整形41

【臨床症状】70代 理容師 手首の痛み

【問題】画像所見と診断名は?

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※ T2*、プロトン強調、脂肪抑制の冠状断、脂肪抑制の横断像の順に表示

    ▶答えはこちら
    • 長母指外転筋腱と短母指伸筋腱周囲に浮腫性変化(液体貯留)を認める
    • 職業上、手を頻繁に使う事から腱鞘炎(デ・ケルバン病)と考えられる
    • 他、月状骨や三角骨、有頭骨に糜爛状の変化あり

    【デ・ケルバン(de Quervain)病】

    ・橈骨茎状突起レベルの長母指外転筋腱と短母指伸筋腱に認められる腱鞘炎で狭窄性腱鞘炎とも言う

    ・ド・ケルバン病(腱鞘炎)とも呼ばれる事もある

    ・原因は継続的なストレス負荷(母指の使い過ぎ)によるものがほとんどで、20~50代の女性(妊娠、出産、育児、更年期)に多い

    ・臨床症状は手関節橈骨側の痛みで、母指を外転、伸展、屈曲させると痛みが増強する

    ・画像所見では、腱鞘の肥厚や液体貯留、腱の肥厚や信号上昇などを認める

    参考文献:骨軟部疾患の画像診断 第2版