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<Provider Id="sundheddkcms"> <Item Id="{A14A0B48-16D7-41E0-9254-ECE72DF6E3F1}" Name="ligamentskade-paa-fingrene" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{2D29BD5B-8914-4E1B-AB1B-C989ECE433E9}" SortOrder="700" PublishDate="2009-01-19T13:34:00" 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 sygehistorien, kliniske fund og røntgen, der kan afklare, om der er et afrivningsbrud eller intraartikulær fraktur i ledfladen</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Smerte ved bevægelse af leddet, ømhed og hævelse, som er lokaliseret ved det afficerede ligament</li> </ul> <h4>Kliniske fund</h4> <ul> <li>Ømhed ved palpation og undersøgelse for sideløshed</li> <li>Instabilitet kan ses ved totalruptur</li> <li>Skaden bør vurderes ved at anvende valgus- og varus-stress mod det involverede led - ved PIP-leddet i 30 graders fleksion, og ved MCP-leddet flekteret til 90 grader. I denne stilling er ligamenterne strakt og bør stabilisere leddet, hvis der ikke foreligger en ruptur (<a href="~/link.aspx?_id=4A2F0C55A9E2445CBEC94CA9036BCED8&_z=z">undersøgelse af PIP og MCP ledstabilitet</a>)</li> <li>Lægen bør sammenligne løshed i det afficerede fingerled med en ikke-afficeret finger, da der er stor individuel variation i ledstabiliteten </li> </ul> <p>[23VIDEO=https://film.sundhed.dk/v.ihtml/player.html?token=ee79101821374137e8c377bc124e45a3&source=embed&photo%5fid=76896089]</p> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen relevante ud over normal undersøgelse af neurovaskulære forhold på fingeren</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Røntgen kan demonstrere en afsprængning ved ligamenttilhæftningen</li> <li>Afsprængning er sjældent i PIP-led, men forekommer noget hyppigere i MCP-led</li> <li>Intraartikulære frakturer er til gengæld hyppigere i PIP-led</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li><a href="~/link.aspx?_id=095680AE8FDD4EC8B4C178D9923B0C6B&_z=z">Seneskader</a></li> <li><a href="~/link.aspx?_id=AC2974CFBE794A9DB735F27DB87C3E95&_z=z">Fingerbrud</a></li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Genoprette ledstabilitet</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Førstehjælpsbehandling <ul> <li>Nedkøling, elevation, kompression og evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/213010">NSAID</a> de første dage</li> </ul> </li> <li>Immobilisering</li> <li>Evt. kirurgi</li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Patienten vurderes med henblik på ledstabilitet og mistanke om fraktur</li> <li>Henvisning til røntgen ved frakturmistanke</li> <li>Primær stabilisering med skinne/sambandagering ved instabilitet indtil vurdering på skadestuen</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Følg lægens råd og hold fingeren i ro, indtil der er foretaget evt. yderligere udredning</li> </ul> <h3>Specifikt</h3> <ul> <li>Ved instabilitet behandles med bølgeskinne i 3 uger, derefter træning med finger tapet til nabofinger i yderligere nogle uger ved aktiviteter med risiko for ny skade, fx håndbold og volleyball eller manuelt arbejde</li> <li>Ved instabilitet af pegefingeren/mistænkt skade på det radiale ligament i pegefinger bør man have lav tærskel for at henvise til ortopædkirurg/håndkirurg, da dette ligament er meget vigtig ved pincetgreb</li> <li>Ved større hævelse og mange smerter kan det være indiceret med immobilisering med gips nogle dage. MCP-leddet skal da stå i 80°, mens PIP- og DIP-leddene er strakte</li> <li>Ved knogleskade kan der være indikation for åben reposition og fiksation af knoglefragment med immobilisering i 3-4 uger</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Kun i form af analgetika</li> </ul> <h3>Anden behandling</h3> <ul> <li>RICE, når skaden er sket</li> </ul> <h3>Kirurgi</h3> <ul> <li>Kirurgi er normalt kun nødvendig ved større knogleafsprængninger på 2-5. finger med dislokation eller subluksation af leddet</li> <li>Undtagelsen er det ulnare collaterale ligament ved tommelen, der oftest behandles med operation hvor ligamentet re-insereres med knogleanker</li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Ingen relevante</li> </ul> <h2>Henvisning</h2> <ul> <li>Ved ustabilt led med patologiske bevægelsesudslag, bør patienten henvises til en ortopædkirurg/håndkirurg</li> <li>Lavere tærskel for henvisning ved pegefingerens radiale ligament</li> <li>Når det gælder børn, bør tærsklen for henvisning være særlig lav, fordi vækstpladen ofte er involveret</li> </ul> <h2>Opfølgning</h2> <ul> <li>Patienter med ligamentskader kan fortsætte med at deltage i idrætsaktiviteter i den grad, symptomerne tillader det</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Normalt opnår man god stabilitet af leddet ved konservativ behandling. Men der kan være længerevarende hævelse og bevægelses indskrænkning af leddet efter endt behandling, uden at der er tale om behandlingssvigt</li> </ul> <h3>Komplikationer</h3> <ul> <li>Generelt sjældne ved korrekt behandling</li> <li>Kronisk instabilitet ses efter manglende behandling og kan føre til artrose</li> </ul> <h3>Prognose</h3> <ul> <li>Prognosen er generelt god. Det kan dog tage lang tid, før man får normal bevægelighed, og PIP-leddet kan være hævet og ømt op til et år</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Ledbåndsskader i fingrene forekommer ved overstrækning eller sidebøjning. Skademekanismen er ofte sport, fx ved at en finger hænger fast i tøjet under kontaktsport eller rammes af en bold<a href=" " data-type="journal-reference" data-value="Leggit JC, Meko CJ, Acute finger injuries: part I. Tendons and ligaments.. Am Fam Physician 2006;73: 810-6" data-value-piped="Leggit JC, Meko CJ|Acute finger injuries: part I. Tendons and ligaments.|Am Fam Physician|2006|73|810-6|16529088" data-url="reference-link" data-pubmedid="16529088" title="Leggit JC, Meko CJ, Acute finger injuries: part I. Tendons and ligaments.. Am Fam Physician 2006;73: 810-6">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Leggit JC, Meko CJ, Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.. Am Fam Physician 2006;73: 827-34" data-value-piped="Leggit JC, Meko CJ|Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.|Am Fam Physician|2006|73|827-34|16529090" data-url="reference-link" data-pubmedid="16529090" title="Leggit JC, Meko CJ, Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.. Am Fam Physician 2006;73: 827-34">2</a><sup>,</sup><a title="Geissler WB, Burkett JL, Ligamentous sports injuries of the hand and wrist. Sports Med Arthrosc 2014;22(1): 39-44" href=" " data-url="reference-link" 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" data-value-piped="Geissler WB, Burkett JL|Ligamentous sports injuries of the hand and wrist|Sports Med Arthrosc|2014|22(1)|39-44">3</a></li> <li>Her gennemgås skader på collaterale ligamenter til PIP- og MCP-led</li> <li><a href="~/link.aspx?_id=38D7D3463940461DB700218E6CE80965&_z=z">Ulnare collaterale ligamenter</a> og senepladen (<a href="~/link.aspx?_id=05191CDA13E64422836D46FB04E1B167&_z=z">fibrocartilago volare</a> - også i daglig tale kaldet fibrocatilagolæsion) behandles i særskilte artikler</li> </ul> <h3>Forekomst</h3> <ul> <li>Disse skader er hyppige i håndbold, volleyball og basketball</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>De radiale ligamenter er mest udsat for skader i 2-5 finger, mens det ulnare ligament i tommelfingeren er hyppigere skadet end det radiale</li> <li>Forceret ulnar eller radial deviation af et interfalangealled kan forårsage delvis eller fuldstændig afrivning af ligamentet </li> <li>Ligamentskader er hyppigst i PIP-leddet </li> </ul> <ul> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Idrætsskader</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad findes af skriftlig patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=115222B80D5F4688A3323D205307A875&_z=z">Øvelser efter fingerskade</a></li> </ul> <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> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og pakkeforløb [ICPC]</li> </ul> <p> </p> <h2>Illustrationer</h2> <ul> <li>Disse artikler indeholder gode illustrationer: <ul> <li> <a rel="noopener noreferrer" href="https://www.aafp.org/pubs/afp/issues/2006/0301/p810.html" target="_blank">Acute Finger Injuries: Part I. Tendons and Ligaments</a> </li> <li> <a rel="noopener noreferrer" href="https://www.aafp.org/pubs/afp/issues/2006/0301/p827.html" target="_blank">Acute Finger Injuries: Part II. Fractures, Dislocations, and Thumb Injuries</a></li> </ul> </li> </ul> <h3>Video</h3> <ul> <li><a href="~/link.aspx?_id=F9F22CCE8EFF40068BC9A68323A8732E&_z=z">Stabilitetstest af fingerled </a></li> <li><a href="~/link.aspx?_id=4A2F0C55A9E2445CBEC94CA9036BCED8&_z=z">Undersøgelse for PIP og MCP led stabilitet </a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Pludseligt indsættende smerter, hævelse og bevægeindskrænkning efter relevant traume </li> <li>Ømhed ved palpation og stabilitetstest</li> <li>Røntgen kan vise knogleafsprængning eller intraartikulær fraktur</li> </ul> <h3>Behandling</h3> <ul> <li>Ved stabile led behandles med kortvarig immobilisering (1-2 uger) som smertebehandling</li> <li>Ved instabilitet anvendes normalt længerevarende immobilisering, fx i 3 uger efterfulgt af beskyttende sammentapening i 3 uger</li> <li>Operation kan være aktuelt ved større dislocerede knogleafsprængning eller subluksation af leddet</li> </ul> <h3>Henvisning</h3> <ul> <li>Ved instabilitet eller mistanke om fraktur</li> </ul> <h3>Seneste væsentlige ændringer</h3> <ul> <li>Ingen</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">17155</TextField> <TextField Name="PageTitle">Ligamentskade på fingrene</TextField> <TextField Name="NavigationTitle">Ligamentskade på fingrene</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2024-01-29T10:30:00</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">L12, L81</TextField> <LinkListField Name="SearchAreaID"> <LinkField linktype="internal">2</LinkField> </LinkListField> <TextField Name="Description">Ledbåndsskader i fingrene forekommer ved overstrækning eller sidebøjning. 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