J Am Acad Orthop Surg. 2013 Oct;21(10):581-91. doi: 10.5435/JAAOS-21-10-581.
Intrinsic contracture of the hand may result from trauma, spasticity, ischemia, rheumatologic disorders, or iatrogenic causes. In severe cases, the hand assumes a posture with hyperflexed metacarpophalangeal joints and hyperextended proximal interphalangeal joints as the contracted interossei and lumbrical muscles deform the natural cascade of the fingers. Considerable disability may result because weakness in grip strength, difficulty with grasping larger objects, and troubles with maintenance of hygiene commonly encumber patients. Generally, the diagnosis is made via history and physical examination, but adjunctive imaging, rheumatologic testing, and electromyography may aid in determining the underlying cause or assessing the severity. Nonsurgical management may be appropriate in mild cases and consists of occupational therapy, orthoses, and botulinum toxin injections. The options for surgical management are diverse and dictated by the cause and severity of contracture.
手部固有挛缩可能由创伤、痉挛、缺血、风湿性疾病或医源性原因引起。在严重的情况下，手会呈现出一种姿势，掌指关节过度弯曲，近端指间关节过度伸展，因为挛缩的蚓状肌和骨间肌使手指的自然排列变形。由于握力减弱、难以抓握较大的物体以及难以保持卫生等问题，患者可能会出现严重的残疾。通常，通过病史和体格检查即可做出诊断，但辅助影像学、风湿学检查和肌电图检查有助于确定潜在病因或评估严重程度。对于轻度病例，非手术治疗可能是合适的，包括职业治疗、矫形器和肉毒毒素注射。手术治疗的选择多种多样，取决于挛缩的原因和严重程度。
