累積性創傷疾病相關之後骨間神經病變：病例報告

Posterior Interosseous Neuropathy Related to Cumulative Trauma Disorder: A Case Report

曾正浩(Cheng-Hao Tseng) ； 黃宗正(Tsung-Cheng Huang) ； 洪禎雯(Jen-Wen Hung) ； 張秉祺(Bin-Chi Chang)

《台灣復健醫學雜誌》 38卷3期 (2010/09) Pp. 188-194

https://doi.org/10.6315/2010.38(3)07

摘要

後骨間神經病變(posterior interosseous neuropathy)是一種較罕見的累積性傷害病變。回顧文獻，並沒有從事鎖匠工作而造成此疾病之報告。本病例爲一57歲男性鎖匠，其平常工作需反覆進行前臂旋前旋後的動作。至門診求診時主訴：打字時右手第三、四指伸展的肌力有減弱現象，且右手腕伸展時會偏向橈側。肌電圖檢查結果推測有後骨間神經病變。磁振造影檢查發現在佛羅氏弓(Arcade of Frohse)處，後骨間神經周圍肌肉有腫脹、界線不清及液體蓄積的狀況，確認非空間佔據病灶(space-occupying lesion)造成的神經病變。綜合判斷病史、理學檢查、肌電圖、磁振造影的發現後，診斷爲後骨間神經病變。本病例在調整了工作型態、選擇合適的工具、接受復健治療後，症狀有所改善，並對日常功能的行使感到滿意。
後骨間神經病變常起因於佛羅氏弓處的局部壓迫(entrapment)，而反覆旋前旋後的動作是局部壓迫的促進因子之一。本病例報告同時也探討與職業相關的累積性創傷疾病的概念。治療此類疾病，要瞭解根本問題的病理生理與生物力學的機制；除治療症狀外更要調整工作習慣與改善環境，才能夠從根本上改善病人的情況。

關鍵字

後骨間神經病變 ； 累積性傷害病變 ； 復健

並列摘要

Work related cumulative posterior interosseous neuropathy is a rare cumulative trauma disorder. To the best of our knowledge, a locksmith with this kind of disorder has never been reported. The locksmith was a 57-year-old man, and he had to perform repeated supination and pronation movements when working. He complained of weakness of right third and fourth finger extension when typing on a computer keyboard. Radial deviation was also noted when his wrist was extended. Electromyography was performed and right posterior interosseous neuropathy was suspected. Magnetic resonance imaging (MRI) showed perineural muscle edema, obliteration and fluid accumulation at the level of the arcade of Frohse. No space-occupying lesions were noted. Based on the information from his past history, physical examination, electromyography and MRI, work related cumulative posterior interosseous neuropathy was diagnosed. The symptoms improved after the patient modified his work style, adopted suitable tools and received rehabilitation treatment. He was also satisfied with the performance of his daily activities.
Posterior interosseous neuropathy is usually caused by an entrapment under the tendinous arcade of Frohse. Repetitiveness of the supination-pronation movements is a precipitating factor of entrapment and may result in cumulative trauma neuropathy. In this case report, we also elaborated the concept of work related cumulative trauma disorder. In addition to symptomatic treatment, a good understanding of the pathophysiology and biomechanics of the core problem in order to modify working habits and improve the workplace should be emphasized. Taking these factors into consideration, patients' problems can ultimately be solved.

並列關鍵字

posterior interosseous neuropathy ； cumulative trauma disorder ； rehabilitation