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<Provider Id="sundheddkcms"> <Item Id="{60FFBEF5-A536-4854-BB8D-9805808F4E42}" Name="finger-luksationer" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{2D29BD5B-8914-4E1B-AB1B-C989ECE433E9}" SortOrder="1000" PublishDate="2009-01-19T13:37:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Diagnosen stilles på grundlag af sygehistorie, typiske kliniske fund og udelukkelse af fraktur ved røntgenundersøgelse</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Hævelse, ømhed, fejlstilling og indskrænket bevægelighed</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Fejlstilling, eller information om, at der har været fejlstilling</li> <li>Hævelse</li> <li>Ømhed</li> <li>Instabilitet, men denne kan være svær at teste på grund af smerte og hævelse</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen relevante, bortset fra at grovreposition kan forsøges sammen med immobilisering</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Røntgen for at se, om der foreligger fraktur</li> <li>Efterkontrol med røntgen skal altid gøres for at bekræfte, at et reponeret fingerled er på plads</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=AC2974CFBE794A9DB735F27DB87C3E95&_z=z">Fingerbrud</a></li> <li><a href="~/link.aspx?_id=095680AE8FDD4EC8B4C178D9923B0C6B&_z=z">Fingerseneskade</a></li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Få leddet på plads og genvinde funktion</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Reponering foretages lettest umiddelbart efter skaden ved at trække i fingerens længderetning, evt. hyperekstendere lidt, mens phalanx proksimalt for dislokationen holdes med modsat hånd. Ved vanskelig reposition, forsøg med flekteret grundled for at afslappe de collaterale ligamenter</li> <li>Tjek specielt sideløshed og tag røntgen efter reposition</li> <li>Fingeren immobiliseres til nabofinger med gips eller tape i 3 uger, derefter optræning</li> <li>Tape til nabofinger i yderligere nogle uger ved idrætsaktivitet</li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Fingeren immobiliseres, og patienten henvises til skadestue</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Hold hånden eleveret og i ro indtil behandling i skadestuen</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Ingen bortset fra analgetika</li> </ul> <h3>Dislokation af DIP-leddet</h3> <ul> <li>Ukompliceret dislokation reponeres ved traktion og evt. dorsalt tryk</li> <li>Immobiliseres med bølgeskinne (Carstamskinne) i 3 uger, og herefter med tapening til nabofinger i yderligere 3 uger</li> <li>Se evt. <a href="~/link.aspx?_id=10C01749401345BE9AF1A0190A7C6A0A&_z=z">anlæggelse af Carstamskinne</a></li> </ul> <h3>Dislokation af PIP-leddet</h3> <ul> <li>Ukompliceret dislokation reponeres ved traktion og evt. volart/dorsalt tryk</li> <li>Immobiliseres i let fleksion med bølgeskinne i 3 uger<a title="Chalmer J, Blakeway M, Adams Z, Milan SJ. Conservative interventions for treating hyperextension injuries of the proximal interphalangeal joints of the fingers. Cochrane Database Syst Rev 2013;Feb 28;2: CD009030" href="EditorPage.aspx?da=core&id=%7B60FFBEF5-A536-4854-BB8D-9805808F4E42%7D&ed=FIELD6513195298&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H6513195357&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-url="http://www.ncbi.nlm.nih.gov/pubmed/23450596" data-value="Chalmer J, Blakeway M, Adams Z, Milan SJ. Conservative interventions for treating hyperextension injuries of the proximal interphalangeal joints of the fingers. Cochrane Database Syst Rev 2013;Feb 28;2: CD009030" data-type="other-reference">2</a>, og herefter med tapening til nabofinger i yderligere 3 uger</li> </ul> <h4>Dorsal dislokation</h4> <ul> <li>Reposition <ul> <li>Foregår ved distal traktion af den skadede finger, mens der udøves et volart rettet tryk på mellemstykket. Man mærker tydeligt, når leddet glider på plads</li> <li>Hvis reposition ikke lykkes ved traktion og volart tryk, kan lægen hyperekstendere den distale del for at "låse op" og herefter igen anvende traktion og volart rettet tryk</li> </ul> </li> <li>Anæstesi <ul> <li>Hvis reponeringen udføres umiddelbart, er anæstesi nogle gange ikke nødvendig</li> <li>Hvis reponeringen er forsinket i mere end en time, er nerveblokade af fingeren ofte påkrævet</li> </ul> </li> <li>Immobilisering <ul> <li>Hvis reponeringen er vellykket, bør mellemleddet immobiliseres - fx ved tapening til nabofingeren i let fleksion (30°) - ringfinger bedst til lillefinger og langfinger bedst til pegefinger</li> <li>Immobiliseres i let fleksion i 3 uger og tapes til nabofinger i yderligere 3 uger</li> </ul> </li> <li>Komplikationer <ul> <li>Hvis røntgen viser et større brudfragment, eller hvis reponeringen er mislykket, henvises til ortopæd/håndkirurg</li> <li>Den volare seneplade kan interponere og umuliggøre reponering, således at kirurgi er nødvendig</li> </ul> </li> </ul> <h4>Lateral dislokation</h4> <ul> <li>Reponeres ved at trykke på midtphalanx mens den proksimale falanx stabiliseres</li> <li>Behandlingen bør fokusere på bløddelsskade og inkludere kontrolrøntgen</li> </ul> <h4>Volar dislokation</h4> <ul> <li>Er sjælden</li> <li>Skaden kan forårsage en rift i den centrale snip i ekstensorsenen</li> <li>Lægen kan forsøge reponering ved at hyperflektere mellemphalanx for at låse leddet op og så anvende traktion</li> <li>Et sådan forsøg bør kun foretages én gang, da reposition ofte ikke er mulig. Hvis reposition lykkes, bør leddet immobiliseres i 6 uger i fuld ekstension, MCP og DIP skal være mobile</li> <li>Ved mislykket reposition, eller hvis et afrivningsbrud involverer mere end 1/3 af leddet, bør patienten henvises til ortopæd/håndkirurg</li> </ul> <h3>Dislokation af MCP-leddet</h3> <ul> <li>En simpel dislokation indebærer ingen bløddelsobstruktion, og reponering bør forsøges</li> <li>Der kan foreligge en kompliceret dislokation med bløddels-interposition (ligamenter, muskulatur, sene), der kræver kirurgi</li> <li>Reponering foregår på samme måde som for PIP- og DIP-dislokationer</li> <li>Immobilisering skal altid være med flekteret MCP-led, da leddet ellers bliver stift i strakt stilling, varighed 3 uger efterfulgt af sammentapening til nabofingeren i 3 uger</li> </ul> <h3>Anden behandling</h3> <ul> <li>Ingen relevant</li> </ul> <h3>Kirurgi</h3> <ul> <li>Er normalt ikke nødvendig bortset fra ved komplicerende fraktur, eller hvis leddet ikke kommer på plads ved reposition. Undtagelsen er dog tommelens ulnare collaterale ligament, der altid behandles operativt ved totalruptur</li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Ingen relevant</li> </ul> <h2>Henvisning</h2> <ul> <li>Henvises mhp. behandling i skadestuen med røntgenundersøgelse. Man kan evt. reponere før henvisning til skadestue</li> </ul> <h2>Opfølgning</h2> <ul> <li>Røntgen bør bruges til at kontrollere, om ledfladerne står korrekt i forhold til hinanden (specielt hvis fingeren er meget hævet, og man er i tvivl). Ny klinisk kontrol bør foretages en uge efter for at tjekke helingen og for at vurdere, om der er sket en reluksation</li> <li>Kollateralligamenterne bør testes, og aktiv fleksion og ekstension bør vurderes med henblik på senernes funktion</li> <li>Patientens samarbejdsevne er vigtig for prognosen. </li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Som hovedregel er varigheden af behandlingen 4-6 uger efterfulgt af mobilisering, der kan tage uger efter afbandagering</li> </ul> <h3>Komplikationer</h3> <ul> <li>Nedsat bevægelighed i leddet ses hyppigt, medens instabilitet er sjælden ved korrekt behandling</li> </ul> <h3>Prognose</h3> <ul> <li>Prognosen er god. Der vil ofte være nedsat bevægelighed - særlig i mellemleddene - i flere måneder efter skaden. Der kan også være varige følger</li> <li>Hævelsen i leddet - dvs. et fortykket led - kan vare i op til et år</li> <li>Idrætsaktivitet kan starte 5-6 uger efter skaden, men fingeren skal beskyttes ved at tape den til nabofinger<a title="Geissler WB, Burkett JL, Ligamentous sports injuries of the hand and wrist. Sports Med Arthrosc 2014;22(1): 39-44" href="EditorPage.aspx?da=core&id=%7B60FFBEF5-A536-4854-BB8D-9805808F4E42%7D&ed=FIELD6513195298&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H6513195357&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-url="reference-link" data-value-piped="Geissler WB, Burkett JL|Ligamentous sports injuries of the hand and wrist|Sports Med Arthrosc|2014|22(1)|39-44" data-value="Geissler WB, Burkett JL, Ligamentous sports injuries of the hand and wrist. Sports Med Arthrosc 2014;22(1): 39-44" data-type="journal-reference">3</a></li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Der skelnes mellem luksationer (dislokationer) i MCP-, PIP- og DIP-led</li> </ul> <h3>Forekomst</h3> <ul> <li>Fingerluksationer er relativt hyppige og ses især ved boldspil<a title="Geissler WB, Burkett JL, Ligamentous sports injuries of the hand and wrist. Sports Med Arthrosc 2014;22: 39-44" href=" " data-url="reference-link" data-value-piped="Geissler WB, Burkett JL|Ligamentous sports injuries of the hand and wrist|Sports Med Arthrosc|2014|22|39-44" data-value="Geissler WB, Burkett JL, Ligamentous sports injuries of the hand and wrist. Sports Med Arthrosc 2014;22: 39-44" data-type="journal-reference">1</a> </li> <li>Luksation af lillefinger eller tommelfinger er hyppigst. Men alle led på alle fem fingre kan luksere </li> <li>Oftest sker luksationerne dorsalt i mellem- eller yderled</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Direkte traume mod led eller mod spidsen af en finger</li> </ul> <h4>Dislokation af DIP-leddet</h4> <ul> <li>Er ofte forårsaget af en knusningsskade, og ledsagende fraktur kan komplicere behandlingen</li> </ul> <h4>Dislokation af PIP-leddet</h4> <ul> <li>Dislokation kan skade volarpladen eller forårsage afsprængning i mellemphalanx</li> </ul> <h4>Dislokation af MCP-leddet</h4> <ul> <li>Som oftest dorsale luksationer som følge af hyperekstensionstraume. Disse kan ofte reponeres lukket. Nogle er dog komplekse med interponerede bløddele, hvilket betyder, at de må reponeres åbent</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Fald og idrætsskader </li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Træningsfilm for hånd og fingre </h3> <ul> <li><a href="~/link.aspx?_id=DC10A7C213DA4F909EAA4AFB32CBE9C0&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=F3DFB2192D6644B08A1D018DC345B083&_z=z"><img alt="" height="84" width="135" src="8396F5CD2AFA48A295F038B1C7A0856B-135-84" style="height: 84px; width: 135px;"></a></li> </ul> <h3>Link til patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=115222B80D5F4688A3323D205307A875&_z=z">Øvelser efter fingerskade</a></li> </ul> <ul> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og pakkeforløb [ICPC]</li> </ul> <ul> </ul> <h2>Illustrationer</h2> <ul> <li> <a href="~/link.aspx?_id=10C01749401345BE9AF1A0190A7C6A0A&_z=z">Anlæggelse af Carstamskinne</a> </li> <li> <a href="http://www.aafp.org/afp/2006/0301/p810.html">Acute Finger Injuries: Part 1, Tendons and Ligaments</a> </li> <li> <a href="http://www.aafp.org/afp/2006/0301/p827.html">Acute Finger Injuries: Part 2, Fractures, Dislocations and Thumb Injuries</a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Fingerluksationer er relativt hyppige og ses især ved boldspil</li> <li>Luksation af lillefinger eller tommelfinger er hyppigst. Men alle led på alle fem fingre kan luksere</li> <li>Oftest sker luksationerne dorsalt i mellem- eller yderled</li> <li>Diagnosen stilles klinisk, men røntgen bør foretages for at udelukke knoglebrud</li> </ul> <h3>Behandling</h3> <ul> <li>Behandlingen er næsten altid konservativ</li> <strong></strong>Undtagelsen er det ulnare collaterale ligement ved tommelen, der normalt behandles med operation <li>Desuden kan komplicerende knoglebrud medføre behov for operation</li> </ul> <h3>Henvisning</h3> <ul> <li>Fingerluksationer bør henvises til skadestue med henblik på behandling med røntgenundersøgelse</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">17157</TextField> <TextField Name="PageTitle">Finger, luksationer</TextField> <TextField Name="NavigationTitle">Finger, luksationer</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2023-07-25T10:09:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{10F0E7D2-8D6D-49AE-94B3-998114356326}</LinkField> <LinkField linktype="internal">{FDEF4DBD-AAF0-4AF0-82F7-983F8710B93E}</LinkField> </LinkListField> <LinkListField Name="Organization"> <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField> </LinkListField> <TextField Name="ICD10">S63, S63.0, S63.1, S63.2, S63.3, S63.4, S63.5, S63.6, S63.7</TextField> <TextField Name="ICPC2">L80</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Fingerluksationer er relativt hyppige og ses især ved boldspil. Luksation af lillefinger eller tommelfinger er hyppigst. Men alle led på alle fem fingre kan luksere. 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