Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States of America; 121 Field Hospital, Camp Humphreys, Republic of Korea.
Brian D. Allgood Army Community Hospital, Camp Humphreys, Republic of Korea; 502 Forward Surgical Resuscitation Team, Camp Humphreys, Republic of Korea.
Am J Emerg Med. 2020 Sep;38(9):1992.e1-1992.e2. doi: 10.1016/j.ajem.2020.05.041. Epub 2020 May 22.
Intrinsic plus hand describes a rare and painful contracture of the intrinsic hand muscles with excessive flexion at the metacarpophalangeal joints and extension at the interphalangeal joints. Resulting from many causes to include trauma and neurologic injury, intrinsic plus hand can involve any number of fingers. Emergency department (ED) assessment should include evaluation for cerebrovascular injury, infection, compartment syndrome, and deep vein thrombosis (DVT). Conservative splinting is generally unsuccessful and ultimately requires operative intervention. We highlight the case of a 61-year-old otherwise healthy male who awoke to a painful and mildly swollen left hand with his fingers held in a contracted position. Evaluation in the ED found no active range of motion in the digits, severe pain with any passive motion, and a negative upper extremity ultrasound for DVT. Ultimately, orthopedic and neurology consults in the ED agreed upon a diagnosis of intrinsic plus hand.
内在加手描述了一种罕见且疼痛的手部内在肌肉挛缩，表现为掌指关节过度弯曲和指间关节过度伸展。这种情况有许多原因，包括创伤和神经损伤，可能涉及多个手指。急诊评估应包括脑血管损伤、感染、筋膜间室综合征和深静脉血栓形成 (DVT) 的评估。保守性夹板固定通常无效，最终需要手术干预。我们强调了一名 61 岁健康男性的病例，他醒来时发现左手疼痛且轻度肿胀，手指呈挛缩状态。在急诊室的评估中，发现手指无主动活动度，被动活动时疼痛剧烈，上肢超声检查未见深静脉血栓形成。最终，急诊的骨科和神经科会诊意见一致，诊断为内在加手。
