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Physical Examination of the Wrist & Hand

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Page 1: Physical Examination of the Wrist & Hand - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungso... · 2016-09-09 · Physical Examination of the Wrist & Hand * 손은 일상생활의

Physical Examination of the Wrist & Hand

Page 2: Physical Examination of the Wrist & Hand - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungso... · 2016-09-09 · Physical Examination of the Wrist & Hand * 손은 일상생활의

* 손은 일상생활의 거의 모든 동작을 완수하는 기능을 지님.

* 손상의 빈도가 높은 곳.

* 손 자체의 병변 유무 검진.

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Wrist joint의 기능해부학(functional anatomy)

1) 손목관절을 구성하는 뼈

- 요골 원위부 - 척골의 관절판

- 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)

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http://www.eorthopod.com/images/ContentImages/wrist/wrist_anatomy/wrist_anatomy_bones01.jpg

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type of joint - radiocarpal joint : condyloid joint

degree of freedom : 2 - flexion/extension, radial/ulnar deviation

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http://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Scheme_human_hand_bones-en.svg/2000px-Scheme_human_hand_bones-en.svg.

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type of joint - 1st carpometacarpal joint : saddle joint metacarpophalageal joint : hinge joint

- 2-5th carpometacarpal joint : plane joint metacarpophalageal joint: condyloid joint

degree of freedom : 1, 2

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시진(Inspection)

보행 시 팔 흔드는 동작 주시

⇒ 손의 병변은 상지 동작에 영향을 준다.

손상된 손은 잡고 있거나 부자연스러운 자세를 취함.

기능적인 면 관찰 ⇒ 자연스럽고 쉽게 잘 사용하는 검진

구조적인 면 관찰 ⇒ 5개가 다 있는지 검진

손의 자세 관찰 ⇒ Neutral position이 정상

만일, extension 한다면 V tendon의 손상의심.

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1) 손바닥 ; 수장면(palmar surface) 많은 피선(손금, numerus creases)

(1) 원위 수장피선(distal palmar crease)

M.P Jt.에서 접혀지는 손금 ⇒ no man's land의 근위부

(2) 근위 수장피선(proximal palmar crease)

(3) 근위 지피선(proximal interphalangeal crease)

PIP Jt.에서 접혀지는 손금 ⇒ no man's land의 원위부

(4) 모지구 피선(thenar crease) 모지구의 윤곽을 나타내는

손금.

cf) thenareminence(모지구), hypothenar eminence(소지구)

시진(Inspection)

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http://medicine.academic.ru/pictures/medicine/374.jpg

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(5) Intrinsic muscle(내재근)

손바닥의 아취 형성

1) 손바닥 ; 수장면(palmar surface)

http://classes.kumc.edu/sah/resources/handkines/images/archhand.gif

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(6) 손바닥의 중수지절 관절 부위(MP Jt. area)

① "언덕과 계곡의 특징

- 언덕 → Neurovascular bundle, Lumbrical muscle

- 계곡 → flexor tendon의 통로

② 합지증(syndactyly) ⇒ 비정상적인 피부막

1) 손바닥 ; 수장면(palmar surface)

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http://www.eatonhand.com/jpg/1385800.jpg

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시진(Inspection)

2) 손등 ; 배측 면(dorsal surface)

(1) M.P Jt. 의 계곡 ⇒ 양손 대칭.

종창 시 계곡을 구별할 수 없음.

(2) 손톱 ⇒ 핑크색이 정상.

병적인 손톱 ⇒ 숟가락 모양이나 곤봉모양.

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http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18127.jpg

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피부의 촉진(skin palpation)

1) 손바닥의 피부는 손등보다 두껍다.

(∵ 피하의 조직을 보호)

2) 손등의 피부는 느슨함.

3) 손가락의 피부

4) 피부의 과도한 국소 열감 ⇒ 화농성 감염의 징후

건조상태 ⇒ 말초신경 손상의심.

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http://upload.wikimedia.org/wikipedia/commons/3/32/Human-Hands-Front-Back.jpg

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https://mastcellblog.files.wordpress.com/2013/05/stretchy-hand-skin.jpg

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뼈의 촉진(Bony palpation)

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뼈의 촉진(Bony palpation)

엄지 → radial styloid process

검지 → ulnar styloid process에 놓고 촉진. 1) 수근관절의 뼈

① 근위수근열(proximal carpal row)

: scaphoid, Lunate, Triquetrum, Pisiform ② 원위수근열(disital carpal row)

Trapezium, Trapezoid, Capitate, Hamat

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http://www.eorthopod.com/images/ContentImages/wrist/wrist_osteoarthritis/wrist_osteoarthritis_anat02.jpg

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뼈의 촉진(Bony palpation)

2) Radial styloid process

Radial styloid process

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뼈의 촉진(Bony palpation)

3) Anatomical snuffbox

http://www.aafp.org/afp/2004/0901/afp20040901p879-f2.jpg

http://www.rudyard.org/wp-content/uploads/2014/06/anatomical-snuffbox-893x1024.jpg

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http://www.youtube.com/watch?v=CFFeKg1o3AY

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뼈의 촉진(Bony palpation)

4) scaphoid ⇒ 수근골 중 골절이 가장 多

http://classes.kumc.edu/sah/resources/handkines/images/scaphoid.gif

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뼈의 촉진(Bony palpation)

5) 대능형골(Trapezium)

http://classes.kumc.edu/sah/resources/handkines/images/trapezium.gif

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scaphoid

Radial syloid process

trapezium 1st metacarpal bone

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뼈의 촉진(Bony palpation)

6) 요골의 결절(tubercle of the radius)

= 리스터의 결절(Lister's tubercle)

Lister's tubercle

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뼈의 촉진(Bony palpation)

7) 유두골(Capitate) ⇒ 수근골 중 가장 大.

http://classes.kumc.edu/sah/resources/handkines/images/capitate.gif

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뼈의 촉진(Bony palpation)

8) 월상골(Lunate) ⇒ 요골결절 바로 아래.

http://classes.kumc.edu/sah/resources/handkines/images/lunate.gif

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Lister’s tubercle

capitate lunate

3rd metacarpal bone

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뼈의 촉진(Bony palpation)

9) 척골 경상돌기(Ulnar styloid process)

⇒ 수근관절의 내후측(medial posterior side)

Ulnar styloid process

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뼈의 촉진(Bony palpation)

10) 삼각골(Triquetrum) ⇒ 척골 경상돌기 바로 아래.

http://classes.kumc.edu/sah/resources/handkines/images/hamate.gif

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뼈의 촉진(Bony palpation)

11) 두상골(Pisiform) ⇒ 가이온 터널의 내측연 형성.

http://classes.kumc.edu/sah/resources/handkines/images/pisiform.gif

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뼈의 촉진(Bony palpation)

12) 유구골의 후크(hook of the hamate)

⇒ 가이온 터널(guyon tunnel)의 외측연 형성.

http://www.eorthopod.com/images/ContentImages/hand/hand_guyon_canal/hand_guyon_canal_anat03.jpg

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뼈의 촉진(Bony palpation)

13) 중수골(metacarpals)

http://classes.kumc.edu/sah/resources/handkines/images/mainmeta.gif

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뼈의 촉진(Bony palpation)

14) 제 1중수골(first metacarpal)

trapezium

http://classes.kumc.edu/sah/resources/handkines/images/1mc.gif

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뼈의 촉진(Bony palpation)

15) 중수지절관절(metacarpophalangeal Jt.)

⇒ 함몰 부위에 신전근 건이 통과.

http://classes.kumc.edu/sah/resources/handkines/images/mpjt1.gif

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뼈의 촉진(Bony palpation)

16) 지절골(phalanges)

⇒ PIP, DIP Jt.

callosity(가골) 형성 시

종창이나 압통.

http://classes.kumc.edu/sah/resources/handkines/images/mainphal.gif