Examination of the hand and wrist by Raoul Tubiana, Jean-Michel Thomine, Evelyn Mackin

By Raoul Tubiana, Jean-Michel Thomine, Evelyn Mackin

content material: 1. useful Anatomy. Skeleton of the hand. Skeleton of the wrist. events of the hand and wrist. epidermis disguise. features of the hand --
2. medical exam of the Teguments, the Skeleton and the Musculotendinous equipment. exam of the teguments, palmar aponeurotic lesions and trophicity. exam of the bones and joints. exam of the musculotendinous equipment --
three. Imaging. Radiological exam. research of the movement --
four. exam of the Peripheral Nerve services within the higher Limb. Innervation of the higher limb and medical good points of nerve paralysis. sensible evaluate of motor functionality. Sensibility overview. symptoms of neural regeneration.

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This is also the length at w hich the greatest tension can be produced by active contraction. Muscle excursion Resting length is approxim ately equal to the distance between maximal stretch and maximal contracture o f a fiber. This is called the potential excursion. At the two extremes o f its potential excursion, the ability o f a muscle to form an active contraction will be close to zero. T his is a useful parameter because it can be measured with ease, and the relative potential excursions allow com parison o f muscles.

T he synovial sheaths at specific sites are surrounded by fibrous sheaths that keep the tendon close to the skeleton, in particular when the pulling tendons cross the sinus o f an articular angle, as on the anterior and posterior aspects o f the wrist or on the palmar aspect o f the digital joints. T he fibrous sheath assumes the role o f a pulley when the tendon changes direction. T he gliding mechanism represented by the synovial sheaths is m uch more developed on the palmar aspect. 45). T he superficial and deep flexor tendons o f the digits also glide over each other.

T he extrinsic muscles continue into the tendons, which, in order to perform their function, must glide in relation to the other elements of the hand. The gliding mechanism, w hich has an essential role, depends on two main factors: the nature o f the anatom ic area through w hich it moves, and the direction and am plitude o f tendon movement. In the unrestricted areas, where the tendon has a straight trajectory, it is surrounded by the paratenon, areolar connective tissue arranged in layers. This is the pattern for m ost o f the extensor tendons except on the dorsal aspect o f the wrist.

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