chenqinghan8333@medmail.com.cn

治疗原则
1.消除致伤原因、限制致伤动作、纠正不良姿势
2.理疗、按摩
3.局部封闭
 A. 诊断明确的慢性损伤性炎症，非细菌性炎症，而非细菌性炎症或肿瘤
B．严格无菌技术
C．注射部位准确
D．注射后短期出现局部严重肿胀或红热者，应停止注射

4.非甾体抗炎药（NSAIDs）
A．必要时短期用药
B．病灶局限且表浅者使用涂擦剂
C．为减少对胃肠道损害，宜首选环氧合酶2（COX2）抑制剂
D．对肾功能欠佳者可选用短半衰期药物、对肾血流影响较小的药物
E．减少对肝功能的影响可选用结构简单、不含氮的药物，避免使用吲哚美辛和阿司匹林
F.   不应同时使用两种非甾体抗炎药

5.手术治疗：非手术治疗无效者，如狭窄性腱鞘炎、腱鞘囊肿、神经卡压等

treatment
Most low back pain can be safely and effectively treated following an examination  and a prescribed period of activity modification and some medication to relieve the pain and diminish the inflammation. Although a brief period of rest may be helpful, most studies show that light activity speeds healing and recovery. It may not be necessary  to discontinue all activities, including work. Instead, adjust  activity

Once the initial pain has eased, a rehabilitation program may be suggested to increase the muscle strength in  low back and abdominal muscles as well as some stretching exercises to increase  flexibility. Weight loss if the patient are overweight, and quitting smoking if they are a smoker also will decrease the chances of a recurrence of  low back pain. proper lifting and postural activities to prevent further injuries

二、狭窄性腱鞘炎
Trigger Finger
Trigger finger is an irritation of the digital sheath which surrounds the flexor tendons. When the tendon sheath becomes thickened or swollen it pinches the tendon and prevents it from gliding smoothly. In some cases the tendon catches and then suddenly releases as though a "trigger" were released.

Sometimes the swelling can be treated with rest, activity modification, oral anti-inflammatories, or steroid injections. The tendon sheath will then return to its normal, pain-free conditions. More severe cases may require surgery to release the tendon. This can be done as an outpatient procedure. Normal activity can be resumed as pain allows.
桡骨茎突狭窄性腱鞘炎 Tendonitis of the Wrist (DeQuervain's disease)

DeQuervain's stenosing tenosynovitis is most common in adult women between the ages of 30 and 50. It is an irritation and swelling of the sheath or tunnel which surrounds the thumb tendons as they pass from the wrist to the thumb. Pain when grasping or pinching and tenderness over the tunnel are the most common symptoms.

Sometimes a lump or thickening can be felt in this area. If the hand is made into a fist with the thumb "tucked in" and bent towards the little finger, the pain gets worse (Finkelstein test).

Tendonitis may be caused by overuse and also can be seen in association with pregnancy or inflammatory arthritis such as rheumatoid disease.
If treated early, many cases improve with rest in a splint, injection with steroids and/or taking anti-inflammatory medications.

More severe cases or those that do not respond to other treatment may require surgery. Modification of the activities which caused the symptoms initially also may be required.
三、腱鞘囊肿Ganglion Cysts

Ganglion cysts are the most common mass or lump in the hand. They are most common on the back of the wrist. These non-cancerous, fluid-filled cysts arise from the ligaments, joint linings, or tendon sheaths when they are irritated or inflamed. They may disappear or change size quickly.

Many ganglion cysts do not require
   treatment. However, if the cyst is
   painful, interferes with function or
   the patient does not like the
   appearance,  The orthopaedic
   surgeon can remove
  the fluid, inject steroids,
  or remove it surgically.
四、肱骨外上髁炎Epicondylitis ；Tennis elbow
The classic tennis elbow is caused by repeated forceful contractions of wrist muscles located on the outer forearm. The stress created at a common muscle origin causes microscopic tears leading to inflammation. Persons who are most at risk of developing tennis elbow are those whose occupations requires strenuous or repetitive forearm movement.

Definition
Tennis elbow is an inflammation of several structures of the elbow. These include muscles, tendons, bursa, periosteum, and epicondyle (bony projections on the outside and inside of the elbow, where muscles of the forearm attach to the bone of the upper arm).

Diagnosis
Diagnosis of tennis elbow includes the individual observation and recall of symptoms, a thorough medical history, and physical examination by a physician. Diagnostic testing is usually not necessary unless there may be evidence of nerve involvement from underlying causes. X rays are usually always negative because the condition is primarily soft tissue in nature, in contrast to a bony disorder.

Treatment
Conservative
 Once acute symptoms have subsided, heat treatments are used to increase blood circulation and promote healing.
 physical therapy to apply diathermy or ultrasound to the inflamed site.
 Occasionally, a tennis elbow splint may be useful to help decrease stress on the elbow throughout daily activities.
  nonsteroidal anti-inflammatory drugs(NSAIDS)
 Injections of cortisone

Surgery
If conservative methods of treatment fail, surgical release of the tendon at the epicondyle may be a necessary form of treatment. However, surgical intervention is relatively rare.
五、肩周炎
俗称凝肩、冻结肩、五十肩，是肩周肌、肌腱、滑囊及关节囊的慢性损伤性炎症。因关节内外粘连，而以活动时疼痛、功能受限为临床特点。

病因：
肩部原因：
软组织退行性变（40岁以后）
长期过度活动、姿势不良—主要因素
肩部固定过久
肩部急性损伤（挫伤、牵拉伤）后治疗不当
肩外因素：颈椎病、心、肺、胆道疾病发生的肩部牵涉痛

临床表现
女性多于男性，左侧多于右侧
中、老年多发
肩部疼痛、肩关节活动受限，可有夜间痛
肩周压痛、肩关节活动受限
X线片：可见骨质疏松、冈上肌肌腱、肩峰下滑囊钙化

治疗
自然病程1年左右
理疗、针灸、推拿、按摩
痛点封闭
NSAIDs、肌肉松弛药
功能锻炼
肩外因素所致者，治疗原发病

第三节  骨的慢性损伤
一、疲劳骨折（fatigued fracture，stress fracture）
    好发于第二跖骨干（行军骨折）和肋骨，其次可发生在第3、4跖骨、腓骨远段、胫骨近段、和股骨远侧。

临床表现
病史
局部疼痛，进行性加重
体检：局部压痛、隆起，无反常活动
X线片：1-2周多无明显异常，3-4周后可见横型骨折线，周围有骨痂形成。

治疗：外固定，康复功能锻炼，避免再伤

二、月骨无菌性坏死
又称Kienbock病，好发于20~30岁之青年人
病因：活动度大，血供差，腕部长期慢性损伤—小血管损伤、闭塞，骨内压增高

临床表现：
腕关节慢性疼痛，活动时加重，腕部肿胀
体检：腕部肿胀，扣击第三掌骨出现月骨处疼痛
X线片早期无异常，数月后----月骨密度增高、表面不光滑，形态不规则，囊性变
放射性核素：异常放射性浓集

治疗：
早期----固定（腕背伸20~30度）1年左右
月骨已坏死、变形-----月骨切除，假体置入或腕关节融合

Symptoms
History of single major wrist injury
History of multiple minor occupational injuries
Chronic Wrist Pain, tenderness and swelling
Restricted wrist range of motion--------Dorsiflexion most often affected

Signs:
          Passive dorsiflexion aggravates pain （ Pain middle finger dorsiflexion ）
          Pain on index finger dorsiflexion ----Preiser's disease (Navicular avascular necrosis)

Radiology: Wrist XRay
Initially: Normal
Eventually: Involved bone dense, white, and sclerotic
Later: Bone fragmentation and collapse occur
End Result: Degenerative arthritis

Management
Early stages
Intermittent immobilation for months
Allows reconstitution of normal bony architecture
Cast removed on daily basis for ROM Exercises
Later stages ：Surgery may be necessary
第四节  软骨的慢性损伤
一、髌骨软骨软化症（chondromalacia of
patella）
病因：
先天性髌骨发育障碍、位置异常，股骨髁大小异常；膝关节内、外翻，胫骨外旋畸形----髌骨不稳定-----慢性损伤
膝关节长期用力过度
髌骨软骨营养不良（滑液成分异常）

临床表现
青年运动员多见，髌骨下疼痛，开始活动明显，稍活动后缓解，过多活动有加重，休息后渐消失,不能下蹲，上下楼梯困难
髌骨边缘压痛：髌骨有摩擦感，伴疼痛，可有关节积液，浮髌试验阳性，股四头肌萎缩
X线片：早期无异常，晚期髌骨软骨下骨硬化、囊性变，边缘骨赘形成，关节间隙边窄，高位髌骨、股骨外髁低平等。
放射性核素浓集
骨内压增高

治疗：非手术治疗为主
出现症状后制动1~2周，股四头肌抗阻训练
肿胀、疼痛加剧时：冷敷，48小时后热敷、理疗
抗炎药物：氨糖美辛、维骨力等
关节内注射玻璃酸钠
关节内注射激素---慎用（抑制糖蛋白、胶原合成
非手术治疗无效或有先天性畸形者可手术治疗————增加髌骨稳定性；刮除软骨病灶；髌骨切除

二、胫骨结节骨软骨病（Osgood-Schlatter病）
病因：胫骨结节骨骺
               牵拉伤
临床表现：好发于
        12~14岁男孩，
         多为单侧，也
         可为双侧。

近期有剧烈运动史，然后胫骨结节处疼痛、隆起
胫骨结节隆起，质硬、压痛，无红热等急性炎症表现，伸膝抗阻疼痛加剧
X线片：胫骨结节骨骺增大、抬高、致密或碎裂

治疗
减少剧烈运动、理疗、制动，成年后仍有碎裂骨骺未与胫骨融合---钻孔植骨。18岁后症状自行消失，但隆起不会改变
“RICE”:
R=Rest the knee from the painful activity.
I=Ice the affected area for 20 minutes, 3 times a day.
C=Compress the painful area with an elastic bandage.
E=Elevate the leg.

 

三、股骨头骨软骨病
又名儿童股骨头缺血性坏死、Legg-Calve-Perthes病（LCPD）、Perthes病、扁平髋等。
病因：慢性损伤---骨骺血管闭塞-----骨骺坏死，4-9岁股骨头骨骺血供最差；滑膜炎症----关节内压增高，骨内压增高----静脉回流障碍----血供降低----骨坏死

 

Causes: The etiology remains unclear; however, the following scenario generally is accepted:

The blood supply to the capital femoral epiphysis is interrupted.
Bone infarction occurs, especially in the subchondral cortical bone, while articular cartilage continues to grow. (Articular cartilage grows because its nutrients come from the synovial fluid.)

Revascularization occurs, and new bone ossification starts.
At this point, a percentage of patients develop LCPD, while other patients have normal bone growth and development.

LCPD is present when a subchondral fracture occurs. This is usually the result of normal physical activity, not direct trauma to the area
Changes to the epiphyseal growth plate occur secondary to the subchondral fracture

病理
缺血期：软骨下骨细胞缺血坏死—骨化中心停止生长，但软骨继续发育（滑液营养）---数月~1年多
血供重建期：新生血管长入骨骺—形成新骨—新生骨被吸收，被肉芽组织取代----股骨头易受压变形----持续1~4年，是治疗的关键
愈合期：骨吸收停止---骨化----纤维肉芽组织为新骨替代
畸形残存期：病变静止，畸形固定-----扁平髋-----骨性关节炎

临床表现
好发于3~10岁儿童，男：女约6：1
髋痛，进行性加重，部分以膝部疼痛为主诉
检查：跛行，患肢肌肉萎缩，内收肌痉挛，患肢稍缩短，Thomas征（+），患髋活动受限（外展、后伸、内旋）
X线片：股骨头密度增高，骨骺碎裂、变扁，股骨颈增粗，髋关节半脱位等
放射性核素骨显像：早期诊断阳性率大于90%

History: Symptoms usually have been present for weeks because the child often does not complain.
Hip or groin pain, which may be referred to the thigh
Mild or intermittent pain in anterior thigh or knee
Limp
Usually no history of trauma

Physical:
Decreased range of motion (ROM), particularly with internal rotation and abduction
Painful gait
Atrophy of thigh muscles secondary to disuse
Muscle spasm
Leg length inequality due to collapse

Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse.
Short stature: Children with LCPD often have delayed bone age.
Roll test
With patient lying in the supine position, the examiner rolls the hip of the affected extremity into external and internal rotation.
This test should invoke guarding or spasm, especially with internal rotation.

Imaging Studies:
Plain x-rays of the hip are extremely useful in establishing the diagnosis.
Frog leg views of the affected hip are very helpful.

Multiple radiographic classification systems exist, based on the extent of abnormality of the capital femoral epiphysis.
Waldenstrom, Catterall, Salter and Thompson, and Herring are the 4 most common classification systems.
No agreement has been reached as to the best classification system

Five radiographic stages can be seen by plain x-ray. In sequence, they are as follows:
Cessation of growth at the capital femoral epiphysis; smaller femoral head epiphysis and widening of articular space on affected side
Subchondral fracture; linear radiolucency within the femoral head epiphysis
Resorption of bone
Re-ossification of new bone
Healed stage

Technetium 99 bone scan - Helpful in delineating the extent of avascular changes before they are evident on plain radiographs

治疗
目的：保持一个理想的解剖学和生物力学环境，预防血供重建期和愈合期股骨头变形
使股骨头包容在髋臼内
避免髋臼外上缘对股骨头局限性压力
减轻对股骨头的压力
维持髋关节又良好的活动范围

非手术治疗
支架固定（髋外展40度、轻度内旋位）1~2年
髋人字石膏（同上），3月更换1次
手术治疗：滑膜切除，骨骺钻孔、股骨转子下内旋、内翻截骨，骨盆截骨，血管置入等

Emergency Department Care:
Goals of treatment
Achieve and maintain ROM
Relieve weight bearing
Containment of the femoral epiphysis within the confines of the acetabulum
Traction

Consultations:
Once the diagnosis of LCPD is suspected, an orthopedic surgeon or a pediatric orthopedic surgeon should be contacted for further management decisions.
An orthopedic consultant may choose to order more specialized tests (eg, bone scintigraphy, arthrogram, and magnetic resonance imaging), usually on an outpatient basis, to better determine the extent of the disease.

Medical treatment does not stop or reverse the bony changes. Appropriate analgesic medication should be given.
Drug Category: Nonsteroidal anti-inflammatory drugs (NSAIDs) -- These drugs most commonly are used for the relief of mild to moderately severe pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for the initial therapy.

 

Further Outpatient Care:
LCPD does not require emergent inpatient care.
Treatment may involve observation, usually in children younger than 6 years.
Bed rest and abduction stretching exercises are recommended.

Nonsurgical containment allows the femoral head to stay within the acetabulum, where it can be molded. Various casts, braces, and crutches have been used for containment.
Initially, close follow-up is required to determine the extent of necrosis.

Once the healing phase has been entered, follow-up can be every 6 months.
Long-term follow-up is necessary to determine the final outcome.
Surgical correction of gross deformities of the femoral head may be necessary.

Complications:
LCPD may result in femoral head deformity and degenerative joint disease.
The femoral head may be distorted permanently.

Prognosis:
The younger the age of onset of LCPD, the better the prognosis.
Children older than 10 years have a very high risk of developing osteoarthritis.
Most patients have a favorable outcome.
Prognosis is proportional to the degree of radiologic involvement

第五节：周围神经卡压综合征（上肢） Peripheral Nerve Entrapment Syndrome（upper extremity)
概述
周围神经受其所经过的狭窄、增生、肥厚、粘连的骨-纤维隧道、腱膜、筋膜的挤压而出现的一系列临床症状体征，称为周围神经卡压综合征。
一、腕管综合征 Carpal Tunnel Syndrome （CTS）
腕管综合征是正中神经在腕管内受压而表现的一组症状、体征。
应用解剖：
腕管内有9条肌腱和正中神经
正中神经支配大鱼肌的2块半，第1、2蚓状肌及手掌桡侧3个半手指及手掌感觉

腕部正中神经支配 2块半大鱼际肌及1、2蚓状肌
拇对掌肌、拇短屈肌（1/2）、拇短展肌

病因
外源性压迫
管腔变小
管腔内容物增多、体积增大
腕管内压力增高（慢性损伤）
临床表现
中年女性多见
桡侧三个手指麻木、无力，夜间或清晨最重
体检：桡侧3个半手指掌侧感觉过敏或迟钝，大鱼肌萎缩，拇对掌无力，Tinel征阳性，Phalen（屈腕试验）阳性
肌电生理检查
治 疗
Mild cases can be treated with a splint or brace to rest the wrist. Steroid injections into the carpal canal to decrease swelling may be used in more severe cases.
Those cases that do not respond to nonsurgical treatment and those that are diagnosed late may require surgery.
二、肘管综合征 Cubital Tunnel Syndrome
尺神经在尺神经沟内的卡压或慢性损伤，过去称为迟发性尺神经炎

应用解剖
尺神经沟浅面有尺侧副韧带、尺侧屈腕肌筋膜和弓状韧带构成的顶，两者之间为肘管
此处无肌支，向下走行支配尺侧屈腕肌、小鱼际肌、3、4蚓状肌和所有骨间肌（7块），手尺侧1个半手指感觉

Anatomy of ulnar nerve
C7, C8, T1
From medial & lateral cords of brachial plexus
Passes through intermuscular septum in mid-arm
Behind medial epicondyle
Between two heads of FCU
Lies anterior to FDP
Gives off dorsal cutaneous branch 5cm proximal to wrist

At wrist lies between FDS & FCU
Through Guyons canal at wrist (betw. pisiform & hook of hamate), medial to ulnar artery
Motor branch winds round hook of hamate
Motor - to FCU, ulnar side of FDP, all small muscles of hand except LOAF
Sensory - ulnar 1 1/2 digits both sides; autonomous zone = tip of little finger

病因
肘外翻：最常见原因
尺神经半脱位
肱骨内上髁骨折
创伤性骨化

Like a telephone cable, the ulnar  nerve is a connection between the spinal cord and muscles of the forearm and hand as well as the skin on the pinkie side of the hand. The ulnar nerve passes across the back of the elbow, behind a bump on the inner side of the upper arm bone. This bump is called the medial epicondyle. The "funny bone" is actually the corner of the nerve as makes the bend around the elbow. Hitting the elbow at this spot tickles the nerve and gives a brief feeling of a shock or tingling.

When the elbow is bent, the nerve may be stretched and push against the bony bump.
Most people with this problem have a habit of sleeping with either their elbows bent, their arms up by their head, or both. These positions aggravate the problem. Over time, this can progressively irritate the nerve, resulting in numbness of the ring and small finger, weakness of  some of the muscles of the hand and forearm, and pain. Nerve damage may occur.

临床表现

手背尺侧、小鱼际、小指及环指尺侧半感觉异常，麻木或刺痛
小指对掌无力及手指内收、外展不灵活
检查：小鱼际肌、骨间肌萎缩，环小指爪状畸形，痛觉减退，夹纸试验阳性，Tinel征阳性
肌电图
基础疾病表现—肘外翻、异位骨化等
治疗treatment
The most effective treatment without surgery is elbow splinting and correction of aggravating postures
ulnar nerve transposition. --The nerve can be moved just under the skin or beneath the muscle in the area
medial epicondylectomy --remove the bump, allowing the nerve to glide forward and back as the elbow bends and straightens

三、旋后肌综合征
又称骨间后神经（posterior interosseous nerve）卡压症，1908年德国的Frohse和Framkel描述了旋后肌（supinator muscle）的两个头在肱骨外上髁的顶部和内侧缘形成一个纤维腱性弓，骨间后神经从该弓底通过，可能被压迫，产生症状。1968年Spinner将此弓命名为Frohse弓.

 

骨间后神经（桡神经深支）为单纯运动神经，支配：旋后肌、尺侧腕伸肌、指总伸肌、食指和小指固有伸肌、拇长伸肌、拇短伸肌、拇长展肌
病因
旋后肌慢性创伤性炎症（手工业、键盘操作）
类风湿性关节炎 (rheumatoid synovitis) ----Frohse腱弓增生、粘连、瘢痕形成
旋后肌处占位--腱鞘囊肿、脂肪瘤、tumors等
桡神经在旋后肌内行走异常
trauma (Monteggia fractures)
 iatrogenic injuries.
临床表现
桡神经深支支配的肌肉不完全性麻痹：
拇指外展、伸直障碍
2-5指掌指关节不能主动伸直（垂指）
腕关节可主动伸直（无垂腕），但偏向桡侧
前臂旋后障碍较轻
虎口区感觉正常
肌电图检查
  

（Attempts at active wrist extension often result in weak dorsoradial deviation due to preservation of the radial wrist extensors but involvement of the extensor carpi ulnaris and extensor digitorum communis. These patients do not have a sensory deficit ）
治疗
神经探查，旋后肌腱弓切开减压、切除致压物

Release the supinator along its entire course. Compression may be present not only at the arcade of Frohse but also as the nerve exits the muscle. The superficial layer of the supinator muscle must be incised very carefully to avoid injuring the enclosed nerve. Distal to the supinator, numerous muscular branches are given off and must be protected. Distally, branches of the RSN and lateral antebrachial cutaneous nerve must be protected.
旋前圆肌综合征 Pronator Teres Syndrome
Compression at
Lacertus fibrosus
pronator teres muscle
fibrous arcade of FDS
ligt of Struthers
 (present in 1.5 % of people)

Causes
Repeated minor trauma/ repetitive use of elbow
fracture / fracture dislocation of elbow
Tight/scarred lacertus fibrosus
Tendinous bands in pronator teres
Abnormal anatomy of pronator teres
Tight fibrous arch at prox FDS

Symptoms
Aching / fatigue of forearm after heavy use
Clumsiness
Vague, intermittent parasthesia, but rarely numbness

Signs
local tenderness to deep pressure and reproduction of symptoms
Tinels test
pain on resisted pronation of forearm with elbow extended = Pronator teres
pain on resisted elbow flexion and supination= lacertus fibrosus
pain on resisted flexion of PIP joint middle finger = FDS arch

Investigations
NCS not much use, intermittent symptoms
EMG may show evidence of reduced innervation of muscles ，may differentiate from CTS

Management
Conservative-avoidance of repetitive elbow movements, NSAIDS, Splintage with elbow flexed with pronation
Surgical- Decompress all the structures
骨间掌侧神经综合征 Anterior Interosseous Syndrome
Compression under humeral part of pronator teres
Anterior interosseous nerve motor to FPL, radial side of FDP and pronator quadratus
Does not supply skin sensation
Afferent sensory fibres from capsular ligament structures of wrist and DRUJ

Clinical diagnosis
spontaneous vague forearm pain
reduced dexterity
weakness of pinch
unable to make 'OK sign' due to weakness of FPL & FDP index finger (makes square instead of circle)
weak pronation with elbow in full extension (isolates PQ)
direct pressure over nerve can elicit symptoms
Tinels sign usually negative

Investigations
NCS unhelpful
Management
Conservative- NSAIDS, avoiding aggravating movements
Surgical exploration- most common compressing structure deep head of pronator teres
腕尺管综合征 Ulnar tunnel syndrome (Compression at Guyons canal)
Anatomy of Guyons canal
floor = transverse carpal ligt to pisiform
ulnar wall = pisiform
radial distal wall = hook of hamate
roof = volar carpal ligt
contains only ulnar nerve and art

Causes
repetitive indirect trauma most common
tumours- ganglion, lipoma
pisiform instability
pisotriquetral arthritis
fractured hook of hamate / pisiform
ulnar artery thrombosis

Symptoms
weakness atrophy para / hypoasthesia ulnar side of hand motor sensory or both
dorsoulnar sensory branch spared

Signs
local tenderness, Tinels test, phalens sign, local swelling, negative Allens test, severe ulnar clawing (remember ulnar paradox)
Investigations
NCS, show delayed motor latency from wrist to 1st dorsal interosseous

Management
Conservative
splinting
avoidance of repetitive trauma
Surgical
decompression of motor and sensory branches
+/- excision of pisiform/ hook of hamate
桡神经浅支卡压 Wartenberg syndrome
Described in 1932- isolated neuritis of superficial sensory branch of radial nerve

The superficial branch, which is purely sensory, runs under cover of the brachioradialis in the forearm. Eight centimeters proximal to the tip of the radial styloid, the nerve pierces the fascia medial to the brachioradialis to lie dorsal to the extensor tendons. It divides into a medial and lateral branch to innervate the radial wrist (with some variable overlap from the lateral antebrachial cutaneous nerve), dorsal radial hand, and the dorsum of the radial 3 1/2 digits (to approximately the middle phalanx level).
Etiology
Many factors may contribute to the development of Wartenberg's syndrome. In patients with de Quervain tendovaginitis, secondary irritation of the RSN is frequent. Other common causes include postsurgical injury, external compression, and trauma

The anatomic site of compression corresponds to the transit of the nerve from its submuscular position beneath the brachioradialis to its subcutaneous position on the extensor carpi radialis longus. Especially with pronation, these 2 muscles can create a scissorlike effect compressing the RSN
Clinical Manifestation
Patients with the diagnosis of Wartenberg syndrome complain of pain over the distal radial forearm associated with paresthesias over the dorsal radial hand. They frequently report symptom magnification with wrist movement or when tightly pinching the thumb and index digit. These individuals demonstrate a positive Tinel sign over the RSN and local tenderness. Hyperpronation of the forearm can cause a positive Tinel sign. A high percentage of these patients reveal physical examination findings consistent with de Quervain tendovaginitis.
Treatment
Wartenberg syndrome is best treated nonoperatively. Only in resistant cases is nerve decompression indicated. Local application of steroids or iontophoresis（电离子透入疗法）is utilized.
References
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