Forman Todd A, Forman Scott K, Rose Nicholas E
The Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
Am Fam Physician. 2005 Nov 1;72(9):1753-8.
A detailed history alone may lead to a specific diagnosis in approximately 70 percent of patients who have wrist pain. Patients who present with spontaneous onset of wrist pain, who have a vague or distant history of trauma, or whose activities consist of repetitive loading could be suffering from a carpal bone nonunion or from avascular necrosis. The hand and wrist can be palpated to localize tenderness to a specific anatomic structure. Special tests can help support specific diagnoses (e.g., Finkelstein's test, the grind test, the lunotriquetral shear test, McMurray's test, the supination lift test, Watson's test). When radiography is indicated, the posterior-anterior and lateral views are essential to evaluate the bony architecture and alignment, the width and symmetry of the joint spaces, and the soft tissues. When the diagnosis remains unclear, or when the clinical course does not improve with conservative measures, further imaging modalities are indicated, including ultrasonography, technetium bone scan, computed tomography, and magnetic resonance imaging. If all studies are negative and clinically significant wrist pain continues, the patient may need to be referred to a specialist for further evaluation, which may include cineroentgenography, diagnostic arthrography, or arthroscopy.
仅详细的病史就可能使约70%手腕疼痛患者得到确诊。出现手腕疼痛自发发作、有模糊或久远的创伤史或者活动主要为反复用力的患者可能患有腕骨不愈合或缺血性坏死。触诊检查手和腕可以确定具体解剖结构的压痛部位。特殊检查有助于支持做出具体诊断（例如，芬克斯坦试验、研磨试验、月三角骨剪切试验、麦克马瑞试验、旋后抬起试验、沃森试验）。当需要进行放射摄影时，正位和侧位片对于评估骨结构和排列、关节间隙的宽度和对称性以及软组织情况至关重要。当诊断仍不明确，或者临床病程经保守治疗无改善时，则需采用进一步的成像检查方法，包括超声检查、锝骨扫描、计算机断层扫描和磁共振成像。如果所有检查结果均为阴性而手腕仍有明显疼痛，则可能需要将患者转诊给专科医生做进一步评估，这可能包括动态X线摄影检查、诊断性关节造影或关节镜检查。
