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 tendon), 단모지신전근 (Ext. poll. brevis tendon) - 척측연 장모지신전근 (Ext. poll. long tendon) - 저면 주상골 (navicular) (2) 터널 Ⅰ: antomical snuffbox의외측연
http://www.drpegoli.com/storage-image/varie/img007%5b1%5d.gif http://www.eorthopod.com/sites/default/files/images/wrist_dequervains_anat01.jpg
연부조직의촉진 (soft tissue palpation) 1) 수근관절제 1 구역 ; 요골경상돌기 (radial styloid process) Finkelstein test 엄지를손안에넣고주먹을쥐게하고 ulnar deviation 시킴 통증시협착성건초염 (stenosing tenosynovitis)
http://www.emed.ie/rheumatology/_img/finkelsteins300.jpg
연부조직의촉진 (soft tissue palpation) 2) 수근관절제 2 구역 ; 요골결절 (tubercle of the radius) = Lister's tubercle (1) 터널 Ⅱ - 장요측수근신근건 (ext. carpi rad. long tendon) - 단요측수근신근건 (ext. carpi rad. brevis tendon) (2) 터널 Ⅲ - 장모지신근 (ext. poll. long) - Colle's Fx. 시 요골결절의마찰근단열가능. - 류마티스성관절염 synovitis 로인해단열가능.
Extensor carpi radialis longus & brevis Extensor pollis longus http://anthropotomy.com/assets/images/part2/m37.jpg
연부조직의촉진 (soft tissue palpation) 2) 수근관절제 2 구역 ; 요골결절 (tubercle of the radius) = Lister's tubercle (3) 터널 Ⅳ - 총지신근건 (extensor digitorum communis tendon) finger ext. 시촉진 - 시지신근건 (extensor indicis tendon) index finger V I 시촉진 낭종 (ganglion) 발생지.
Extensor indicis Extensor digitorum communis http://anthropotomy.com/assets/images/part2/m37.jpg
http://towerorthopaedics.com/images/ganglionsmall.gif
연부조직의촉진 (soft tissue palpation) 3) 수근관절제 3 구역 ; 척골경상돌기 (ulnar styloid process) (1) 터널 Ⅴ : 소지신전근건 (ext. dig. minimi) 통과 - 테이블위에손을놓고 5th finger 움직일때촉진 - 류마티스성관절염시 활막염으로마모되기쉽다. (2) 터널 Ⅵ 척측수근신근건 (ext. carpi. ulnaris tendor) ulnar deviation 시촉진.
Extensor digitorum minimi Extensor carpi ulnaris http://anthropotomy.com/assets/images/part2/m37.jpg
연부조직의촉진 (soft tissue palpation) 4) 수근관절제 4구역 ; 두상골 (pisiform) (1) 척측수근굴근 (flexor carpi ulnaris) (2) 가이온터널 (guygon tunnel) 척골동맥, 척골신경이통과 (3) 척골동맥 (ulnar artery)
pisiform http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-carpiulnaris/atlasimage
연부조직의촉진 (soft tissue palpation) 5) 수근관절제 5구역 ; 장장근과수근관 (palmaris longus & carpal tunnel) (1) 장장근 (palmaris longus) opposition시촉진 (2) 수근관 (carpal tunnel) - 주상골결절과두상골 (pisiform) - 근위 - 대능형골결절과유구골후크 (hook of the hamate) - 원위 - 손가락굴곡건과 median N. 통과
http://nervesurgery.wustl.edu/nerveimages/misc%20- %20EM%20(Images%20Require%20Captions)/Palmaris_longus---IMG_0829.jpg
http://blog.corewalking.com/wp-content/uploads/2013/11/wrist.jpeg
연부조직의촉진 (soft tissue palpation) 5) 수근관절제 5 구역 ; 장장근과수근관 (palmaris longus & carpal tunnel) carpal tunnel syndrome 정중신경압박, 감각과운동기능제한. 수근관협착 - 굴곡제한수근관압박 - 정중신경지배영역내동통유발 or 증상재현 phalen's test carpal tunnel syndrome test (3) 요측수근굴근 (flexor carpi radialis) radial deviation 시촉진.
http://www.eorthopod.com/images/contentimages/hand/hand_carpal_tunnel/hand_carpal_tunnel_symptoms01.jpg http://drprafullkdavemd.com/images/carpaltunnelanatomy.jpg
http://upload.wikimedia.org/wikipedia/commons/6/68/untreated_carpal_tunnel_syndrome.jpg
phalen's test http://healingartsce.com/images/cts-phalen-test.jpg http://www.ehealthstar.com/wp-content/uploads/2013/09/reverse-phalens-test.jpg
연부조직의촉진 (soft tissue palpation) 6) 손제 1구역 ; 모지구 (thenareminance) - 정중신경의지배 - 표층 : 단모지외전근 (abductor pollicis brevis) - 중층 : 모지대립근 (opponens pollicis) - 심층 : 단모지굴근 (flexor pollicis brevis) 7) 손제 2 구역 ; 소지구 (hyperthenar eminance) - 척골신경지배 - 소지외전근 (abductor digiti minimi) - 소지대립근 (opponens) - 소지굴곡근 (flexor digiti quinti)
http://www.eorthopod.com/sites/default/files/images/hand_anatomy_muscles01.jpg
연부조직의촉진 (soft tissue palpation) 8) 손제 3 구역 ; 손바닥 (palm) (1) 수장건막 (palmar aponeurosis) - Dupuytren s contracture http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/dupuytrens_contractur e_slideshow/nucleus_rm_illustration_of_dupuytrens_contracture.jpg
http://www.lakeoswegoplasticsurgery.com/hand/dupuytrens_progression_needle_aponeurotomy_final-s.png
연부조직의촉진 (soft tissue palpation) 8) 손제 3구역 ; 손바닥 (palm) (2) 손가락굴곡근 (finger flexor tendon) - trigger finger, trigger thumb 9) 손제 4구역 : 손등 (1) 신전근건 (extensor tendon) 압통시염좌나단열
http://www.medguidance.com/images/10422531/trigger-finger.jpg
연부조직의촉진 (soft tissue palpation) 10) 손제 5구역 ; 지절골 (IP Jt.) (1) swan neck deformity - 류마티스성관절염 (2) boutonniere deformity - 총지신근단열 (3) Heberden's node - 골관절염 (4) mallet finger - 총지신근의원위부에서단열
http://cdn2.hubspot.net/hub/30688/images//swannecklabel.jpg?t=1420836945533 http://www.eorthopod.com/images/contentimages/hand/finger_swan_neck_deformity/finger_swanneck_cause02_c ollage_booklet.jpg
http://www.wiscboneandjoint.com/wp-content/uploads/2014/08/a_wbj_boutonnierredeformity.jpg
http://www.osteoarthritisblog.com/wp-content/uploads/2012/03/nodes.jpg http://0.tqn.com/y/osteoarthritis/1/s/l/0/-/-/osteo_ss_hand.jpg
http://www.eorthopod.com/images/contentimages/hand/finger_mallet/finger_mallet_intro01.jpg
관절가동범위 : 능동
관절가동범위
관절가동범위
관절가동범위 : 수동
신경학적검사 (neurologic examination)
근육검사 (muscle testing) wrist MP joint Flexion extension Flexion extension Flexor carpi radialis Flexor carpiulnaris Extensor carpiradialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Lumbricales Dorsal Interossei Palmar Interossei Extensor digitorum Extensor indicis Extensor digiti minimi
근육검사 (muscle testing) IP joint finger Flexion extension abduction adduction Flexor digitorum Superficialis Flexor digitorum profundus Extensor digitorum communis Interossei dorsalis Abductor digitiminimi Interossei palmaris
감각검사 (sensation testing) 1) 손의감각을지배하는말초신경의검사 http://media.tumblr.com/0cbbda59826b46a6499db312436daadb/tumblr_inline_n9h82bebky1qa52i5.jpg
감각검사 (sensation testing) 2) 손에관련된신경학적레벨검사
감각검사 (sensation testing) 1) 손의감각을지배하는말초신경의검사
정밀검사 (Special test)
정밀검사 (special test) 1) 손가락의장굴곡근 (long flexor) 검사 (1) 천지굴근 (flexor digitorum superficialis) 의검사 (2) 심지굴근 (flexor digitorum profundus) 의검사
정밀검사 (special test) 1) 손가락의장굴곡근 (long flexor) 검사
손가락의장굴곡근 (long flexor) 검사 (1) 천지굴근 (flexor digitorum superficialis) 의검사
손가락의장굴곡근 (long flexor) 검사 (2) 심지굴근 (flexor digitorum profundus) 의검사
손가락의장굴곡근 (long flexor) 검사 (3) 번넬 - 리틀러테스트 (bunnel - littler test) - 내재근의단축을평가
손가락의장굴곡근 (long flexor) 검사 (4) Allen test - 요골동맥과척골동맥이혈액을충분히공급하고있는지검사
compression