高雄醫學大學高雄醫學大學骨科骨科傅尹志傅尹志醫師醫師

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Special Test : Flexor tendon Examination

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Soft Tissue Palpation (Posterior)

Act on the hand at the wrist joint Act on the fingers (digits 2-5)Act on the thumb

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Soft Tissue Palpation (Anterior)

Superficial muscles of the anterior compartmentMiddle muscle of the anterior compartmentDeep muscles of the anterior compartment

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

From: MayoClinic.com

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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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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

� Drop hand

� Ape hand

� Bishop ’s hand

Median & ulnar N compression

Radial N palsy

腕隧道症候群

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

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Hand & finger Injuries: Soft tissue

•• ContusionsContusions

•• Mallet fingerMallet finger

•• Trigger fingerTrigger finger

• Boutonniere deformity

• Swan neck deformity

• Jersey finger

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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

Thank you