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Туннельные невропатии: акцент на синдром кубитального канала
Туннельные невропатии: акцент на синдром кубитального канала
Акарачкова Е.С., Котова О.В., Беляев А.А. Туннельные невропатии: акцент на синдром кубитального канала. Consilium Medicum. 2020 (22); 2: 54–57. DOI: 10.26442/20751753.2020.2.200088
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Аннотация
Аннотация
Синдром кубитального канала (СКК) занимает второе место по частоте встречаемости после синдрома карпального канала. Повторяющиеся сгибание и разгибание локтевого сустава, артриты и вальгусные деформации в локтевом суставе увеличивают его уязвимость при травматизации. Достаточно редко встречается двустороннее поражение локтевого нерва. В таких случаях необходимо оценивать наличие предрасполагающих факторов: нарушения обмена веществ, системных заболеваний, таких как сахарный диабет, алкоголизм, дефицит витаминов, анемия, наличие неврологических заболеваний, протекающих с полиневропатиями. Симптомы СКК обычно начинаются медленно, если это не связано с острой травмой. Основными проявлениями локтевого туннельного синдрома являются боль, онемение и/или покалывание. На начальных стадиях заболевания проводится консервативное лечение. Основными консервативными методами лечения СКК являются снижение частоты внешнего сдавливания нерва и максимальное исключение сгибания в локтевом суставе. К фармакологическому лечению СКК относят применение нестероидных противовоспалительных препаратов. При лечении СКК, как и других туннельных синдромов, возможно использование биорегуляционных препаратов. Пациенту с СКК при острой боли можно назначить на 2–3 дня нестероидные противовоспалительные препараты с дальнейшим переходом на внутримышечные инъекции препаратов Траумель® С и Коэнзим Композитум 1–3 раза в неделю, курсом от 1 до 3 нед.
Ключевые слова: синдром кубитального канала, невропатия локтевого нерва, диагностика, консервативная терапия, биорегуляционные препараты, Траумель С, Коэнзим Композитум.
Cubital tunnel syndrome (CTS) takes second place on the incidence after carpal tunnel syndrome. Repeated elbow joint flection and extention, arthritides, and valgus in elbow joint increase its vulnerability to traumatization. Bilateral ulnar nerve involvement is quite rare. In these cases, it is necessary to evaluate such predisposing factors as metabolic disorders, systemic disorders such as diabetes mellitus, alcohol use disorders, vitamin deficiency, anemia, various neurologic disorders associated with polyneuropathies. CTS symptoms usually develop slowly in case it is not associated with acute trauma. The main symptoms of ulnar tunnel syndrome include pain, numbness and/or tingling. At the initial stage of the disease conservative treatment is performed. Primary conservative methods of CTS syndrome treatment include decrease of frequency of outside nerve compression and maximal avoidance of ulnar joint flection. CTS pharmacological treatment includes using non-steroidal anti-inflammatory drugs. In CTS treatment as well as in other tunnel syndromes treatment use of bioregulational medications is possible. In patients with acute pain in CTS non-steroidal anti-inflammatory drugs can be used with following switch to intramuscular injections of medications Traumeel® С and Coenzyme Compositum 1-3 times a week with the course duration from 1 to 3 weeks.
Key words: cubital tunnel syndrome, ulnar nerve neuropathy, diagnostics, conservative treatment, bioregulational medications, Traumeel® С, Coenzyme
Compositum.
Синдром кубитального канала (СКК) занимает второе место по частоте встречаемости после синдрома карпального канала. Повторяющиеся сгибание и разгибание локтевого сустава, артриты и вальгусные деформации в локтевом суставе увеличивают его уязвимость при травматизации. Достаточно редко встречается двустороннее поражение локтевого нерва. В таких случаях необходимо оценивать наличие предрасполагающих факторов: нарушения обмена веществ, системных заболеваний, таких как сахарный диабет, алкоголизм, дефицит витаминов, анемия, наличие неврологических заболеваний, протекающих с полиневропатиями. Симптомы СКК обычно начинаются медленно, если это не связано с острой травмой. Основными проявлениями локтевого туннельного синдрома являются боль, онемение и/или покалывание. На начальных стадиях заболевания проводится консервативное лечение. Основными консервативными методами лечения СКК являются снижение частоты внешнего сдавливания нерва и максимальное исключение сгибания в локтевом суставе. К фармакологическому лечению СКК относят применение нестероидных противовоспалительных препаратов. При лечении СКК, как и других туннельных синдромов, возможно использование биорегуляционных препаратов. Пациенту с СКК при острой боли можно назначить на 2–3 дня нестероидные противовоспалительные препараты с дальнейшим переходом на внутримышечные инъекции препаратов Траумель® С и Коэнзим Композитум 1–3 раза в неделю, курсом от 1 до 3 нед.
Ключевые слова: синдром кубитального канала, невропатия локтевого нерва, диагностика, консервативная терапия, биорегуляционные препараты, Траумель С, Коэнзим Композитум.
________________________________________________
Cubital tunnel syndrome (CTS) takes second place on the incidence after carpal tunnel syndrome. Repeated elbow joint flection and extention, arthritides, and valgus in elbow joint increase its vulnerability to traumatization. Bilateral ulnar nerve involvement is quite rare. In these cases, it is necessary to evaluate such predisposing factors as metabolic disorders, systemic disorders such as diabetes mellitus, alcohol use disorders, vitamin deficiency, anemia, various neurologic disorders associated with polyneuropathies. CTS symptoms usually develop slowly in case it is not associated with acute trauma. The main symptoms of ulnar tunnel syndrome include pain, numbness and/or tingling. At the initial stage of the disease conservative treatment is performed. Primary conservative methods of CTS syndrome treatment include decrease of frequency of outside nerve compression and maximal avoidance of ulnar joint flection. CTS pharmacological treatment includes using non-steroidal anti-inflammatory drugs. In CTS treatment as well as in other tunnel syndromes treatment use of bioregulational medications is possible. In patients with acute pain in CTS non-steroidal anti-inflammatory drugs can be used with following switch to intramuscular injections of medications Traumeel® С and Coenzyme Compositum 1-3 times a week with the course duration from 1 to 3 weeks.
Key words: cubital tunnel syndrome, ulnar nerve neuropathy, diagnostics, conservative treatment, bioregulational medications, Traumeel® С, Coenzyme
Compositum.
Полный текст
Список литературы
1. Левин О.С. Полинейропатии. М.: Медицинское информационное агентство, 2005.
[Levin O.S. Polyneuropathy. Moscow: Meditsinskoe informatsionnoe agentstvo, 2005 (in Russian).]
2. Аль-Замиль М.Х. Карпальный синдром. Клиническая неврология. 2008; 1: 41–5.
[Al'-Zamil' M.Kh. Karpal'nyi sindrom. Klinicheskaia nevrologiia. 2008; 1: 41–5 (in Russian).]
3. Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234 (1–2): 5–10.
4. https://www.rmj.ru/articles/bolevoy_sindrom/Tunnelynye_sindromy_ruki/#ixzz6HVbFT35n
5. Werner CO, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985; 56 (5): 404–6.
6. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther 2005; 28: 345.
7. Wei YP, Yang SW. Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia: A Case Report. Medicine (Baltimore) 2019; 98 (45): e17863. DOI: 10.1097/MD.0000000000017863
8. Vimercati L, Lorusso A, L’Abbate N et al. Bilateral carpal tunnel syndrome and ulnar neuropathy at the elbow in a pizza chef. BMJ Case Rep 2009; 2009: 1293.
9. Rothenberg R, Sufit R. Drug-induced peripheral neuropathy in a patient with psoriatic arthritis. Arthritis Rheum 1987; 30: 221–4.
10. Sampath G, Pandurangi A. Bilateral ulnar nerve paralysis: an unreported complication of drug-induced extrapyramidal rigidity. Aust N Z J Psychiatry 1997; 31: 427–8.
11. Idler RS. General principles of patient evaluation and nonoperative management of cubital syndrome. Hand Clin 1996; 12 (2): 397–403.
12. Мозолевский Ю.В. Заболевания периферической нервной системы. Практическое руководство. М.: МЕДпресс-информ, 2019.
[Mozolevsky Yu.V. Diseases of the peripheral nervous system. A practical guide. Moscow: MEDpress-inform, 2019 (in Russian).]
13. Terayama Y, Uchiyama S, Ueda K et al. Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography. J Hand Surg Am 2018; 43 (6): 529–36.
14. Chang KV, Wu WT, Han DS, Özçakar L. Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements. Arch Phys Med Rehabil 2018; 99 (4): 743–57.
15. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993; 43 (9): 1673–7.
16. Hong CZ, Long HA, Kanakamedala RV et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil 1996; 77 (6): 573–7.
17. VanVeen KE, Alblas KC, Alons IM et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve 2015; 52 (3):380–5.
18. Хайне Х. Иммунологическая воспалительная реакция, вызванная антигомотоксической терапией воспалительных заболеваний суставов. Биологическая медицина. 1999; 1: 5–8.
[Khaine Kh. Immunologicheskaia vospalitel'naia reaktsiia, vyzvannaia antigomotoksicheskoi terapiei vospalitel'nykh zabolevanii sustavov. Biologicheskaia meditsina. 1999; 1: 5–8 (in Russian).]
19. Dietz A-R. Possibilities for a lymph therapy with diabetic polyneuropathy: Matrix therapy with type II diabetes: a practice-based study [in German]. Biol Med 2000; 29 (1): 4–9.
20. Porozov S, Cahalon L, Weiser M et al. Inhibition of IL-1b and TNF-a secretion from resting and activated human immunocytes by the homeopathic medication TraumeelR S. Clin Dev Immunol 2004; 11 (2): 143–9.
21. Seilheimer B, Wierzchacz C, Gebhardt R. Influence of Traumeel on cultured chondrocytes and recombinant human matrix metalloproteinases: implications for chronic joint diseases. Eur J Integr Med 2009; 1 (4): 252–3.
22. St Laurent G, Tackett M, McCaffrey T, Kapranov P. Deep sequencing transcriptome analysis of Traumeel therapeutic action in wound healing (THU0016). Ann Rheum Dis 2013; 72 (Suppl. 3).
23. Caliandro P, La Torre G, Padua R et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016; 11: CD006839.
2. Al'-Zamil' M.Kh. Karpal'nyi sindrom. Klinicheskaia nevrologiia. 2008; 1: 41–5 (in Russian).
3. Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234 (1–2): 5–10.
4. https://www.rmj.ru/articles/bolevoy_sindrom/Tunnelynye_sindromy_ruki/#ixzz6HVbFT35n
5. Werner CO, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985; 56 (5): 404–6.
6. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther 2005; 28: 345.
7. Wei YP, Yang SW. Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia: A Case Report. Medicine (Baltimore) 2019; 98 (45): e17863. DOI: 10.1097/MD.0000000000017863
8. Vimercati L, Lorusso A, L’Abbate N et al. Bilateral carpal tunnel syndrome and ulnar neuropathy at the elbow in a pizza chef. BMJ Case Rep 2009; 2009: 1293.
9. Rothenberg R, Sufit R. Drug-induced peripheral neuropathy in a patient with psoriatic arthritis. Arthritis Rheum 1987; 30: 221–4.
10. Sampath G, Pandurangi A. Bilateral ulnar nerve paralysis: an unreported complication of drug-induced extrapyramidal rigidity. Aust N Z J Psychiatry 1997; 31: 427–8.
11. Idler RS. General principles of patient evaluation and nonoperative management of cubital syndrome. Hand Clin 1996; 12 (2): 397–403.
12. Mozolevsky Yu.V. Diseases of the peripheral nervous system. A practical guide. Moscow: MEDpress-inform, 2019 (in Russian).
13. Terayama Y, Uchiyama S, Ueda K et al. Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography. J Hand Surg Am 2018; 43 (6): 529–36.
14. Chang KV, Wu WT, Han DS, Özçakar L. Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements. Arch Phys Med Rehabil 2018; 99 (4): 743–57.
15. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993; 43 (9): 1673–7.
16. Hong CZ, Long HA, Kanakamedala RV et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil 1996; 77 (6): 573–7.
17. VanVeen KE, Alblas KC, Alons IM et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve 2015; 52 (3):380–5.
18. Khaine Kh. Immunologicheskaia vospalitel'naia reaktsiia, vyzvannaia antigomotoksicheskoi terapiei vospalitel'nykh zabolevanii sustavov. Biologicheskaia meditsina. 1999; 1: 5–8 (in Russian).
19. Dietz A-R. Possibilities for a lymph therapy with diabetic polyneuropathy: Matrix therapy with type II diabetes: a practice-based study [in German]. Biol Med 2000; 29 (1): 4–9.
20. Porozov S, Cahalon L, Weiser M et al. Inhibition of IL-1b and TNF-a secretion from resting and activated human immunocytes by the homeopathic medication TraumeelR S. Clin Dev Immunol 2004; 11 (2): 143–9.
21. Seilheimer B, Wierzchacz C, Gebhardt R. Influence of Traumeel on cultured chondrocytes and recombinant human matrix metalloproteinases: implications for chronic joint diseases. Eur J Integr Med 2009; 1 (4): 252–3.
22. St Laurent G, Tackett M, McCaffrey T, Kapranov P. Deep sequencing transcriptome analysis of Traumeel therapeutic action in wound healing (THU0016). Ann Rheum Dis 2013; 72 (Suppl. 3).
23. Caliandro P, La Torre G, Padua R et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016; 11: CD006839.
[Levin O.S. Polyneuropathy. Moscow: Meditsinskoe informatsionnoe agentstvo, 2005 (in Russian).]
2. Аль-Замиль М.Х. Карпальный синдром. Клиническая неврология. 2008; 1: 41–5.
[Al'-Zamil' M.Kh. Karpal'nyi sindrom. Klinicheskaia nevrologiia. 2008; 1: 41–5 (in Russian).]
3. Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234 (1–2): 5–10.
4. https://www.rmj.ru/articles/bolevoy_sindrom/Tunnelynye_sindromy_ruki/#ixzz6HVbFT35n
5. Werner CO, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985; 56 (5): 404–6.
6. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther 2005; 28: 345.
7. Wei YP, Yang SW. Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia: A Case Report. Medicine (Baltimore) 2019; 98 (45): e17863. DOI: 10.1097/MD.0000000000017863
8. Vimercati L, Lorusso A, L’Abbate N et al. Bilateral carpal tunnel syndrome and ulnar neuropathy at the elbow in a pizza chef. BMJ Case Rep 2009; 2009: 1293.
9. Rothenberg R, Sufit R. Drug-induced peripheral neuropathy in a patient with psoriatic arthritis. Arthritis Rheum 1987; 30: 221–4.
10. Sampath G, Pandurangi A. Bilateral ulnar nerve paralysis: an unreported complication of drug-induced extrapyramidal rigidity. Aust N Z J Psychiatry 1997; 31: 427–8.
11. Idler RS. General principles of patient evaluation and nonoperative management of cubital syndrome. Hand Clin 1996; 12 (2): 397–403.
12. Мозолевский Ю.В. Заболевания периферической нервной системы. Практическое руководство. М.: МЕДпресс-информ, 2019.
[Mozolevsky Yu.V. Diseases of the peripheral nervous system. A practical guide. Moscow: MEDpress-inform, 2019 (in Russian).]
13. Terayama Y, Uchiyama S, Ueda K et al. Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography. J Hand Surg Am 2018; 43 (6): 529–36.
14. Chang KV, Wu WT, Han DS, Özçakar L. Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements. Arch Phys Med Rehabil 2018; 99 (4): 743–57.
15. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993; 43 (9): 1673–7.
16. Hong CZ, Long HA, Kanakamedala RV et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil 1996; 77 (6): 573–7.
17. VanVeen KE, Alblas KC, Alons IM et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve 2015; 52 (3):380–5.
18. Хайне Х. Иммунологическая воспалительная реакция, вызванная антигомотоксической терапией воспалительных заболеваний суставов. Биологическая медицина. 1999; 1: 5–8.
[Khaine Kh. Immunologicheskaia vospalitel'naia reaktsiia, vyzvannaia antigomotoksicheskoi terapiei vospalitel'nykh zabolevanii sustavov. Biologicheskaia meditsina. 1999; 1: 5–8 (in Russian).]
19. Dietz A-R. Possibilities for a lymph therapy with diabetic polyneuropathy: Matrix therapy with type II diabetes: a practice-based study [in German]. Biol Med 2000; 29 (1): 4–9.
20. Porozov S, Cahalon L, Weiser M et al. Inhibition of IL-1b and TNF-a secretion from resting and activated human immunocytes by the homeopathic medication TraumeelR S. Clin Dev Immunol 2004; 11 (2): 143–9.
21. Seilheimer B, Wierzchacz C, Gebhardt R. Influence of Traumeel on cultured chondrocytes and recombinant human matrix metalloproteinases: implications for chronic joint diseases. Eur J Integr Med 2009; 1 (4): 252–3.
22. St Laurent G, Tackett M, McCaffrey T, Kapranov P. Deep sequencing transcriptome analysis of Traumeel therapeutic action in wound healing (THU0016). Ann Rheum Dis 2013; 72 (Suppl. 3).
23. Caliandro P, La Torre G, Padua R et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016; 11: CD006839.
________________________________________________
2. Al'-Zamil' M.Kh. Karpal'nyi sindrom. Klinicheskaia nevrologiia. 2008; 1: 41–5 (in Russian).
3. Mondelli M, Giannini F, Ballerini M et al. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci 2005; 234 (1–2): 5–10.
4. https://www.rmj.ru/articles/bolevoy_sindrom/Tunnelynye_sindromy_ruki/#ixzz6HVbFT35n
5. Werner CO, Ohlin P, Elmqvist D. Pressures recorded in ulnar neuropathy. Acta Orthop Scand 1985; 56 (5): 404–6.
6. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther 2005; 28: 345.
7. Wei YP, Yang SW. Simultaneous bilateral ulnar neuropathy: an unusual complication caused by neuroleptic treatment-induced tardive dyskinesia: A Case Report. Medicine (Baltimore) 2019; 98 (45): e17863. DOI: 10.1097/MD.0000000000017863
8. Vimercati L, Lorusso A, L’Abbate N et al. Bilateral carpal tunnel syndrome and ulnar neuropathy at the elbow in a pizza chef. BMJ Case Rep 2009; 2009: 1293.
9. Rothenberg R, Sufit R. Drug-induced peripheral neuropathy in a patient with psoriatic arthritis. Arthritis Rheum 1987; 30: 221–4.
10. Sampath G, Pandurangi A. Bilateral ulnar nerve paralysis: an unreported complication of drug-induced extrapyramidal rigidity. Aust N Z J Psychiatry 1997; 31: 427–8.
11. Idler RS. General principles of patient evaluation and nonoperative management of cubital syndrome. Hand Clin 1996; 12 (2): 397–403.
12. Mozolevsky Yu.V. Diseases of the peripheral nervous system. A practical guide. Moscow: MEDpress-inform, 2019 (in Russian).
13. Terayama Y, Uchiyama S, Ueda K et al. Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography. J Hand Surg Am 2018; 43 (6): 529–36.
14. Chang KV, Wu WT, Han DS, Özçakar L. Ulnar Nerve Cross-Sectional Area for the Diagnosis of Cubital Tunnel Syndrome: A Meta-Analysis of Ultrasonographic Measurements. Arch Phys Med Rehabil 2018; 99 (4): 743–57.
15. Dellon AL, Hament W, Gittelshon A. Nonoperative management of cubital tunnel syndrome: an 8-year prospective study. Neurology 1993; 43 (9): 1673–7.
16. Hong CZ, Long HA, Kanakamedala RV et al. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil 1996; 77 (6): 573–7.
17. VanVeen KE, Alblas KC, Alons IM et al. Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial. Muscle Nerve 2015; 52 (3):380–5.
18. Khaine Kh. Immunologicheskaia vospalitel'naia reaktsiia, vyzvannaia antigomotoksicheskoi terapiei vospalitel'nykh zabolevanii sustavov. Biologicheskaia meditsina. 1999; 1: 5–8 (in Russian).
19. Dietz A-R. Possibilities for a lymph therapy with diabetic polyneuropathy: Matrix therapy with type II diabetes: a practice-based study [in German]. Biol Med 2000; 29 (1): 4–9.
20. Porozov S, Cahalon L, Weiser M et al. Inhibition of IL-1b and TNF-a secretion from resting and activated human immunocytes by the homeopathic medication TraumeelR S. Clin Dev Immunol 2004; 11 (2): 143–9.
21. Seilheimer B, Wierzchacz C, Gebhardt R. Influence of Traumeel on cultured chondrocytes and recombinant human matrix metalloproteinases: implications for chronic joint diseases. Eur J Integr Med 2009; 1 (4): 252–3.
22. St Laurent G, Tackett M, McCaffrey T, Kapranov P. Deep sequencing transcriptome analysis of Traumeel therapeutic action in wound healing (THU0016). Ann Rheum Dis 2013; 72 (Suppl. 3).
23. Caliandro P, La Torre G, Padua R et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016; 11: CD006839.
Авторы
Е.С. Акарачкова1, О.В. Котова*1, А.А. Беляев2
1 Международное общество «Стресс под контролем», Москва, Россия;
2 ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского» Департамента здравоохранения г. Москвы, Москва, Россия
*ol_kotova@mail.ru
1 International Society "Stress under control", Moscow, Russia;
2 Sklifosovsky Research Institute of Emergency, Moscow, Russia
*ol_kotova@mail.ru
1 Международное общество «Стресс под контролем», Москва, Россия;
2 ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского» Департамента здравоохранения г. Москвы, Москва, Россия
*ol_kotova@mail.ru
________________________________________________
1 International Society "Stress under control", Moscow, Russia;
2 Sklifosovsky Research Institute of Emergency, Moscow, Russia
*ol_kotova@mail.ru
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