Joseph R B, Linscheid R L, Dobyns J H, Bryan R S
J Hand Surg Am. 1981 Mar;6(2):172-80. doi: 10.1016/s0363-5023(81)80172-4.
The relatively rigid second and third carpometacarpal joints provide stability for the cantilevered metacarpals of the index and middle fingers, about which the thumb and ulnar metacarpals move, providing spatial adaptation for grasping objects. Although seldom recognized, sprains of the carpometacarpal joints as part of a range of injury which includes subluxations, dislocations, and fractures are apparently common. The entity known as carpe bossu also may be related. The second and third carpometacarpal joints are more susceptible to injury in palmar flexion than in dorsiflexion. The sprain may be acute or chronic. Severe swelling over the carpometacarpal area, with tenderness and weakness without significant roentgenographic findings, is suggestive of the acute sprain, which generally responds to immobilization. The chronic sprain is often overlooked or misdiagnosed. Point tenderness of one or more carpometacarpal joints, a palpable laxity, and crepitus with manipulation are seen as physical findings, in decreasing order of frequency. Lidocaine, 0.5 ml, injected directly into the joint offers dramatic relief. If conservative measures are insufficient, arthrodesis of the joint is relatively simple, symptomatically reliable, and functionally uncompromising, especially of the second and third rays.
相对僵硬的第二和第三腕掌关节为示指和中指的悬臂状掌骨提供稳定性，拇指和尺侧掌骨围绕其运动，从而为抓握物体提供空间适应性。腕掌关节扭伤作为包括半脱位、脱位和骨折在内的一系列损伤的一部分，虽然很少被认识到，但显然很常见。被称为“carpe bossu”的情况也可能与之相关。第二和第三腕掌关节在掌屈时比背屈时更容易受伤。扭伤可能是急性的或慢性的。腕掌区域严重肿胀，伴有压痛和无力，而X线检查无明显异常，提示急性扭伤，这种情况通常通过固定来缓解。慢性扭伤常常被忽视或误诊。一个或多个腕掌关节的压痛点、可触及的松弛以及手法检查时的摩擦音是体格检查的发现，出现频率依次降低。直接向关节内注射0.5毫升利多卡因可显著缓解疼痛。如果保守治疗措施不足，关节融合术相对简单，症状缓解可靠，且功能不受影响，尤其是对于第二和第三掌骨。
