered adrenaline effect indicates a vascular dysregulation in TE, which islikely to be of clinical significance by contributing to the development and maintenance of thechronic muscle pain in this large patient group. Whether the vasoregulatory alteration, whichwould be expected to involve recurring relative muscle ischemia, represents the primaryaetiology in TE or is a secondary effect of the muscle injury cannot be determined.In conclusion, a small muscle injury, acute or chronic, seems to alter the effect of adrenalineon skeletal muscle blood flow in a vasoconstrictory direction.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2010. 68 p.
adrenaline, blood flow, blood redistribution, ischemia, muscle injury, skeletal muscle, strain-gauge plethysmography, sympathetic tone, transmural pressure, 99mTechnetium clearance, tennis elbow, venous compliance, venous occlusion plethysmography, 133Xenon clearance
National Category
urn:nbn:se:uu:diva-169655 (URN)978-91-7409-659-0 (ISBN)
Public defence
2010-12-10, Aulan Södersjukhuset, Stockholm, 09:00 (Swedish)
Available from: 2012-03-06 Created: 2012-03-05 Last updated: 2012-03-08Bibliographically approved

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Vedung, Torbjörn
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