手部常見的疾病

高雄醫學大學 骨科 傅尹志 醫師

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• RICE • Rest Ice Compression • PRICE Protection

Elevation

何時可以再運動？ 何時可以再運動？ • •

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Special Test : Flexor tendon Examination

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Soft Tissue Palpation (Posterior) Act on the thumb hand at (digits fingers the wrist 2-5)joint

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Soft Tissue Palpation (Anterior) Superficial Middlemuscles Deep muscle muscles of of the the ofanterior anterior the anterior compartment compartment compartment

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Finkelstein’s test: Test for de Quervain’s disease

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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

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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

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Special Test : Neurological evaluation

Sensation evaluation

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Wrist Injuries: Nerve • Claw hand Median & ulnar N compression

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Drop hand

Ape hand

Bishop’s hand

Radial N palsy

腕隧道症候群

腕隧道症候群

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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

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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

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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 • • • • • •

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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

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Trigger finger • Stenosing tenosynvitis over A1 pulley area • A lump can be felt at the base of the flexor tendon sheath

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Swan neck deformity • Volar plate of the PIP joint tear • Hyperextension of PIPJ • Splinting at 20-30 degrees of flexion for 3 weeks

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Thank you