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Sagittal Band Rupture (Boxer's Knuckle)

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A knuckle injury where the tendon slips off the top of the joint — the "boxer's knuckle" — and how early splinting or surgery treats it.

Illustrasyon ng likod ng isang nakapikit na kamay na may sakit na nakatuon sa isang knuckle kung saan nalipat ang extensor tendon.
Sagittal band rupture ('boxer's knuckle'): ang sagittal band na nagtutugma ng extensor tendon sa ibabaw ng knuckle ay napuputol, na nagdudulot ng pagdulas ng tendon sa isang gilid. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Ang knuckle sa base ng isa sa iyong mga daliri (karaniwan ang gitnang daliri) ay nangingisip, bahagyang pamamaga, at may pakiramdam na hindi gumagalaw nang wasto ang bahaging iyon. Ang klasikal na senyales ay ang pakiramdam na ang tendon sa likod ng knuckle ay sumasabog o lumilipat sa gilid kapag iyong binubuksan at binababang ang daliri. Maaaring mapansin mo na bahagyang lumilipat ang daliri patungo sa gilid ng maliit na daliri, at mahirap itong tuwidin nang sarili mula sa nakabukang posisyon, bagaman kapag may nagtutuwid nang dahan-dahan para sa iyo, kayang panatilihin nito ang posisyong iyon.

Maraming tao ang unang nararamdaman ito matapos magpunch (laban sa bag, pader, o sa away), kaya ang pinsala ay tinatawag na "boxer's knuckle." Ngunit maaari itong mangyari rin sa mas maliit na galaw, tulad ng pilit na pagtutuwid ng daliri, o maaari itong unti-unting lumitaw sa mga taong may inflammatory arthritis. Maaaring may masakit na pag-click o pag-catch bawat gamitin ang kamay.

Ano ang nangyayari talaga

Sa likod ng bawat knuckle, ang straightening (extensor) na tendon ay dumadaan sa gitna ng daliri tulad ng isang kable sa loob ng isang guhit. Ang manipis na mga sling ng tisyu na tinatawag na sagittal bands ay nasa magkabilang gilid at pinapanatili ang tendon na nasa gitna sa itaas ng knuckle. Ang sling sa gilid ng hinlalaki ang pinakamahalaga.

Kapag ang sling na ito ay napunit o naunat (mula sa isang suntok, biglaang makapangyarihang galaw, o matagal nang pamamaga ng kasu-kasuan), ang tendon ay hindi na pinapanatili sa tamang posisyon at dumudulas mula sa itaas ng knuckle patungo sa lambak sa pagitan ng mga buto, papunta sa gilid ng maliit na daliri. Dahil ang tendon ay nasa gilid na imbes na nasa itaas, hindi ito maaaring hilahin ang daliri na tuwid nang epektibo mula sa ganap na nakabukang posisyon, at ito ay sumasabog pabalik-balik habang gumagalaw ang daliri. Ang pagdudulas, pag-sabog, at kahinaan sa pagtutuwid ay ang buong problema sa isang sakto.

Ano ang maaari naming gawin dito

Ang magandang balita ay kung maagang matukoy, madalas itong gumagaling nang walang operasyon. Ang susi ay pigilan ang pagdulas ng tendon habang nag-aayos ang sarili ang sling.

Pag-splint (hindi operasyon). Ang pinakakaraniwang gamutan ay isang maliit, custom na splint na hahawak sa sugatang knuckle upang hindi ito dumulas o dumikit nang sobra habang pinapayagan ang ibdalang daliri at ang mga joint ng daliri na mas malayo, na malayang gumalaw nang normal. Isang magandang bersyon, minsan tinatawag na relative-motion o "yoke" splint, ay simpleng hahawak sa sugatang daliri nang kaunti nang mas mataas kaysa sa katabi nito, na pinapanatili ang tendon sa gitna habang ginagamit mo ang kamay. Karaniwang isusuot ang splint sa loob ng anim hanggang walong linggo. Kung sisimulan ito sa loob ng unang ilang linggo ng sugat, epektibo ito para sa karamihan ng mga tao.

Operasyon. Kung lumang na ang sugat bago ito makita, kung hindi ito aayusin ng splint, o kung ganap na nagdudulas ang tendon, maaaring ayusin ng operasyon ang mga bagay. Ang surgeon ay maaaring ayusin ang naputol na sling nang direkta o muling itayo ito sa pamamagitan ng paggamit ng malapit na strip ng tendon upang muling lumikha ng sling at muling itaas ang tendon sa itaas ng knuckle. Pagkatapos ng operasyon, ang daliri ay protektado sa isang splint sa loob ng isang panahon habang ito ay nagagaling.

Ano ang inaasahan

Para sa mga maagang sugat na ginagamutan sa pamamagitan ng splint, maganda ang prognosis: humihinto ang pag-snapping, bumabalik ang daliri sa normal na pagkakatuwid, at karamihan sa mga tao ay bumabalik sa buong paggamit ng kamay. Kinakailangan nito ang pagiging pasensyoso: isusuot ang splint sa loob ng ilang linggo, at ang sobrang pagpilit sa kamay nang maaga ay maaaring magdulot ng muling pagdulas ng tendon bago pa matapos ang paggaling ng sling.

Para sa mga sugat na nangangailangan ng operasyon (karaniwan ang mga lumang o mas seryoso), ang pagkukumpuni o rekonstruksyon ay karaniwang maaasahan sa pagpigil sa dislokasyon at pagpapanumbalik ng makinis na galaw, na sinusunod ng isang panahon ng paggamit ng splint at terapiya sa kamay upang muling mapalago ang galaw at lakas. Ang mga boxer, martial artist, at iba pang atleta ay karaniwang maaaring bumalik sa kanilang isport, ngunit kailangan ng kamay ng oras upang gumaling nang maayos bago upang maiwasan ang pagbabalik ng problema.

Kailan kumonsulta sa doktor

  • Isang knuckle na nag-snap, nag-click, o nag-catch kapag yumuyuko at nagtutuwid ang daliri, lalo na pagkatapos ng isang punch o makapangyarihang galaw: ipakita ito agad, dahil ang maagang pag-splint ang nagdudulot ng pagkakaiba.
  • Hirap na ituwid ang daliri mula sa posisyong yumuko nang mag-isa, o ang pag-drift ng daliri patungo sa gilid ng maliit na daliri.
  • Patuloy na sakit at pamamaga sa isang knuckle na hindi nawawala, o pakiramdam na ang tendon ay "nasa maling posisyon."
  • Sugat sa knuckle sa isang boxer o martial artist: madali itong ipagpatuloy ang gawain at madaling malampasan, at mas maganda ang resulta kapag pinagagamutan nang maaga kaysa huli.

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