Isani A
Hand Surgery Service, New York University Medical Center, New York.
Sports Med. 1990 Jan;9(1):48-61. doi: 10.2165/00007256-199009010-00005.
Sports-related injuries to the intricate small joints of the hand are quite frequent. The majority of such injuries result in joint contusions, partial tears or ligament sprains which do not jeopardise the basic stability of the joint and readily respond to a short course of protective splinting with rapid recovery of motion, strength and function. In fact, many patients never seek medical attention unless persisting pain, chronic swelling or restriction of motion persuade them to do so. Partial tears or sprains need to be distinguished from more serious injuries that cause profound ligamentous and capsular disruption resulting in dislocations, articular incongruency, joint instability or fracture-dislocations. While simple dislocations are readily reducible and generally stable, a complex dislocation by definition implies irreducibility by closed means. This category of complex joint injury requires prompt diagnosis, as optimal management warrants active surgical intervention to achieve a stable and congruous reduction. Following surgical repairs the injured joint is immobilised for a variable length of time, determined by the type, extent and the nature of the specific injury, prior to initiating remobilisation efforts. A supervised and well-executed rehabilitation programme should encompass all the various modalities of physical therapy that are effective in increasing mobility, correcting deformity and restoring strength and function to the injured hand. The ultimate goal of treatment is to enable the athlete to resume sports, unimpaired with the same skill, dexterity and competitive edge as before.
手部复杂小关节的运动相关损伤相当常见。此类损伤大多会导致关节挫伤、部分撕裂或韧带扭伤，这些损伤不会危及关节的基本稳定性，通过短期保护性夹板固定，运动、力量和功能能迅速恢复。事实上，许多患者除非持续疼痛、慢性肿胀或活动受限，否则从不寻求医疗帮助。部分撕裂或扭伤需要与更严重的损伤相区分，后者会导致韧带和关节囊严重破裂，从而引起脱位、关节不匹配、关节不稳定或骨折脱位。虽然简单脱位很容易复位且通常稳定，但复杂脱位按定义意味着无法通过闭合方法复位。这类复杂关节损伤需要及时诊断，因为最佳治疗需要积极的手术干预以实现稳定且匹配的复位。手术修复后，受伤关节会根据特定损伤的类型、程度和性质固定不同时长，然后才开始进行恢复活动的努力。一个有监督且执行良好的康复计划应涵盖所有有效的物理治疗方式，这些方式有助于增加受伤手部的活动度、纠正畸形并恢复力量和功能。治疗的最终目标是使运动员能够毫无损伤地恢复运动，具备与之前相同的技能、灵活性和竞争优势。
