de Quervain’s Tenosynovitis桡骨茎突狭窄性腱鞘炎A Patient’s Guide to de Quervain’s Tenosynovitis桡骨茎突狭窄性腱鞘炎患者指南Introduction引言
桡骨茎突狭窄性腱鞘炎会引起手腕和前臂桡侧的疼痛，位置恰好在拇指上方。这是腕部常患的疾病，通常诊断比较容易。 This guide will help you understand 这个指南将帮助你理解 · how this condition starts · how to recognize the symptoms · what can be done to stop the pain · 发病原因？ · 如何诊断？ · 怎么治疗？ Anatomy解剖What part of my thumb and wrist is causing problems? 我拇指和手腕的哪一部分出现了问题？ De Quervain’s tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). 桡骨茎突狭窄性腱鞘炎影响到拇指的两条肌腱，分别是拇长展肌腱（APL）和拇短伸肌腱（EPB）。 Tendons connect muscle to bone. Muscles pull on tendons for movement. The muscles connected to the APL and EPB tendons are on the back of the forearm. The muscles angle toward the thumb. 肌腱将肌肉连接到骨骼。肌肉牵拉肌腱产生了运动。连接拇长展肌腱和拇短伸肌腱的肌肉位于前臂的背侧。这些肌肉经一个折角走行到拇指。 On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole. 拇长展肌腱和拇短伸肌腱沿着腕部桡侧边缘并列走行，一直到拇指。在前臂的桡骨远端附近，他们经过一个管道。这个管道帮助把肌腱的位置控制住，就像钓鱼竿上的导线环。 This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. In de Quervain’s tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel. 这个管道里的一层光滑的外套叫做腱鞘。两条肌腱带动拇指活动的时候，光滑的腱鞘使得它们的前后滑动很容易。腱鞘和肌腱的炎症叫做腱鞘炎。桡骨茎突狭窄性腱鞘炎发生时，炎症会让肌腱在管道里的活动受到限制。 Related Document: A Patient’s Guide to Wrist Anatomy 相关阅读：腕关节解剖患者指南（翻译招募中，有意者请留言） Causes病因How did this condition develop? 这个病症是如何发生的？ Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel. Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel. 反复做手和拇指的动作，比如抓、捏、挤或者绞可能导致腱鞘炎。炎症引起的肿胀会阻碍肌腱在管道里的光滑移动。某些全身性的关节炎性疾病，例如类风湿性关节炎，也可以引起拇指的腱鞘炎。其他有些病例中，创伤造成的疤痕组织会让肌腱通过管道滑动变得困难。 Symptoms症状What problems does this condition cause? 这个病会引起什么症状？ At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist and thumb. 一开始，唯一的表现可能是在前臂的腕部附近，拇指这一侧的酸痛。如果没有得到治疗，疼痛可能会向上蔓延到前臂，或者向下波及腕部和拇指。 As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. If the condition is especially bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful. 随着摩擦的增加，两条肌腱在通过缩窄的管道时甚至可能发出吱吱的响声。这种杂音叫做捻发音。如果情况非常严重，在腕部边缘会发生沿着管道的肿胀。用拇指与手抓握物体可能会变得越来越疼痛。 Diagnosis诊断What tests will my doctor want to do? 医生会给我做什么检查？ Doctors usually diagnose de Quervain’s tenosynovitis easily through a physical examination. Most of the time no special tests are required. The major problem can be distinguishing de Quervain’s tenosynovitis from intersection syndrome, which is a very similar condition. 医生往往通过体格检查来诊断桡骨茎突狭窄性腱鞘炎。大多数情况下不需要特殊检查。需要和桡骨茎突狭窄性腱鞘炎区分的主要疾病是交叉综合征，二者症状非常相似。 Related Document: A Patient’s Guide to Intersection Syndrome 相关阅读：交叉综合征患者指南（翻译招募中，有意者请留言）
需要特别关注的是疼痛的部位，是在靠近桡骨远端的德奎万尔鞘管，还是在腕部的交叉点上？交叉点是在腕关节线向上三英寸的前臂部位。
最好的诊断方法之一是Finklestein试验。你可以自己做这个试验。让拇指弯曲贴住手掌，用其他手指抓住，握成一个拇指在里的拳。然后朝拇指相反的方向弯曲你的腕关节。如果感到拇指的肌腱部位疼痛，那么你的问题可能就是桡骨茎突狭窄性腱鞘炎。 Treatment治疗How can I make the pain go away? 我怎样才能让疼痛消失？ Nonsurgical Treatment非手术治疗If at all possible, you must change or stop all activities that cause your symptoms. Take frequent breaks when doing repeated hand and thumb actions. Avoid repetitive hand motions such as heavy grasping, wringing, or turning and twisting movements of the wrist. Keep the wrist in a neutral alignment. In other words, keep it in a straight line with your arm, without bending it forward or backward. 如果可能的话，你必须改变或者停止一切造成你症状的活动。在做手和拇指重复动作的过程中，间断地休息一下。避免重复的手部动作，例如大力地抓握、拧或扭转。保持腕关节于中立位。也就是说，让你的腕关节与前臂保持在同一直线，不要弯向掌侧或背侧。
医生可能要你佩戴一种特殊的从前臂到拇指的夹板，叫做拇指穗形夹板。这种夹板固定了腕关节和拇指指间关节，从而让拇长展肌腱和拇短伸肌腱得到休息，给他们开始愈合的机会。 Anti-inflammatory medications may also help control the swelling of the tenosynovium and ease symptoms. These medications include common over-the-counter medications such as ibuprofen and aspirin. 抗炎药物也可以帮助控制腱鞘炎的肿胀，缓解症状。这些药物包括常见的非处方药例如布洛芬和阿司匹林。 If these simple measures fail to control your symptoms, your doctor may suggest an injection of cortisone into the irritated tunnel. Cortisone reduces the swelling of the tenosynovium and may temporarily relieve your symptoms. Cortisone injections will usually control the inflammation in the early stages of the problem. 如果这些简单的措施不能控制你的症状，医生可能建议注射可的松到受累的管道内。可的松能缓解腱鞘的肿胀，暂时缓解症状。可的松注射通常用于在这个病症的早期阶段控制炎症。 Related Document: A Patient’s Guide to Joint Injections for Arthritis 相关阅读：关节内注射治疗关节炎患者指南（翻译招募中，有意者请留言） Your doctor may have you work with a physical or occupational therapist. The main focus of therapy is to reduce or eliminate the cause of irritation of the thumb tendons. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems. 医生可能会让你接受物理或职业治疗师的治疗。治疗的主要重点是减少或消除刺激拇指肌腱的病因。医生可能会查看你的工作地点和你完成工作的方式，给你一些建议，包括使用健康的身体力线和手腕的姿势，有益的锻炼方式和如何预防将来问题的技巧。 Surgery手术If all else fails, you may need surgery. The goal of surgery is to give the tendons more space so they no longer rub on the inside of the tunnel. To do this, the surgeon performs a surgical release of the roof of the tunnel. 如果其他的所有方法都失败了，那么你可能需要手术治疗。手术的目的是给肌腱更大的空间，这样他们就不会再摩擦管道的内壁。为此，医生将施行管道顶部的手术松解。 This surgery can usually be done on an outpatient basis, which means that you won’t have to spend the night in the hospital. It can be done using a general anesthetic, which puts you to sleep, or a regional anesthetic. A regional anesthetic blocks the nerves going to only a certain part of the body. Injection of medications similar to novocaine can block the nerves for several hours. 这种手术通常可以在门诊完成，这意味着你不必在医院过夜。这可以在全麻下你睡着的时候进行，或者在区域麻醉下进行。区域麻醉仅仅阻滞了支配身体一个部分的神经。注射例如奴佛卡因这样的药物可以阻滞神经长达数个小时。 In surgery for de Quervain’s tenosynovitis, you may get an axillary block, which puts the arm to sleep, or a wrist block, which puts only the hand to sleep. It is even possible to perform the surgery by simply injecting novocaine around the area of the incision. 在桡骨茎突狭窄性腱鞘炎的手术中，你可能会接受腋神经阻滞，麻醉整个手臂，或者采用仅麻醉手部的腕部阻滞。甚至仅仅将奴佛卡因注射到切口区域周围，也可以施行这个手术。
Once you have anesthesia, your surgeon will make sure the skin of your forearm and wrist is free of infection by cleaning the skin with a germ-killing solution. The first step in the surgical release is to make a small incision along the thumb side of the wrist. 一旦你的麻醉完成，你的医生会用杀菌溶液清洁皮肤，来确保你的前臂和腕部的皮肤不受感染。松解手术的第一步是沿着腕部的拇指一侧做一个小切口。
医生将其他组织向两边分离，找到肌腱和鞘管。切开鞘管的顶壁。这样就把鞘管打开了，为肌腱创造了更多的空间。鞘管最终会愈合起来，但是会比之前更大。疤痕组织会填充鞘管切开的空隙。 The skin is then stitched together, and your hand is wrapped in a bulky dressing. 然后，缝合皮肤，用厚敷料将你的手包扎起来。 Rehabilitation康复What can I expect after treatment? 治疗后应该做什么？ Nonsurgical Rehabilitation非手术治疗的康复If nonsurgical treatment is successful, you may see improvement in four to six weeks. You may need to continue wearing your thumb splint to control symptoms. Try to do your activities using healthy body and wrist alignment. Limit activities that require repeated motions of the wrist and thumb. 如果非手术治疗成功，你会在4到6周的时间里看到改善。你可能需要继续佩戴拇指夹板来控制症状。试着用健康的身体和腕关节姿势来完成你的活动。限制那些需要重复活动腕关节和拇指的动作。 After Surgery手术后康复Rehabilitation is more involved after surgery. Full recovery could take several months. Pain and symptoms generally begin to improve after surgery, but you may have tenderness in the area of the incision for several months. 手术后更需要康复。完全恢复可能需要几个月。疼痛和症状会在手术后开始逐渐改善，但是几个月内在切口区域还会有疼痛。 Take time during the day to support your arm with your hand elevated above the level of your heart. You should move your fingers and thumb occasionally during the day. Keep the dressing on your hand until you return to the surgeon. Avoid getting the stitches wet. Your stitches will be removed 10 to 14 days after surgery. 在白天需要花些时间支撑你的手臂，让你的手抬起来高过心脏水平。还要偶尔活动你的拇指和其他手指。在找医生复查之前，保持手上的敷料不要动。避免缝线被弄湿。你的缝线将在手术后10到14天拆除。 You will probably need to attend occupational or physical therapy sessions for six to eight weeks. You’ll begin doing active hand movements and range-of-motion exercises. Therapists also use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion. When the stitches are removed, you may start carefully strengthening your hand and thumb by squeezing and stretching putty. Therapists also use a series of gentle stretches to encourage the thumb tendons to glide easily within tunnel. 你可能需要参加6至8个星期的职业或物理治疗。你将开始做积极的手部动作以及活动度练习。治疗师也使用冰袋、软组织按摩和辅助拉伸来帮助增加活动度。缝线拆除后，你可以开始认真地用手和拇指挤压和拉伸胶泥来加强力量。治疗师还会采用一系列温和的拉伸来促进拇指肌腱在管道里轻松地滑动。 As you progress, your therapist will give you exercises to help strengthen and stabilize the muscles and joints in the hand and thumb. Other exercises are used to improve fine motor control and dexterity. Some of the exercises you’ll do are designed to get your hand working in ways that are similar to your work tasks and sport activities. 随着你的进步，治疗师会给你锻炼任务，目的是加强和稳定手部以及拇指的肌肉和关节。其他一些锻炼方法可以提高精细动作控制和灵活性。你的手活动的方式在一些练习里被设计成类似于你的工作和体育活动的方式。 Your therapist will help you find ways to do your tasks that don’t put too much stress on your thumb and wrist. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. 在治疗师的帮助下，你将找到完成工作的方法，不会给你的拇指和手腕施加太大的应力。疗程结束之前，治疗师会教你若干方法来避免将来的问题。
（张弛 译）
张弛，主治医师，本科毕业于温州医科大学。曾在上海长征医院和德国哈雷大学医院进修学习。 技术专长：四肢与脊柱骨折创伤的微创治疗，关节病变与运动损伤的诊治。 门诊时间：周三全天 门诊地点：慈溪市中医医院门诊骨伤科 编辑：胡佰文 |
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