Bickert B, Sauerbier M, Germann G
Abteilung für Verbrennungen, plastische und Handchirurgie, Berufsgenossenschaftlichen Unfallklinik, Ludwigshafen.
Zentralbl Chir. 1997;122(11):1010-5.
A highly differentiated clinical examination of the wrist joint has been established in the past years. The history of the accident is usually unreliable, but patient's statement of a hyperflexion injury should alert for a fracture of the scaphoid tubercle. First of all, X-rays of the wrist indicate therapy in the case of fractures and gross dislocations. Only after some days of reduction of pain and swelling, a thorough clinical examination will be possible, which consists of: localizing points of tenderness, in particular the scapho- lunate, lunato-triquetal and the scapho-trapezio-trapezoid (SL-, LT- and STT-) joints and the triangular fibrocartilage (TFC); testing for abnormal dorso-palmar shifts of the carpus and the ulnar head; provoking catch up clunks by radio-ulnar movements of the clenched fist; provoking subluxations, in particular of the scaphoid in Watson's test; provoking pain in the discuss grinding test. Comparing clinical diagnosis with arthroscopic findings in 37 patients, the results for ligamentous lesions in general, SL ligament lesions in particular and for TFC lesions were as follows: sensitivity 100%, 91% and 69%, resp.; specificity 77%, 77% and 67%, resp.; positive predictive values 75%, 62% and 61%, respectively. In conclusion, exact clinical examination is a reliable tool to determine further diagnostics and therapy of wrist injuries.
在过去几年中，已经建立了一种高度分化的腕关节临床检查方法。事故病史通常不可靠，但患者关于过屈损伤的陈述应警惕舟骨结节骨折。首先，腕关节的X线检查可用于诊断骨折和严重脱位的治疗。只有在疼痛和肿胀减轻几天后，才可能进行全面的临床检查，包括：确定压痛部位，特别是舟月、月三角和舟大多角小多角（SL、LT和STT）关节以及三角纤维软骨（TFC）；测试腕骨和尺骨头的异常背掌侧移位；通过紧握拳头的桡尺运动引发卡顿；在沃森试验中引发半脱位，特别是舟骨半脱位；在旋前研磨试验中引发疼痛。对37例患者的临床诊断与关节镜检查结果进行比较，一般韧带损伤、特别是SL韧带损伤和TFC损伤的结果如下：敏感性分别为100%、91%和69%；特异性分别为77%、77%和67%；阳性预测值分别为75%、62%和61%。总之，准确的临床检查是确定腕部损伤进一步诊断和治疗的可靠工具。
