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Wrist pain (손목 통증)

The Root of Ambulatory Care (외래 진료 지침서) 전체 목록 보기
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The Root of Ambulatory Care

The Root of Ambulatory Care

  • 저 자 : 이진우
  • 출 판 : 군자출판사
  • 페이지수: 543면

이진우 선생님, 군자출판사와 제휴를 통해 책 내용 및 그림을 제공합니다.
무단 복제/배포 금지.

KEYWORDS: ▶ The bones of the wrist ..Acute wrist injury - Colles’fracture (distal radius) ▶ 후방 전위되어 있는 관절외 골절인 전형적인 Colles’s fracture Wrist pain Hamate Capitate Distal carpal row Proximal carpal row Pisiform Triquetrum Lunate Ulna Radius Scaphoid Trapezium Trapezoid - Scaphoid fracture ▶ Wrist PA view에서는 골절 선을 발견하기 힘들며, Oblique view에서 2mm이상 전위된 주상골 요부의 골절이 보인다. - Sprain of wrist - Scapholunate dissociation Radiologic test for wrist injury Wrist PA, lateral/PA with both radial and ulnar deviation/PA with clenched fist if needed. ▶ 손을 쭉 편 상태에서 떨어진 후 radial-sided pain이 지속되어 Scaphoid fracture가 의심 되면 최초 X-ray에서 골절이 보이지 않더라도 14일 이내에 다시 촬영을 해 봐야 한다. ▶ 골프채로 스윙하면서 뒤땅을 칠 경우 잘 생기는 유구골 후크 골절 (fracture of the hook of hamate)의 경우 단순 X-ray로는 알기 어려우며, carpal tunnel view/lateral oblique view로 알 수 있다. ..Chronic wrist pain - DeQuervain's tenosynovitis - Triangular Fibrocartilage complex (TFCC) tear - Ganglion 257 The Root of ambulatory care Key questions Key symptoms & Signs Wrist pain 1. What was the mechanism of injury? An acute event (such as fall, or hit by an object) or one that occurred over time (chronic overuse)? → 손목을 신전한 상태에서 땅으로 넘어지는 경우 : distal radius fracture, scaphoid fracture, ligament rupture 2. What activities or motions aggravate it? Relieve it? → 반복적인 운동 후에 통증이 생기고 쉬고 나면 뻣뻣해지는 경우 : tendinitis → Weight-bearing activites 후에 통증이 생기는 경우: bony, arthritic pathology 3. Is the pain located on the dorsal or volar aspect of the wrist ? → Local tenderness : fracture, sprain (e.g., Anatomical snuffbox tenderness : Scaphoid fracture) 4. Is there a noise such as grinding, popping, snapping, or clicking associated with the pain? → may be related with Carpal instability/TFCC tear 5. Was any swelling noted either acutely or overtime? 6. What has been done to date for Treatment? Response to date? De Quervain’s tenosynovitis ..반복적인 엄지손가락 사용으로 발생한다. 1. Pain, swelling near or over radial styloid 2. Tenderness, swelling over radial styloid (inflammation in first dorsal extensor compartment) : positive Finkelstein's test : 진단은 Finkelstein's test로 하며 다른 방 사선 검사는 필요치 않다. 259 The Root of ambulatory care .. Finkelstein test ▶ Finkelstein test 엄지를 굴곡시키고 손목을 척측으로 편항시킬 때 손목의 dorsoradial aspect에 pain이 있으 면 first dorsal compartment 에 tenosynovitis를 의미한다. (abductor pollicis longus & extensor pollicis brevis & extensor pollicis longus) 1. Immobilization: thumb spica cast : for 1week 2. Drug : NSAIDs ; Ibuprofen 600~800mg with food tid/Naproxen 500mg with food bid for 2weeks or longer depending on the condition. 3. De Quervain injection : 4. Operative treatment : should be considered if corticosteroid injections are not successful. Key treatment ▶ Injection for de Quervain’s tenosynovitis. The needle is placed into the first extensor compartment and directed proximally toward the radial styloid. methylprednisolone 20~40mg (or triamcinolone 20~40mg) + lidocaine 1% 2cc into the tendon sheath (the patient should have no more than three injections) Key symptoms & Signs Key treatment Wrist pain TFCC tear (Triangular FibroCartilage Complex, TFCC) ▶ Triangular Fibrocartilage Complex 1. Dorsal ulnar-sided pain during ulnar deviation with pronation and supination 2. Pain with forced passive pronation and supination of the wrist : dorsal subluxation of the ulna often with a painful “chunk” ..체조 선수나 라켓 스포츠에서 심한 ulnar deviation에 의해 주로 생긴다. 1. Immobilization : for 4~6week 2. Drug : NSAIDs ; Ibuprofen 600~800mg with food tid/Naproxen 500mg with food bid for 2weeks or longer depending on the condition. 3. Physical therapy 4. Arthroscopic operation : should be considered if pain persist. Triangular FibroCartilage Complex(TFCC) Injuries Triangular fibrocartillage complex Ulna 261 The Root of ambulatory care 참고 문헌 Kenneth M. Bielak : Hand and Wrist pain,in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 973-976 김병성 : 손목 및 손의 통증, in 가정의학 임상편. 서울, 계측문화사, 2002, P 1155-1169 Nicole G. Stern, M.D. : Hand & Wrist Complaints, in A Lange clinical manual Family Medicine Ambulatory Care & Prevention, 4th ed, Mark B. Mengel, M.D., L. Peter Schwiebert M.D. (ed). United States of America, The McGrwa-Hill Companies, Inc., 2005, P 194-205 Walter B. Greene, M.D.(ed) : De Quervain Tenosynovitis, in Essentials of Musculoskeletal Care. Rosemont, American Academy of Orthopaedic Surgeons, 2001, P 232-234 ALFRED F. TALLIA, M.D., M.P.H., and DENNIS A. CARDONE, D.O., C.A.Q.S.M. : Diagnostic and therapeutic injection of the Wrist and Hand region. A journal of the American Family Physicains 2003 ; 67(4) : 745-756 김영민 외 : 골절학. 서울, 군자출판사, 2001, P 353 정문상 외 : 손외과학. 서울, 군자출판사, 2005, P 1084