Anatomy 結構
The index to little fingers have 3 bones in the digit and one bone in the palm. The thumb has one bone less in the digit.
The wrist is more complicated. It has 8 bones aligned in two rows and it is articulating with the forearm through a complex soft tissue structure, which composes of a very firm tissue called Triangular FibroCartilage Complex (TFCC) and a lot of bounding ligaments. The two forearm bones can rotate along a common axis.
There are 3 major nerves innervating the hand. The Median Nerve goes through a bony tunnel in wrist, called Carpal Tunnel, where compression might take place.
A complex arrangement of the tendon allows maximal mechanical advantage be achieved for our daily function, but it also cast a major challenge for intervention and rehabilitation.
食指到尾指這4根手指，在每隻手指中有都3根骨頭，而在手掌中就有1根骨頭。拇指的手指只要2根骨頭，即少了一根。
手腕更複雜。它具有8粒小骨頭以兩個弧形排列，並通過複雜的軟組織結構與前臂連接。該結構由非常堅韌的軟骨組織組成（稱為三角纖維軟骨（TFCC））和許多旁邊韌帶組成。 前臂的兩根骨骼可以沿共同軸心旋轉。
手部有3條主要神經。正中神經穿過腕部的骨及韌帶構建的管道，稱為腕骨隧道。如有增生，可能令正中神經受壓。
複雜的肌腱結構可以令筋腱產生最大的物理優勢，但同時也給醫生在治療和康復時帶來了巨大的挑戰。
Pathology 毛病
Disease 病變
The followings are common pathologies in hand
以下是常見手及腕病變
- Carpal Tunnel Syndrome 腕管綜合症
- TFCC tear 三角纖維軟骨撕裂
- Trigger finger 彈弓手
- Scaphoid Fracture 舟骨骨折
- Distal Radius fracture 前臂腕骨折
- Infection 感染
Investigation 評估
MRI is usually required to review soft tissue status. Occasionally, nerve conduction study would be needed.
磁力共震片能夠提供軟組織情況，所以很多時會是醫生的選擇。某些情況需安排神經功能測試。
Management 治療
Conservative treatments are indicated for majority of cases. They included,
- Physiotherapy
- Chiropractor
- TCM practitioner
- Prescribed Exercise
- Medication
For cases failed conservative treatments, or when the injury is unstable, then surgical intervention would be indicated.
For patients with neurological deficit lasting more than 6 weeks or witnessed deterioation, surgical intervention might be advocated.
絕大多數病人只需採取保守治療。他們包括
- 物理治療
- 脊醫
- 中醫
- 處方運動
- 藥物（口服及外敷）
對於保守治療無效的病例，或受傷位置不穩定，醫生會改為介入治療，例如打針甚至手術。
對於持續超過6週或惡化的神經受損的患者，醫生往往會建議手術，以保神經功能。
Common Interventions include
- Injection of steroid
- Injection of PRP
- CarpoMetacarpal Joint Injection of hyaluronic acid
- Percutaneous trigger finger release
- Carpal Tunnel Release
- Cast application for immobilisation
- Surgical reduction and plating
- Wrist arthroscopy