#1
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Äîëãî áîëèò â çàïÿñòüå
Äîáðîãî âðåìåíè!
Ïðåäûñòîðèÿ:  íîÿáðå 2017 ãîäà ïðè çàíÿòèè â òðåíàæ¸ðíîì çàëå ïîâðåäèëà çàïÿñòüå, ñàì ìîìåíò òðàâìû íå ïîìíþ, âèäèìî êàê òî íåëîâêî ïîâåðíóëà ðóêó. Ïîêà ìûøöû áûëè ðàçîãðåòû áîëü íå ÷óâñòâîâàëà, íî ãäå-òî ÷åðåç ÷àñ ïîñëå òðåíèðîâêè óæå îùóòèëà òóïóþ áîëü â ëåâîì çàïÿñòüå, íåáîëüøóþ ïðèïóõëîñòü. Ëå÷èëàñü ñòàíäàðòíî ÍÏÂÏ, ìàçü, õîëîä ïåðâûå äíè, ôèêñàöèÿ ýëàñòè÷íûì áèíòîì, ïîêîé ðóêå. Ïåðâûå íåäåëþ-äâå áîëü áûëà îùóòèìàÿ è ïî÷òè ïîñòîÿííàÿ, âðàùàòåëüíûå äâèæåíèÿ, çàõâàò, ïîäíÿòèå êàêèõ-òî òÿæåñòåé áûëè áîëåçíåííûå. Çàòåì áîëü óòèõëà, ðåøèëà âîçîáíîâèòü òðåíèðîâêè, íî ïðè íàãðóçêå áîëü îïÿòü âåðíóëàñü. Îáðàùàëàñü ê îðòîïåäó êðîìå îñìîòðà íèêàêèõ èññëåäîâàíèé íå ïðîâîäèëîñü. Ñòàíäàðòíûé äèàãíîç ðàñòÿæåíèå. Ðåêîìåíäîâàëè ïîêîé ìàçè ÍÏÂÏ, ôèêñàòîð ïðè íàãðóçêàõ. Ñêàçàëè, ÷òî çàæèâàòü áóäåò äîëãî - íåñêîëüêî ìåñÿöåâ, íî ïðîøåë ïî÷òè ãîä, à áîëü ïðè íàãðóçêàõ òàê è îñòàëàñü. Ñîâñåì íå ìîãó çàíèìàòüñÿ â çàëå áåç ñïîðòèâíîãî ôèêñàòîðà äëÿ ëó÷åçàïÿñòíîãî ñóñòàâà, èíà÷å ïîòîì áîëü â òå÷åíèè íåñêîëüêèõ äíåé îáåñïå÷åíà, äà è ïîäíÿòèå êàêèõ-òî òÿæåñòåé â áûòîâîé æèçíè òàêæå âûçûâàåò áîëåâûå îùóùåíèÿ. Âîïðîñ: äåéñòâèòåëüíî ëè "ðàñòÿæåíèå" ìîæåò òàê äîëãî çàæèâàòü? Âîçìîæíî ñòîèò ïðîâåñòè äîï îáñëåäîâàíèå? Íà ôîòî óêàçàëà ìåñòî ìàõ áîëåâûõ îùóùåíèé. Ïðè íàæàòèè â äàííîì ìåñòå, äàæå ïî÷òè ãîä ñïóñòÿ, ñèëüíàÿ áîëü, àæ èñêðû èç ãëàç! Î ñåáå: æåí. 36 ëåò, ðîñò 159 ñì., âåñ îêîëî 65 êã. Ðàáîòàþ çà êîìïüþòåðîì â îôèñå 8 ÷ â äåíü, íå êóðþ. Çàíèìàþñü â òðåíàæåðêå áåç ôàíàòèçìà äëÿ ïîääåðæàíèÿ ôîðìû+ñòðåé÷.  ïðîøëîì áûëè ðàñòÿæåíèÿ, â òîì ÷èñëå è ëó÷åçàïÿñòíîãî ñóñòàâà, îáû÷íî îòíîñèòåëüíî áûñòðî âñå çàæèâàëî. Òàêæå áûë ðàçðûâ ñâÿçîê êîëåíà è ìåíèñêà, â ðåçóëüòàòå íåóäà÷íîãî ïàäåíèÿ 10 ëåò íàçàä, îïåðàöèÿ ÷àñòè÷íàÿ ìåíèñêîýêòîìèÿ â 2012 ãîäó, ïëàñòèêà ÏÊÑ â 2018 ãîäó. Íà ðåàáèëèòàöèè ïîñëå ïëàñòèêè, ñêàçàëè, ÷òî åñòü ãèïåðìîáèëüíîñòü ñóñòàâîâ. |
#2
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Ïîïðîáóéòå ñäåëàòü ýòî
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#3
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Ñïàñèáî âàì çà îòâåò.
Íåò, ïðè äàííîì òåñòå áîëè îñîáîé íåò, ì.á. íåáîëüøîé äèñêîìôîðò íå áîëåå. Ðåíòãåí òîæå íå äåëàëè. Äèàãíîçà âíÿòíîãî íåò âîîáùå è ïî÷åìó òàê íà ìîé âçãëÿä äîëãî áîëèò íå ïîíÿòíî... Áûëè ñåðüåçíûå ïðîáëåìû ñ êîëåíîì, ïîýòîìó íà ìîè æàëîáû íà áîëè â çàïÿñòüå âðà÷ îñîáî íå îòðåàãèðîâàë, âñå ÷òî îí ðåêîìåíäîâàë ÿ íàïèñàëà âûøå èç ñåðèè "ñàìî ñî âðåìåíåì çàæèâ¸ò". |
#4
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Êàê ìèíèìóì ñíèìêè â 2-õ ïðîåêöèÿõ ñäåëàòü íóæíî. À òàì âèäíî áóäåò, äîñòàòî÷íî èõ, èëè åùå ÷òî-òî ïîíàäîáèòñÿ. Âûêëàäûâàéòå ñíèìêè â õîðîøåì êà÷åñòâå
- ïîñìîòðèì. Õîòÿ îáû÷íî â ýòîé îáëàñòè áûâàåò òåíäèíèò/ñòèëîèäèò, åñòü è äðóãèå ïîòåíöèàëüíûå äèàãíîçû. Åñëè òàê äîëãî áîëèò, íóæíî äîîáñëåäîâàòüñÿ. |
#5
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#6
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Ñìîòðÿ ÷òî íàçûâàòü ñòèëîèäèòîì. Åñëè òåíîñèíîâèò Äå-Êåðâåíà (It is stenosing tenosynovitis affecting the tendons of abductor pollicis longus and extensor pollicis
brevis. Fritz de Quervain, a Swiss surgeon, described it in 1895. It is also called as radial styloiditis. - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]), òî î÷åíü ÷àñòî (The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties.). Òàê ïî ñòàðèíêå íàçûâàþò åãî ó íàñ (è ó âàñ â Õàðüêîâå òîæå) äî ñèõ ïîð, êàê è ñèíäðîì Çóäåêà, íàïðèìåð. È â íåìåöêîÿçû÷íîé ëèòåðàòóðå (òóäà òîæå èíîãäà ìîæíî çàãëÿäûâàòü) òîæå. Åñòü òðàäèöèîííûå íàçâàíèÿ, êîòîðûå äîëãî íå âûõîäÿò èç óïîòðåáëåíèÿ. Íî íà ëå÷åíèå ýòî íå âëèÿåò. Åñëè îáðàòèëè âíèìàíèå ïèñàë ÷åðåç "/". Íî ñóòè ýòî íå ìåíÿåò, åñëè òîëüêî íå õî÷åòñÿ ïîñïîðèòü íè î ÷¸ì)) Ìíå ïðèÿòíî, ÷òî âû çíàåòå è ïðî brachioradialis) |
#7
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Öèòàòà:
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#8
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Öèòàòà:
À íà ñ÷åò íàëè÷èÿ èñòèííîãî òåíîñèíîâèòà ïðè ñèíäðîìå/áîëåçíè Äå-Êåðâåíà (è îòëè÷èè ñèíäðîìà/áîëåçíè Äå-Êåðâåíà îò òåíîñèíîâèòà Äå-Êåðâåíà, è åñòü ëè âîîáùå ºòî îòëè÷èå) ìîæíî åùå ìíîãî ãîâîðèòü. Åñòü èññëåäîâàíèÿ, êîòîðûå ïîêàçûâàþò, ÷òî äåëî âîîáùå íå â òåíîñèíîâèòå. |
#9
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Êàê çà÷åì? Ïîòîìó ÷òî ýòîò òåñò - ïàòîãíîìîíè÷íûé äëÿ áîëåçíè äå Êåðâåíà. Ðàçâå íå òàê? À âîò ïðèäóìàë ýòîò òåñò íå Ôèíêåëüøòåéí.  1959 ãîäó îäèí òîâàðèÑ× ñäåëàë íåïðîñòèòåëüíóþ îøèáêó è ýòó îøèáêó ïîâòîðÿþò íåãðàìîòíûå âðà÷è.ß îñîáî íå ðàçáèðàþñü â áîëåçíè äå Êåðâåíà, ïîýòîìó â ëèòåðàòóðå âñòðå÷àë 3 ôîðìû: òåíîñèíîâèèò, òåíäîâàãèíèò è ìèêñò. Íî åùå ðàç õî÷ó ïîä÷åðêíóòü, ÷òî ñòèëîèäèò è áîëåçíü äå Êåðâåíà - ýòî íå îäíî è òî æå ïàòîëîãè÷åñêîå ñîñòîÿíèå.
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#10
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Öèòàòà:
À ÷òî ïî âàøåìó òàêîå "Ñòèëîèäèò"? Åñòü êàêîå-òà îôèöèàëüíàÿ òðàêòîâêà â ìåæäóíàðîäíûõ èñòî÷íèêàõ? Ïðî Ôèíêåëüøòåéíà íå çíàë, íàïðèìåð. À íà ñ÷åò òîãî, êòî ïåðâûé ïðèäóìàë è ïî÷åìó íàçâàëè, òî â ìåäèöèíå ñëèøêîì ìíîãî ïðèìåðîâ, ÷òîá ëåçòü â ýòè äåáðè. ÊÐÁÑ, òîò æå ñèíäðîì Çóäåêà, îïèñàë âïåðâûå òîæå íå Çóäåê, à Ìèò÷åëë, è íàçâàë êàóçàëãèåé. Íî âñå çíàþò Çóäåêà. Îí åãî îïèñàë äåòàëüíåå. Òàê ÷òî, åñòü ïðèíÿòûå íàçâàíèÿ. Ìû æå çäåñü íå ïåðåèìåíóåì ñèíäðîì èëè òåñò. Íóæíî íà ìåæäóíàðîäíûõ êîíðåññàõ ýòè âîïðîñû ïîäíèìàòü)) Òàì ðåàëüíî ìîæíî äîáèòüñÿ ïåðåèìåíîâàíèÿ. |
#11
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Ïðàâèëüíî, ïîòîìó ÷òî áîëåçíü äå Êåðâåíà - ýòî íå ñòèëîèäèò. äå Êåðâåí íàçûâàë ýòî ñîñòîÿíèå de Quervain F. Ueber eine Form von chronischer Tendovaginitis. Korrespondenzblatt für Schweizer Arzte 1895;25:
389–394. Ñòèëîèäèòîì âðîäå áû è íå ïàõíåò. ×èòàéòå ïåðâîèñòî÷íèêè.Áûâàåò. Íî ñåé÷àñ äàæå â ðóññêîÿçû÷íîé ëèòåðàòóðå èíîãäà âñòðå÷àåòñÿ ïðàâèëüíîå íàçâàíèå ïðèâåäåííîãî íà âèäåî òåñòà. Ëþäè ïðîãðåññèðóþò, ÷òî ðàäóåò! Öèòàòà:
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#12
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Êàê ïðèìåð èñïîëüçîâàíèÿ èìåííûõ íàçâàíèé (ýïîíèìîâ) ïðè ïåðåëîìàõ âåðõíåé êîíå÷íîñòè:
What's in a name? Upper extremity fracture eponyms (Part 1) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
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Öèòàòà:
Çâó÷èò çàìàí÷èâî, íî íå âûéäåò)) |
#14
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Ïî÷åìó íå âûéäåò. Ãðàìîòíûå âðà÷è, ïðè÷åì äàæå ðóññêîÿçû÷íûå, äàâíî óæå çíàþò, ÷òî ýòî òåñò íå Ôèíêåëüøòåéíà, à Eichhoff’s test. Íà îäíîì èç ðåñóðñîâ íà ìîå çàìå÷àíèå î òîì, ÷òî íà âèäåî ñóïåð-ïóïåð çíàìåíèòîãî àìåðèêàíñêîãî ïðîôåññîðà ( íà òèòóëüíîé ñòðàíèöå!) îøèáî÷íî òåñò íàçâàí èìåíåì Ôèíêåëüøòåéíà, òîò ïðîôåññîð îòâåòèë ìíå: Did a russian colleague come up with similar test? often happens in medicine but in US, the test has this name associated ...... Îò ìåíÿ ïîëó÷èë "íàø îòâåò Êåðçîíó":....... but I read beautiful article N. K. Ahuja, K. C. Chung, A. Arbor. Fritz de Quervain, MD (1868–1940): Stenosing Tendovaginitis at the Radial Styloid Process // J Hand Surg 2004;29A:1164–1170, in which authors wrote: “The test Finkelstein described differed from Eichhoff’s test in that it did not involve gripping the thumb within the fist. Rather, the test Finkelstein described is as follows: “On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is excruciating” 11(Fig. 2)”.
Besides I read the article M. WASEEM, M. KHAN, N. HUSSAIN, P. V. GIANNOUDIS, J. FISCHER, R. M. SMITH. Eponyms : Errors in clinical practice and scientific writing // Acta Orthop. Belg., 2005, 71, 1-8, in which authors wrote: “Finkelstein described the most pathognomonic sign of de Quervain’s disease in 1930 by eliciting pain on traction of the thumb, which was worsened with ulnar deviation of the hand (12-14, 20). Errors incorrectly describing the Finkelstein test can be traced to Leao (1958) who quoted Eichhoff’s manoeuvre as Finkelstein’s test (16, 20, 39). There have been incorrect descriptions of the test since then in the literature by many other authors (9, 19,25, 28, 41, 42, 48, 57, 61)”. Ïîíÿòíî æå âñå íàïèñàíî. ×åãî êîïüÿ ëîìàòü? |
#15
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åùå èç òåçèñîâ ñòàòüè î ïåðåëîìàõ êèñòè - àâòîðñòâî ïåðâî-îïèñàòåëåé è â ïðîøåäøèõ ñòîëåòèÿõ íå ïðèçíàâàëè, åñëè îíè ïóáëèêîâàëèñü â ìåíåå èçâåñòíûõ "ïðîâèíöèàëüíûõ" ìåä. æóðíàëàõ:
Abraham Colles had the good fortune to describe the most common fracture about the wrist but, because its description was published in a provincial journal, it received little attention and was almost never referred to in his lifetime. The same can be said of Claude Pouteau who described the same fracture in another lesser-known medical journal. Robert Smith described the fracture that bears his name in 1847 although it had already been described by Jean-Gaspar-Blaise Goyrand some years before. Galeazzi's fracture had been described nearly 90 years earlier by Sir Astley Cooper and is also known as Dupuytren's and Piedmont fracture. To add to the conflicting nomenclature it is sometimes not clear whether a Smith's II fracture is a Barton's fracture or a reversed Barton's fracture. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |