The fourth chapter wrist and hand tendon injury

The wrist is connected the forearm and hand, forearm tendon, blood vessels and nerves. The pipeline. A wide 3cm of dorsal wrist extensor ret

Content

The wrist is connected the forearm and hand, forearm tendon, blood vessels and nerves. The pipeline. A wide 3cm of dorsal wrist extensor retinaculum, play a role. Palmar side of the transverse carpal ligament and wrist to form a deep depression, composed of osteofirous pipeline, namely the carpal tunnel, flexor pollicis for flexor tendons and median nerve. Female carpal canal less than male.

The wrist is stable, in addition to relying on the various ligament (Figure 4-1), the external hand muscle is also an important factor, is mainly 3 wrist extensor flexor muscle of wrist and finger flexor, the hand, only large objects have the stable function of carpal joint.

Sprain of wrist joint

The wrist is located between the hand and forearm, wrist is a composite joint, wrist joints, wrist and distal radioulnar joint composition, conduction stress and dorsiflexion, deflection, rotation, swing and other functions. The wrist is composed of metacarpal base, the distal end of the forearm, wrist, TFCC, ligament and joint capsule. When a person falls to the ground, the wrist joint is the first joint to bear the external force to the proximal limb. Therefore, the wrist is vulnerable to damage, such as improper treatment after injury, can cause the change of intercarpal relationship, called Carpal instability.

Etiology and pathogenesis

Sprain of wrist joint is caused by external force. There are different views on the mechanism of wrist injury, but many of them considered by the over extension of the wrist caused by violence. When the wrist joint in flexion and ulnar deviation of position, by the external force and the fierce, wrist activity beyond the normal range, will cause the corresponding carpal ligament and fascia tissue injury.

[diagnosis]

(a) clinical manifestations

According to the position and direction of force in different or opposite parts of the corresponding wrist swelling and aching weakness, local tenderness, limited wrist joint function. Sometimes a subcutaneous ecchymosis.

(two) X-ray examination

There were no abnormal findings in the positive and lateral radiographs of the wrist joint. As with suspected scaphoid fracture, in 2 weeks after the review of butterfly radiographs.

Syndrome differentiation treatment

(I) general treatment

Wrist sprain after bed rest, if necessary, plaster external fixation in 1 ~ 2 weeks. Early can give cold, do not use hot compress and massage.

(two) manipulation therapy

According to the different parts of wrist injury can be used in the following one or two methods of use.

1 pulling method. The patients sitting, wrist stretch, palm down, the doctor stands in the injured side, holding the forearm and lower, with the thumb on the first metacarpal root (Yang Xixue). The other hand the first metacarpal and thumb, with the increase of around 6 or 7 times after Akira stretching, while maintaining the pulling force at the same time, the thumb flexion, while holding the wrist thumb down according to stamp (Figure 4-2).

2 flexion method. The patients sitting, wrist outstretched, palms up, the doctor stood in front of patients, holding the wrist, and with the middle finger on wounds (Tai Yuanxue), another hand thumb and first metacarpal, from outside to inside ring turn shake 6 or 7 times, and then stretching, while maintaining pulling power will wrist flexion, wrist and hand pointing down by stamp (Figure 4-3).

3 reinforcement method. The patient is sitting, the injured wrist stretches out, the palm downward. The doctor stands in front of patients, a hand grip and wrist, with the middle finger button. (Yang Guxue), on the other hand from the side, and shows that the ring and little finger from inside to outside, or from outside to inner ring turn shake 6 or 7 times, and then stretching. Keep pulling force at the same time, the wrist to fnexor, then quickly to the ulnar flexor, and asked the wrist hand pointing to the radial side by stamp (Figure 4-4).

4 flexion method. Patient sitting. Wrist injury, palm up. The healer stands in front of the patient. A hand grip and wrist, with the middle finger on the wound (Shenmen). On the other hand from the side, and refers to the show ring and little fingers, from outside to inside ring turn shake 6 or 7 times, and then to the radial side above the ramp to stretch, ulnar flexion, wrist and hand in to get under the stamp press (Figure 4-5).

5 channels of tendon. The patient is sitting, the injured wrist extends. Tiger down, the doctor stands in a hand from the wrist injury, dorsal wrist and thumb hold, hold the wound (Shenmen), on the other hand from the back side and the palm of your hand, ring turn shake 6 or 7 times to that side stretching, and then make the injured arm to hold (palms forward take the hand of the palm), wrist flexion, wrist with hand thumb down straight injured tendons (Figure 4-6).

6 bar method. The patient is sitting, the injured wrist extends. Palm down, the doctor stands in front of a patient, from hand wrist and finger side grip, the thumb button on the wound (Yang Chi Xue), on the other hand from the side, and shows the thumb ring and little fingers, from the inner to the outer ring turn shake 6 or 7 times, and then pull the wrist flexion stretch, then quickly dorsiflexion, and thumb down by stamp (Figure 4-7).

7 interpolation method. Patients will hurt the wrist stretched out, sitting, open fingers, palms forward, the doctor stood in front of patients, a hand thumb side hold the wrist, thumb button on the wound (Yang Chi point), on the other hand fingers and injured fingers relative cross fastened by the outgoing ring

Shake for 6 or 7 times, and then make the wrist flexion and extension of the wrist, and then quickly back, while taking the wrist of the injured thumb down press (Figure 4 -).

8 force along the reinforcement method. The patients sitting, wrist stretch, healers stood in front of patients, the patients with injured hands placed on medical medicine chest, with one hand by the little finger side hold another hand from injury of palm, thumb side and wrist, thumb button press the wound (acupoint), chest to push medical patients. The doctor took the palm hand quickly wounded arm held high, while the wrist palmar flexion, wrist with hand thumb down, Shun reinforcement (Figure 4-9).

9 push method. Dorsal carpal hematoma. A person holding the assistant doctors who hold the patient's elbow, with the back of the hand, first against stretching, and then use the thumb to push the hematoma, in pushing before putting pressure on the central visual moving to the hematoma, hematoma and then decide which side direction, upwards or downwards push. When the finger is scattered hematoma broken voice, hematoma immediately disappear.

The 10 doctor hands and 1 patients respectively by ~ 5, and then one by one in the drawing ring rotary shaking 1 ~ 5 fingers and shaking manipulation of the muscles to relax spasm.

(three) drug treatment

1 internal medicine early swelling and see, treated with blood stasis, detumescence and acesodyne, with hulisan capsule. The swelling of joint is stiff, with Xiaohuoluo Dan or Lycopodii capsule.

2 external medicine early topical pain cream, later with hematoxylin mixture fumigation.

(four) other therapies

1 treatment of wrist joint sprain and contusion can be used in the treatment of intermediate frequency physiotherapy, in order to relieve pain and muscle spasm, accelerate local tissue metabolism.

2 local injection of triamcinolone (20mg, Shu Song is phlogistic) 2ml lidocaine plus saline 2ml after mixing the pain points and the surrounding closed treatment.

Injury of the second triangular fibrocartilage

The triangular fibrocartilage of the wrist and wrist articular disc, is located between the ulna and triangular fibrocartilage bone, triangular. The triangular thick tip by fibrous tissue attached to the radial styloid process of ulna and the ulnar notch basal pits, triangular fibrocartilage thin bottom attached to the distal radius, in parallel with the radial distal surface, become a part of the ulnar side of the wrist joint. The dorsal aspect of the triangular fibrocartilage is closely connected with the dorsal metacarpal ligament of the wrist joint and the distal radioulnar joint. The wrist joint is transversely separated from the distal radioulnar joint and the wrist joint, and the two joint cavities are completely separated. In order to enhance the sliding joint and prevent the damage in the cyclotron, with sacciform recess to cushion. Triangular fibrocartilage is the buffer pad of the wrist joint, which is the main stable structure of the distal radioulnar joint.

Etiology and pathogenesis

Congenital, traumatic and degenerative can cause carpal triangular fibrocartilage injury. The damage occurred at the junction of the triangular fibrocartilage and the ulnar side of the distal radius. General wrist pronation is at work, the wrist joint ulnar flexion and dorsiflexion, the distal articular surface of the triangular bone pressed the triangular fibrocartilage of the wrist, to a certain extent restrict its activities; at the same time of the triangular fibrocartilage surface accompanied by radial rotation, sliding in the head of the ulna, so in the triangular fibrocartilage on the articular surface because of unbalanced force distortion damage. The arm pronation, wrist flexion, ulnar dorsal extension was fixed in the hand, the triangular fibrocartilage tear. In addition, due to the distal radius fractures and other injuries, can also cause the rupture of the wrist joint disc. Therefore, the early symptoms of fibrous cartilage injury in the wrist are often masked by other serious injuries.

[diagnosis]

(a) clinical manifestations

The main symptom is chronic ulnar wrist pain accompanied by weakness of the wrist, wrist joint function limitation, forearm rotation activity and anti rotation activities caused by pain, pain increased especially after rotation. Physical examination: the ulnar wrist and distal radioulnar joint tenderness, wrist flexion, rotation restricted activity, decreased grip strength, arthrosnap. If there is damage to the ligaments around the wrist joint instability may occur in the late stage of wrist joint traumatic arthritis.

(two) auxiliary examination

1 X-ray examination showed the radial ulnar joint gap widened, dorsal displacement of the head. The position of the triangular fibrocartilage could be judged by the lipiodol or air contrast of the wrist joint.

2.MRI can be used to display the structure of bone and cartilage in multi plane and multi layers. It not only can directly show the damage and tear of triangular fibrocartilage, but also can display the abnormal changes of bone and soft tissue, which is helpful for the diagnosis and differential diagnosis.

3 arthroscopy is the most reliable method for arthroscopic examination. Wrist arthroscopy can understand the size, shape and position of the triangular fibrocartilage injury, cartilage damage, joint ligament injury, and injury can be directly found for repair or other treatment.

Syndrome differentiation treatment

The triangular fibrocartilage of the wrist has no direct blood supply, a small amount of blood supply only in the attachment and around the joint capsule and the bone, most dependent on synovial fluid in the joint cavity.

(1) manipulation therapy

1 patients with tendon method is sitting, injured wrist extension, palm down. The doctor stands in front of patients, a hand grip and wrist, with the middle finger button. (Yang Guxue), on the other hand from the side, and shows that the ring and little finger inside out or outside the inner ring turn shake 6 or 7 times, and then stretching. Keep pulling force at the same time, the wrist to fnexor, then quickly to the ulnar flexor, while supporting wrist hand refers to the radial side by stamp (see Figure 4-4).

2 patients with flexion. Wrist injury, palm up. The healer stands in front of the patient. A hand grip and wrist, with the middle finger on the wound (Shenmen). On the other hand from the side, and refers to the show ring and little fingers, from outside to inside ring turn shake 6 or 7 times, and then to the radial side above the ramp to stretch, ulnar flexion, wrist and hand in to get under the stamp press (see Figure 4-5).

(two) drug treatment

At the beginning of 1 can choose medicine hulisan, treated by activating blood and detumescence and acesodyne; late treatment should be Shujin, choose Xiaohuoluo pills or Lycopodii capsule.

2 external medicine early topical pain cream, later with hematoxylin washing agent.

(three) functional exercise

Try to avoid the injury of wrist protection activities, 5 to 7 days of pain relieved or disappeared after external fixation gradually under the function of wrist extensor, do a fist. However, with the function of causing pain around the case of head of ulna.

(four) other therapies

1. Local blocking therapy, triamcinolone 20mg, lidocaine 2ml plus saline 2ml after mixing the pain points and the surrounding closed.

2 surgical treatment, according to the degree of injury can choose different operation. Ulnar shortening; triangular fibrocartilage resection; ulnar head resection. Optional dorsal incision incision cubit.

3 arthroscopic treatment.

The third part of the wrist extensor carpi radialis

Frequent excessive wrist flexion and extension activities caused by radial carpal extensor tendon aponeurosis and fascia around aseptic inflammation, called radial carpal extensor myotenositis.

Etiology and pathogenesis

Wrist strain or wrist dorsiflexion of the disease caused by a sudden force. In addition to anatomical characteristics. In the 1/3 under the abductor pollicis longus and extensor pollicis brevis and from dorsal forearm extensor carpi radialis longus, extensor carpi radialis brevis on oblique cross, there is no aponeurosis, only a layer of loose fascia covering, when the thumb or wrist frequent activity, the cross tendon friction, cause the tendon and fascia of aseptic inflammation. Local hyperemia, edema, and inflammatory exudate, tendon sliding can be touched when the pronunciation.

[diagnosis]

(a) clinical manifestations

A wrist strain history, such as in packaging industry, wood etc.. The radial side of the wrist pain and weakness, forearm dorsal 1/3 radial pain, swelling and pain aggravation of wrist extensor and flexor activity.

(two) examination

In the long and short radial carpal extensor carpi brevis and abductor pollicis longus and extensor hallucis in dorsal forearm and 1/3 have apparent tenderness, wrist flexion and pressing the affected area can be heard crepitus.

Syndrome differentiation treatment

Light local hot compress or reduce the activity of the symptoms can be cured. The onset of acute pain and activity should be the wrist joints, the board can be used to fix the wrist joint, including the thumb, triangular bandage suspended limb.

(1) manipulation therapy

Local feasible push method, kneading method of treatment, patients with forearm extensor muscles along the direction from the wrist to push, rub to Shu Tong Qi and blood, swelling and pain. Until the wrist joint movement of the disappearance or reduction of pronunciation.

(two) drug treatment

1 internal medicine treatment should be blood stasis detumescence and analgesic, side Xuanshen pill.

2 external medicine topical anti-inflammatory analgesic cream or Ruyi jinhuanggao, with hematoxylin washing agent.

(three) other therapies

1 physical therapy if electronic physiotherapy, vinegar treatment.

2 local blocking therapy triamcinolone 20mg, lidocaine 2ml plus saline 2ml after mixing the pain points and the surrounding closed.

Fourth carpal tunnel syndrome

The carpal canal is composed of carpal and transverse carpal ligament stretching lack of bone fiber of pipeline. There are 4 carpal tunnel wall: anterior to the transverse carpal ligament, posterior wall fascia lunate, capitate bone and the proximal end of metacarpal bone and the surface of the radial side wall and scaphoid tubercle of trapezium bone, ulnar side wall is a triangular bone, bone and ligament of pea. There were 9 flexor tendons and median nerve in the carpal tunnel.

Carpal tunnel syndrome is a clinical syndrome that is caused by the median nerve innervation of the median nerve and the involvement of the intrinsic muscles of the hand. As the radial side of the 3 or 4 finger numbness and pain, thenar muscle atrophy, weakness of abduction of the thumb and palm, feel the median nerve distribution area.

Etiology and pathogenesis

(I) carpal canal volume reduction

The dislocation or fracture of scaphoid, lunate, wrist fracture malunion, traumatic arthritis can cause carpal tunnel lumen narrowing, transverse carpal ligament thickening can also make the carpal tunnel volume reduced, the median nerve compression.

(two) the increase of the contents of carpal tunnel

Common are: the carpal canal tumor, such as tumor, lipoma, ganglion cyst, multiple myeloma; synovial hypertrophy, such as wrist rheumatoid arthritis and so on; the carpal canal hematoma, such as hemophilia, anticoagulation, tendon and muscle trauma; mutation.

[diagnosis]

(a) clinical manifestations

The majority of middle-aged patients, more women than men, to see more unilateral. The main symptoms of the 3.5 fingers of the radial side of the palm feel abnormal, burning, numb like feeling. Light only at night or paresthesia after hard labor, but the movement disorder is not obvious, only a minority of patients with finger function is not flexible feeling. Or tingling of the fingers, numbness, lasting and obvious, sometimes the pain can be forward arm and upper arm, shoulder girdle, night intensifies, and even affect sleep. Later, patients can also be thenar muscle atrophy and dysfunction of thumb opposition.

(two) examination

1 wrist flexion test wrist flexion and compression of the median nerve of 1 ~ 2 minutes, the numbness is aggravating, pain can radiate to the middle finger and index finger, the wrist flexion test positive (Figure 4-10).

With a finger tapping wrist and palm 2.Tinel test in the Tinel test positive for finger numbness. Tourniquet test: application of sphygmomanometer balloon inflated to systolic blood pressure and diastolic blood pressure between the hands hyperemia after 1 minutes as positive symptoms.

Wrist flexion test on both sides of the comparison, more conducive to a clear diagnosis.

Syndrome differentiation treatment

(1) manipulation therapy

In the limb pain point and Waiguan, Yangxi, thenar, Hegu, Laogong with Zhanjin Dan Waicha local massage, and then hand in hand pull again with a mild reinforcement method. In addition, the pressure to the left hand holding the wrist, right hand thumb and two finger pinch patients hand thumb, distally stretching to occur rapidly, snapping is better, followed by 2, 3, stretching 4 fingers above manipulation can once a day.

(two) drug treatment

1 internal medicine to cure Qufengtongluo, oral Xiaohuoluo pills, capsules and other lycopodii.

2 external medicine with bone paste, and wash with hematoxylin mixture.

(three) other therapies

1 local blocking therapy triamcinolone 20mg, lidocaine 2ml plus saline 2ml after mixing in the proximal margin of the transverse carpal ligament to the midpoint in the carpal tunnel injection.

2 surgical treatment of patients with conservative treatment is invalid, the operation of the transverse carpal ligament decompression. The incision along the lines from the thenar arc incision, avoid injury or cut off the palmar cutaneous branch of the median nerve and the recurrent branch. Attention should be paid to the examination of carpal tunnel in the operation, such as synovial hypertrophy, occupying lesions and abdominal muscle into the carpal tunnel should be removed; postoperative pressure bandage and wrist neutral plaster fixation for 3 weeks, as soon as possible after the hand function training.

The fifth section refers to the extension, the flexor tendon rupture

Trauma caused by finger extension, finger flexor tendon partial or complete fracture is not uncommon in clinical, early and effective treatment is the key to restore the function of the finger.

Etiology and pathogenesis

Rupture of the tendon of the hand is mostly caused by tearing, cutting and stabbing. Starting from the forearm extensor tendon and dorsal, stop at the distal phalanx in subcutaneous, only a bag in a tendon sheath in the dorsal carpal ligament. The flexor digitorum profundus tendon from the forearm, wrist, hand, tube after flexor tendon sheath in the distal phalanges of the palmar side. After flexor tendon rupture, if the chance of early repair, proximal retraction more.

Flexor tendon Division: according to the anatomical and physiological characteristics of flexor tendon, it can be divided into 5 areas (Figure 4-11). Forearm region (I): from the beginning of the tendon to the proximal end of the carpal tunnel, i.e., the lower 1/3 of the forearm. The flexor tendon has more, peritendon tissues and soft tissue protection, less adhesion. If the conditions are suitable, can be done in this area a suture, the effect is better. Note that avoid anastomotic in the same plane to reduce adhesion. If necessary, only the deep flexor tendon. The wrist district (District II): the carpal tunnel has 9 tendons and median nerve, small space. Treatment: cut the transverse carpal ligament, only suture of flexor digitorum profundus tendon and flexor pollicis longus tendon. The anastomosis should not be in the same plane, and the median nerve should be at the same time as the median nerve. The palm area (Area III): the transverse carpal ligament distal to the tendon sheath into the area in front of. The sheath region (District IV): also known as the "land", from the beginning to the festival of the insertion of the flexor digitorum superficialis. This section of flexor tendon is limited in a narrow range, prone to adhesion after injury, treatment effect is poor. The tendon of the flexor digitorum profundus bunt district (District V): from the middle phalanx near to deep flexor tendon stopping point. The area only refers to the deep flexor tendon, should be early after the fracture repair, direct suture broken end.

[diagnosis]

The deep and superficial flexor tendon were fracture, interphalangeal joint in extension position, do wrist test, fingers can bend. Fixation of the proximal interphalangeal joints, if not active flexion of the distal interphalangeal joints for finger deep flexor tendon rupture (Figure 4-12). Check the superficial flexor tendon of finger extensor tendon, to exclude the influence of the. Two o hold a finger in full extension, such as check the superficial flexor tendon of finger without fracture, can active flexion of proximal interphalangeal joint (Figure 4-13), or not. Fixed the thumb metacarpophalangeal joint, such as buckling thumb interphalangeal joints, for the flexor pollicis longus tendon rupture.

Extensor tendon rupture, the performance of the mallet finger deformity, some patients with avulsion fracture (Figure 4-14). The central tendon bundle fracture, long time not timely repair of the central beam, forming a typical "hole" deformity (Fig. 4-15).

Syndrome differentiation treatment

(1) surgical treatment

Fresh finger tendon rupture, should strive for a surgical repair. In the later period, it is difficult to increase the adhesion of tendon and tendon.

There are several ways to suture the tendon, see Figure 4-16 to 4-24.

(two) fixed treatment

Fixed: flexor tendon in tendon relaxation to the wrist and fingers fixed to fixed extensor extensor tendon. Fixed time of 4 ~ 6 weeks.

(three) drug treatment

1 internal medicine early injury and postoperative treatment with heat clearing and detoxicating, promoting blood circulation to remove blood stasis, five oral disinfection drink or taohongsiwutang.

2 external medicine in later stage with herbal fumigation, such as hematoxylin mixture.

(four) functional exercise

General tendon rupture, the need to brake for 4 to 6 weeks, after the removal of the brake, began to practice activities, increase the amount of activity after 1 weeks.

The sixth section ganglion cyst

Ganglion cyst occurred in the vicinity of the joints growth in the joint capsule, ligament or tendon sheath cystic mass, it does not contain tumor cells are not actually tumor that occurs in young adults, more common in women.

Etiology and pathogenesis

The cause is unknown, that repeated chronic fatigue is a major cause of the disease, is common in industrial workers and housewives. Some people think that with the joint capsule, ligament, tendon tissue degeneration related.

Ganglion cyst occurred in the joint capsule, ligament, tendon sheath, but not with the synovial joint cavity or tendon sheath. The cyst wall dense tough fibrous connective tissue in the capsule is transparent gelatinous mucus containing hyaluronic acid and protein.

[clinical manifestations]

Good site: the most common in the dorsal wrist, back side from the scaphoid and lunate joint, extensor radialis; the second is the radial side of the wrist and palm, flexor carpi radialis tendon and abductor pollicis longus; finger joint transverse metacarpal skin of the flexor tendon sheath. Here is the mass bean size, hard texture.

In addition to the general case of mass, no other discomfort. Cysts are hemispherical, smooth surface, no adhesion with the skin, almost no activity, according to the tension and elastic. Some patients may be weakening the wrist, holding a squeezing pain. The size of the cyst is not directly related to the severity of the symptoms, but the pain of the cyst is small and the tension is more obvious. In addition, the symptoms of cysts are related to the location of cysts.

This disease with lipoma, GCTTS phase identification.

Syndrome differentiation treatment

(1) manipulation therapy

On the wall is thin, do acupressure. Such as cysts in the back of the wrist, the wrist as far as possible flexion, so that more prominent cyst and fixed. Patients with thumb on cyst, and increase the pressure of the squeeze. At this time the cyst inside the mucous membrane to break through the wall, scattered into the subcutaneous, cyst is not obvious. Massage and scattered swelling and blood circulation, local bandage pressure bandage 1 ~ 2 days. But some patients still relapse.

(two) other therapies

1 local block therapy with a large needle as much as possible to exhaust sac mucus, and then fixed the needle and syringe exchange, with Cu Ann Ned 20mg, 2ml normal saline, 2% lidocaine 2ml local blocking therapy and compression bandage.

2 surgical treatment of repeated hair, feasible surgical removal. With blood on the arm down, after the local incision on the cyst surface incision should be large enough. Attention should be paid to the blood vessels, nerves and tendons around the cyst

The cyst wall at the base of the cyst cavity was removed completely around the tendon to avoid recurrence.

The seventh section radial styloid stenosing tenosynovitis

The radial styloid stenosing tenosynovitis called abductor pollicis longus, extensor pollicis brevis tenosynovitis. Because the abductor pollicis longus and extensor pollicis brevis from radial dorsal central and interosseous membrane, together with narrow radial styloid, respectively in first and first metacarpal phalangeal base. The radial styloid muscle tendon of tendon sheath in the long time excessive friction or repeated injury, showing synovial edema and exudation increased, causing sheath wall thickening, adhesion or stenosis, called radial styloid stenosing tenosynovitis.

Etiology and pathogenesis

Short abductor pollicis longus and extensor pollicis joint by radial styloid parts of tendon sheath, radial styloid sheath groove shallow and narrow ditch bottom surface uneven, the groove surface covered with the dorsal carpal ligament, the formation of fibrous sheath of tendon sheath, two fold after a certain angle were ended in the first metacarpal bone and the thumb, the anatomical features are cause of the disease. Often used the work of the wrist can lead to the occurrence of this disease. Such as the family of women, women in lactation and packaging workers work, when the thumb and wrist extensor muscle activity, the abductor pollicis longus tendon and the thumb back and forth whet, in common in the long sheath strain, tendon sheath local thickening, wall thickening, inflammatory injury, lumen caused by congestion, edema, fiber tube narrowing, tendon gliding in the lumen is difficult to produce the corresponding symptoms.

[diagnosis]

Slow onset, the thumb and wrist strain history. The radial side wrist pain, increase the thumb and wrist activity, rest after reducing. The thumb and wrist activity, increases the pain into persistent pain. Check the visible styloid process of radius has apparent tenderness, with the ulnar thumb flexion test was positive; the remaining 4 fingers, holding the thumb, wrist to ulnar deviation, radial styloid process of severe pain is positive.

Syndrome differentiation treatment

(1) manipulation therapy

The doctor on hand to hold the patient hands, massage and kneading the other hand on the wrist side and back pain around it, and then press the hand in three, Yang Xi, Hegu acupoint, and plucked tendon of 4 or 5 times. With the left-hand fixed limb forearm, right hand holding the hand of a patient in a mild stretch the affected hand slowly rotation and flexion, finally with the right hand thumb, two finger pinch hand thumb, to the distal end suddenly can cause tension, snapping up Shujin role. Before the end of the affected area once again massage, massage can be 1 times daily or every other day.

(two) other therapies

1 local blocking therapy with Cu Ann Ned 20mg, physiological saline 2ml, 2% lidocaine 2ml intrathecal injection, once a week for 1 times.

2 surgical treatment for a longer period of time, repeated hair, should be treated with surgery. Taking the radial styloid process of longitudinal "S" incision, to completely open bone trench, sheath fiber interval must be removed. Attention should be paid to avoid the injury of superficial branch of radial nerve. During the operation, we should check the abduction of the thumb, and then complete the incision. Early postoperative thumb exercise to prevent adhesion.

The eighth section of stenosing tenosynovitis of the flexor tendon

Stenosing tenosynovitis is common in the manual operation of the staff. With the thumb and index finger and middle finger involvement were more common, the most common thumb. Mainly for finger flexion and extension activities are snapping, also known as the "finger" and "trigger finger".

Etiology and pathogenesis

Stenosing tenosynovitis of the flexor tendon lesion of the metacarpophalangeal joint and volar ligament bone formation of the cyclic sheath, at the initial part of the fibrous sheath of metacarpal head in front of the tube, these parts of the sheath is relatively narrow due to anatomical factors of the disease. Finger frequent activities, tendon friction each other in the sheath, sheath hyperemia, edema, hypertrophy and fibrosis gradually, the tendon sheath thickening, stenosis due to compression and extrusion of tendon, tendon thinning, dilated into a gourd shaped ends. Flexor, tendon swollen part through the narrow fiber tube, the finger bounce, interlocking can be serious, the finger can not buckling.

[diagnosis]

Early onset finger flexion, flexion pain when the force, and the emergence of bouncing action. The morning and after heavy manual labor, or after hot compress after reduce. Check the volar side of metacarpal head can touch the grain size of the nodules, tenderness, hold this nodule, ask the patient to do full flexion and extension activities, significant pain, and are snapping this issue. When severe, can not take the initiative to straighten the flexion, the need to help the health of the hand to straighten out.

Syndrome differentiation treatment

(1) manipulation therapy

In the first place to do massage, dial of collaterals, refers to the gun technique, and then the surgeon from the radial side and with thumb on the back of the hand, the first metacarpophalangeal joint tendon, the other hand holding the thumb to the distal thumb stretching and shake 5 ~ 7 times, in the stretch suddenly under the thumb flexion. At the same time, the finger pressing sheath according to the metacarpophalangeal joints. Finally, hold the finger quickly opened to the distal end, such as playing sound effect is good, 1 times daily or every other day.

(two) other therapies

1 local blocking therapy with Cu Ann Ned 20mg, physiological saline 2ml, 2% lidocaine 2ml intrathecal injection, once a week for 1 times.

2 surgical treatment for a long time, repeated hair should be treated with surgery. Surgical methods for open dissection. The distal palmar stripes do about 2cm long incision, the incision of skin after longitudinal incision of palmar aponeurosis, blunt dissection of the subcutaneous tissue revealed tendon sheath, sheath from the lateral longitudinal incision of a small incision, small incision and small scissors into the inner longitudinal cut thickening of the tendon sheath or partial resection of tendon sheath; check finger flexion freely after the party can sew up the incision. The next day after practice finger flexion, preventing adhesion.

 

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