高雄醫學大學 骨科 傅尹志 醫師
• • •
vs酚
: •
: •
(
)
,
, (
,
)
,酚
,酚
,酚
,酚 ,酚
,
,酚
,酚
,酚
,酚
,
• • • • • •
(sprain)酚 (fracture) (dislocation)
( ,酚 ,酚
,酚
) ,酚 ,酚
,酚
•
•
•
•
•
,
!! • • •
• • • • •
15酚
3醯酚
• • • •
3醯酚
6醯酚
•
24-48
• RICE • Rest Ice Compression • PRICE Protection
Elevation
何時可以再運動？ 何時可以再運動？ • •
• •
Special Test : Flexor tendon Examination
17
Soft Tissue Palpation (Posterior) Act on the thumb hand at (digits fingers the wrist 2-5)joint
18
Soft Tissue Palpation (Anterior) Superficial Middlemuscles Deep muscle muscles of of the the ofanterior anterior the anterior compartment compartment compartment
21
Finkelstein’s test: Test for de Quervain’s disease
23
From: MayoClinic.com
Wrist ganglion • Etiology – Herniation of joint capsule, synovial sheath of tendon – Contain a clear, mucinous fluid – Most often appears on the back of the wrist
• S/S – Symptom: occasional pain with a lump – Sign: feel soft, rubbery or hard of cystic structure
• management: – Pressure to break down – Aspiration with chemical cauterization – Surgical exision
28
Wrist ganglion • Etiology – Herniation of joint capsule, synovial sheath of tendon – Contain a clear, mucinous fluid – Most often appears on the back of the wrist
• S/S – Symptom: occasional pain with a lump – Sign: feel soft, rubbery or hard of cystic structure
• management: – Pressure to break down – Aspiration with chemical cauterization – Surgical exision
29
Special Test : Neurological evaluation
Sensation evaluation
30
Wrist Injuries: Nerve • Claw hand Median & ulnar N compression
31
Drop hand
Ape hand
Bishop’s hand
Radial N palsy
腕隧道症候群
腕隧道症候群
•
• (4 (4
) )
•
有腕隧道症候群的人，也許會半夜或早上醒來想要甩一甩手或手 腕
•
如何診斷是腕隧道症候群？
神經傳導速率〈nerve conduction velocity〉及肌電圖 〈electromyolography〉檢查，可用來做進一步的診斷
•
•
• – • –
• – acetaminophen,
•
• (carrying酚angle) • • •
1醯
•
•
•
Pathoanatomic components • Pathoanatomic components – loss of intrinsics • leads to loss of baseline MCP flexion and loss of IP extension
– strong extrinsic EDC • leads to unopposed extension of the MCP joint • remember the EDC is not a significant extensor of the PIP joint – most of the MCP extension forces on the terminal insertion of the central slip come from the interosseous muscles
– strong FDP and FDS • leads to unopposed flexion of the PIP and DIP
Hand & finger Injuries: Soft tissue • • • • • •
53
Contusions Mallet finger Trigger finger Boutonniere deformity Swan neck deformity Jersey finger
Mallet finger • Sometimes called baseball finger • Jamming and avulsing the extensor tendon • Immediately splint in extension position for 6 – 8 weeks
54
Trigger finger • Stenosing tenosynvitis over A1 pulley area • A lump can be felt at the base of the flexor tendon sheath
55
Swan neck deformity • Volar plate of the PIP joint tear • Hyperextension of PIPJ • Splinting at 20-30 degrees of flexion for 3 weeks
57
Thank you