Orthopedic surgery / by Sir Robert Jones and Robert W. Lovett.

  • Robert Jones
Date:
1929
Catalogue details

Licence: Public Domain Mark

Credit: Orthopedic surgery / by Sir Robert Jones and Robert W. Lovett. Source: Wellcome Collection.

    87/832 (page 67)
    The joint is a condyloid joint, which means that it is a double hinge, having movement around two axes, one anteroposterior, and the other transverse. A combination of these movements results in circumduction, but rotation does not occur in this joint. The hand can be flexed to about 90 degrees with the forearm, but part of this motion takes place in the carpal bones. Extension in the same way reaches 65 degrees with the line of the fore¬ arm. Probably about 140 degrees of this combined motion occurs in the wrist joint proper. The wrist can be abducted and adducted about one-half as much as it can be flexed and extended; adduction, or bending to the ulnar side being much greater than to the radial side on account of the formation of the bones. It must be remembered that flexion and exten¬ sion of the wrist is performed by the flexors and extensors of the carpus and also by the flexors and extensors of the thumb and fingers. The extent of the movements in the wrist varies greatly in different individuals. The joint is particularly prone to sprains and injuries of the tendons, which are in close relation to the articular surfaces, and on account of the lax complicated articulation, relaxation of the joint is likely to follow serious injuries. The joint is accessible to examination in all parts and swelling may be manifested anywhere in its circumference, but as a rule occurs dorsally. The joint is particularly prone to injuries and tenosynovitis, but dislocation without fracture is not common in the wrist joint proper and when it does occur, is usually a dislocation of the semilunar, although fracture above the joint is very common and frac¬ ture of the carpal bones, particularly the scaphoid is of importance. Muscular Strains.—Strains of some of the tendinous attachments about the carpus are not uncommon on account of their superficial situation and the anatomical diagnosis is generally easy. They are not generally severe enough to require more than the use of a firm strap around the wrist which affords relief. Fixation may occasionally be necessary. Tenosynovitis (of the tendons) about the wrist occurs not uncommonly after a hard spell of some unaccustomed form of work such as rapid trench¬ digging, lifting weights or the prolonged use of scissors or pruning shears. Bricklayers, for instance, are prone to a synovitis of the sheath of the extensors of the left thumb (ext. ossis metacarpi and ext. primi internodii pollicis). It is almost invariably on the second day of work after a long period of rest that this condition shows itself. It is the repeated full abduction required in picking up and laying bricks that brings on this condition in muscles which are out of training for this especial demand. For these simple but often disabling conditions the best treatment is a few days’ rest with massage and firm bandaging, followed by gentle exercise. It must here again be remembered that the tendon may require rest and should be put in the relaxed position. If neglected in the first instance, the slight effusion and considerable tenderness may become chronic, with acute exacer¬ bation, whenever the patient attempts to work or even to use the parts for complicated movements. Sprains of the Wrist.—If an X-ray photograph is taken of every “ sprained” wrist it will be found that a very large number of them are really cases of fracture of some bone of the carpus, or of a styloid process, and not merely the injury of a ligament. Fracture of a carpal bone, if the patient is careless and uses the wrist roughly, may result in considerable permanent stiffness. The most common fracture of the carpals is that of the scaphoid, and accompanying this fracture there is often displacement. An attempt should be made to manipulate the prominent bones into position. The manipulation most usually successful is first to flex the wrist fully, and with the thumb placed on the prominent scaphoid, pressure is maintained as the wrist is brought into full dorsiflexion. Here it must be remembered that, unless at the completion of manipulation free