護理業職業性肌肉骨骼疾患－奎緬氏症病例報告及文獻回顧

Occupational Musculoskeletai Disorders in nursing-A Case of De Quervains' Tenosynovitis and Articles Review

10.30027/CJOM.200904.0004

賴昭男(Chao-Nan Lai)；顏銘傭(Ming-Yung Yen)；高東煒(Tung-Wei Kao)；羅慶徽(Ching-Hui Loh)；劉紹興(Saou-Hsing Liou)；周稚傑(Chih-Chieh Chou)

奎緬氏症 ； 職業性肌肉骨骼疾患 ； 拇指狹窄性腱鞘炎 ； De Quervains' tenosynovitis ； occupational musculoskeletal disorders ； thumb stenosing tenosynovitis

中華職業醫學雜誌

16卷2期（2009 / 04 / 01）

119 - 126

繁體中文

國人對於職業性肌肉骨骼疾患的重視及了解程度，雖然逐年成長，仍不及於歐美等先進國家，所以這方面是值得臨床醫師去注意的。就腱鞘炎來說全身最常發生地方就在手與手就部位，而奎緬氏症(De Quervains' syndrome)又是其中較常見的疾病。奎緬氏症以其發生的部位命名，也稱拇指狹窄性腱鞘炎(thumb stenosing tenosynovitis)，由於常常好發於媽媽身上，又稱「媽媽手」，也是一種很常見由職業因素導致的疾患。病因是由於過多重覆性或過度使用手或大拇指，導致包覆伸拇短肌與外展拇長肌肌腱清膜鞘鞠發炎導致肌腱滑動疼痛與受阻，最常發生在中年女性身，亦為上肢遠端相當常見之骨骼肌肉疾患。診斷主要是以病史以及理學檢查拇指伸展抵抗試驗與芬克史坦測試(Finkelstein)為主，近年來由於肌肉軟組織超音速影像品質進步，也被用來診斷以及治療療效的評估。在治療方面，主要先以保守治療為主，如物理治療、非類固醇消炎止痛藥物或是類固醇局部肌腱注射為主，手術則是放在最後一線，當所有治療都無效時才考慮施行。

Although people in Taiwan are paying more attention to occupational musculo-skeletal disorders, the infiltration of these disorders is lagging behind Western countries, so this should be brought to the attention of clinical physicians. Tenosynovitis usually involves tendons of hands and wrists. Thumb stenosing tenosynovitis, also known as de Quervains' tenosynovdts or mother's wrist, is usually seen in mothers. It is also a common occupational disease. This disorder is characterized by pain over the radial (thumb) side of the wrist, impairment of thumb function, and thickening of the ligamentous structure covering both tendons in the first dorsal compartment of the wrist. This tenosynovitis restrains the movement of the tendons of the extensor pollicis brevis and abductor pollicis longus muscles, It is more common in middle-aged women, and is a relatively common, and uncomplicated musculoskeletal disorder of the distal upper extremity. In addition to history, Finkelstein's test and abduction of the thumb against resistance are useful tests to confirm the diagnosis of thumb stenosing tenosynovitis in people who have wrist pain. The progress of ultrasound for soft tissues and muscles provides another diagnostic and evaluating tool. Thumb stenosing tenosynovitis can be managed by rest, analgesics, spica splint, physical therapy and local steroids injection. If all treatments fail, surgical intervention may be considered.