三角纖維軟骨複合體(TFCC)是位於手腕尾指一側的軟骨盤及韌帶結構,是手腕疼痛原因中最常被忽略的一員。三角纖維軟骨複合可以出現在手經常負重的人士,在過往臨床診症中,曾見此病症發生在裝修師傅、廚房清潔人員、高爾夫球愛好者,甚至經常健身人士身上,或不小心跌倒時用手撑扶的傷者。
TFCC解剖及功能
三角纖維軟骨位置,正正於前臂尺骨末端,功能除傳遞握物重量外,其實亦提供前臂尺骨及橈骨關節的穩定性,及連接前臂尺骨至手腕骨。如果手腕沒有了三角纖維軟骨如此精細的結構,這肯定大大減低手腕的負重能力、穩定性及靈活性。至於其受傷機制,主要包括創傷及勞損兩大原因:前者包括跌仆時,傷者以手腕支撑身體,這往往致前臂橈骨骨折外,亦可引致手腕舟骨骨折及三角纖維軟骨複合的損傷;後者勞損,則可因為重複用手搬運或推重物,或健身運動中舉過重重量等,致手腕在負重情況下重複過度扭轉,或後伸動作過度加壓致傷。
TFCC 症狀
患者症狀常表現為手腕後伸或手腕屈往尾指方向時疼痛;治療人員當檢查尺骨末端凹陷處,亦可發現明顯壓痛點。西醫一般會以磁力共振或內窺檢查三角纖維軟骨的完整性,內窺鏡檢查同時可進行修補軟骨手術。
TFCC 損傷的治療
對於輕微撕裂或勞損者,傷患軟骨有機會能自行修復,非手術治療例如物理治療或針灸,亦有良好促進療效。但假如症狀持續,並嚴重影響日常生活者,建議看西醫作進一步檢查。若須作手術修補者,術後一般會接受約8至12星期物理治療,改善症狀及作鍛練運動,以回復手腕功能。此外,患者亦要改變用手習慣,康復期內減少推門、扭毛巾等動作,及適當鍛練前臂肌肉。
撰文 : 盧文健 物理治療師、註冊中醫師
欄名 : 理療感悟
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