PowerPoint 프레젠테이션

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성민 지
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1 Physical Examination of the Wrist & Hand

2 * 손은일상생활의거의모든동작을완수하는기능을지님. * 손상의빈도가높은곳. * 손자체의병변유무검진.

(scaphoid), 월상골 (lunate) 삼각골 (triquetrum), 입방골 (pisiform) 원위열

3 Wrist joint 의기능해부학 (functional anatomy) 1) 손목관절을구성하는뼈 - 요골원위부 - 척골의관절판 - 수근골 (carpal bone) 근위열 (proximal row) 주상골 (scaphoid), 월상골 (lunate) 삼각골 (triquetrum), 입방골 (pisiform) 원위열 (distal row) 대능형골 (trapezium), 소능형골 (trapezoid) 유두골 (capitate), 유구골 (hamate)

6 type of joint - radiocarpal joint : condyloid joint degree of freedom : 2 - flexion/extension, radial/ulnar deviation

8 Scheme_human_hand_bones-en.svg.

9 type of joint - 1 st carpometacarpal joint : saddle joint metacarpophalageal joint : hinge joint th carpometacarpal joint : plane joint metacarpophalageal joint: condyloid joint degree of freedom : 1, 2

10 시진 (Inspection) 보행시팔흔드는동작주시 손의병변은상지동작에영향을준다. 손상된손은잡고있거나부자연스러운자세를취함. 기능적인면관찰 자연스럽고쉽게잘사용하는검진 구조적인면관찰 5 개가다있는지검진 손의자세관찰 Neutral position 이정상 만일, extension 한다면 V tendon 의손상의심.

11 시진 (Inspection) 1) 손바닥 ; 수장면 (palmar surface) 많은피선 ( 손금, numerus creases) (1) 원위수장피선 (distal palmar crease) M.P Jt. 에서접혀지는손금 no man's land 의근위부 (2) 근위수장피선 (proximal palmar crease) (3) 근위지피선 (proximal interphalangeal crease) PIP Jt. 에서접혀지는손금 no man's land 의원위부 (4) 모지구피선 (thenar crease) 모지구의윤곽을나타내는 손금. cf) thenareminence( 모지구 ), hypothenar eminence( 소지구 )

13 1) 손바닥 ; 수장면 (palmar surface) (5) Intrinsic muscle( 내재근 ) 손바닥의아취형성

14 1) 손바닥 ; 수장면 (palmar surface) (6) 손바닥의중수지절관절부위 (MP Jt. area) 1 " 언덕과계곡의특징 - 언덕 Neurovascular bundle, Lumbrical muscle - 계곡 flexor tendon의통로 2 합지증 (syndactyly) 비정상적인피부막

17 시진 (Inspection) 2) 손등 ; 배측면 (dorsal surface) (1) M.P Jt. 의계곡 양손대칭. 종창시계곡을구별할수없음. (2) 손톱 핑크색이정상. 병적인손톱 숟가락모양이나곤봉모양.

19 피부의촉진 (skin palpation) 1) 손바닥의피부는손등보다두껍다. ( 피하의조직을보호 ) 2) 손등의피부는느슨함. 3) 손가락의피부 4) 피부의과도한국소열감 화농성감염의징후건조상태 말초신경손상의심.

22 뼈의촉진 (Bony palpation)

23 뼈의촉진 (Bony palpation) 엄지 radial styloid process 검지 ulnar styloid process에놓고촉진. 1) 수근관절의뼈 1 근위수근열 (proximal carpal row) : scaphoid, Lunate, Triquetrum, Pisiform 2 원위수근열 (disital carpal row) Trapezium, Trapezoid, Capitate, Hamat

25 뼈의촉진 (Bony palpation) 2) Radial styloid process Radial styloid process

뼈의촉진 (Bony palpation) 3) Anatomical snuffbox http://www.aafp.

26 뼈의촉진 (Bony palpation) 3) Anatomical snuffbox

28 뼈의촉진 (Bony palpation) 4) scaphoid 수근골중골절이가장多

30 뼈의촉진 (Bony palpation) 5) 대능형골 (Trapezium)

31 scaphoid Radial syloid process trapezium 1st metacarpal bone

32 뼈의촉진 (Bony palpation) 6) 요골의결절 (tubercle of the radius) = 리스터의결절 (Lister's tubercle) Lister's tubercle

33 뼈의촉진 (Bony palpation) 7) 유두골 (Capitate) 수근골중가장大.

34 뼈의촉진 (Bony palpation) 8) 월상골 (Lunate) 요골결절바로아래.

35 Lister s tubercle lunate capitate 3 rd metacarpal bone

36 뼈의촉진 (Bony palpation) 9) 척골경상돌기 (Ulnar styloid process) 수근관절의내후측 (medial posterior side) Ulnar styloid process

37 뼈의촉진 (Bony palpation) 10) 삼각골 (Triquetrum) 척골경상돌기바로아래.

38 뼈의촉진 (Bony palpation) 11) 두상골 (Pisiform) 가이온터널의내측연형성.

39 뼈의촉진 (Bony palpation) 12) 유구골의후크 (hook of the hamate) 가이온터널 (guyon tunnel) 의외측연형성.

40 뼈의촉진 (Bony palpation) 13) 중수골 (metacarpals)

41 뼈의촉진 (Bony palpation) 14) 제 1 중수골 (first metacarpal) trapezium

42 뼈의촉진 (Bony palpation) 15) 중수지절관절 (metacarpophalangeal Jt.) 함몰부위에신전근건이통과.

43 뼈의촉진 (Bony palpation) 16) 지절골 (phalanges) PIP, DIP Jt. callosity( 가골 ) 형성시종창이나압통.

PowerPoint 프레젠테이션

PowerPoint 프레젠테이션 Physical Examination of the Wrist & Hand 연부조직촉진 (soft tissue palpation) 연부조직의촉진 (soft tissue palpation) 1) 수근관절제 1구역 ; 요골경상돌기 (radial styloid process) (1) Anatomical snuffbox - 요측연 장모지외전근 (Abd. poll. long