Anatomy 結構
The wrist is complicated joint with 5 metacarpal bones (palm bones), 8 small carpal bone (wrist bones) and 2 forearm bones, bound by a lot of ligaments and a very firm tissue called Triangular FibroCartilage Complex (TFCC). The two forearm bones can rotate along a common axis, with 2 articulating joints in between them.
There are 3 major nerves traveled across the wrist to innervate 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 carpal bone allows perfect balance between stability and flexibility. For any reason they are damaged, treating it is a major challenge for not only for surgical intervention but also rehabilitation.
手腕是一個複雜的關節，由5根掌骨，8粒腕骨和2根前臂骨，和許多韌帶及1塊非常堅韌的纖維組織（稱為三角纖維軟骨複合物（TFCC））組成。 兩根前臂骨之間有2個關節，它們可以沿著軸旋轉作180度的旋轉。
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。
腕骨的複雜排列可以在穩定性和柔韌性之間實現完美的平衡。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 wrist
以下是常見手腕病變
- Carpal Tunnel Syndrome
- Ganglion
- De Quervain’s disease
- Distal radius fracture
- Ulnar styloid fracture
- Scaphoid fracture
- Scaphoid non union
- Scaphoid avascular necrosis
- TFCC tear
- Guyon’s canal Syndrome
- Scapholunate dissociation
- DISI (dorsal intercalated segmental instability)
- VISI (ventral intercalated segmental instability)
- 腕管綜合症
- 水瘤
- 狹窄性肌腱滑膜炎 (媽媽手)
- 橈骨遠端骨折
- 尺骨莖突骨折
- 舟骨骨折
- 舟骨骨折不癒
- 舟骨缺血性枯死
- TFCC撕裂
- 手腕關節處尺神經壓迫
- 舟月韌帶損傷 (舟月骨解離)
- 腕骨錯位
Investigation 評估
MRI is required to review soft tissue status. X-ray would be needed for bony pathology. Nerve conduction study might be indicated for possible nerve palsy.
磁力共震片能夠提供軟組織情況。骨頭問題，例如骨折，就會需要照X光。神經線問題可以電神經測試得知情況。
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 witnessed deterioration, 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。
對於持續惡化的患者，醫生往往會建議手術，以保肢體功能。
Reference
- Sabbagh MD, Morsy M, Moran SL. Diagnosis and Management of Acute Scaphoid Fractures Hand Clin. 2019 Aug;35(3):259-269. https://pubmed.ncbi.nlm.nih.gov/31178084/
- Sampson SP, Wisch D, Badalamente MA. Complications of conservative and surgical treatment of de Quervain’s disease and trigger fingers.
Hand Clin. 1994 Feb;10(1):73-82. https://pubmed.ncbi.nlm.nih.gov/8188781/