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UNIVERSITATEA SPIRU HARETFACULTATEA DE KINETOTERAPIE SI MOTRICITATE SPECIALA
MASTER : FIZIOKINETOTERAPIA IN AFECTIUNILELOCOMOTORII
LUCRARE DE DISERTATIE
Recuperarea mâinii reumatoide în stadiile II i III
Coordonator tiin!i"ic
#ASTERANDSTE$AN LE%N #ARIAN
BUCURESTI2011
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CUPRINSINTRODUCERE ......... ................................................................... pag. 3
Cap. I ANATOMIA MÂINII ................................................................... pag. 4
1.1. Oas! "#$%$$ ........................................................................ pag. 4
1.2. M&'()$$ "#$%$$ ....................................................................... pag. *1.3. A+,$(&!a-$$! "#$%$$ .................................................................. pag. Cap.II BIOMECANICA MÂINII .............. .............................................. pag. 1*
2.1. B$/"(a%$(a g#,&!&$ "#$%$$.................................................... pag. 1*2.2. B$/"(a%$(a &!,$"!/+ pa,+& g,....................................... pag. 12.3. B$/"(a%$(a p/!$(!&$ .......................................................... pag. 1
Cap.III ASPECTE TOPORAFICE ...................................................... pag. 1
3.1. Rg$&%a pa!"a+ a "#$%$$ ................................................... pag. 13.2. Rg$&%a /+sa! a "#$%$$ ..................................................... pag. 213.3. Dg,! "#$%$$ ...................................................................... pag. 22
Cap.IV
CARACTERISTICI AR5ITECTURALE ALE MÂINII................. pag. 24 Cap.V TIPURI DE PRE5ENSIUNE ALE MÂINII.................................. pag. 26
Cap.VI BAZELE BIOMECANICE ALE RECUPER7RII MI8C7RILOR MÂINII ......................................................... pag. 30
Cap.VII POLIARTRITA REUMATOID7 ................................................ pag. 32
6.1. %+a!$,-$............................................................................. pag. 326.2. E,$/pa,/g%$a......................................................................... pag 326.3. A%a,/"$a pa,/!/g$(.............................................................. pag. 346.4. S$"p,/"a,/!/g$a ................................................................... pag. 36.*. Ta9!/&! (!$%$( ......................................................................... pag. 36
6.. D$ag%/s,$(&! P.R. ................................................................... pag. 4*6.6. I%s,$ga-$$ !a9/+a,/+ ......................................................... pag. 466.. D$ag%/s,$(&! $;+%-$a! .......................................................... pag. 46.. E/!&-$< (/"p!$(a-$$< p+/g%/s,$( ............................................ pag. *16.10. T+a,a"%,&! P.R. ................................................................... pag. *26.11. Ba!%/,+ap$a ........................................................................ pag. 46.12. C!$"a,/,+ap$a ....................................................................... pag. *
Cap. VIII MATERIAL 8I METOD7 ....................................................... pag.
Cap. IX PLANUL DE RECUPERARE................................................... pag. 62
.1. T)%$($ g%+a! g$"%as,$( +&(a,$ sg"%,a+...... pag. 63
.2. T)%$($ '$ p+/g+a" g$"%as,$( +&(a,$ .................... pag. 6.3. Masa=&! ................................................................................. pag. *.4. E+g/,+ap$a ............................................................................ pag. .*. R>&!,a, ............................................................................... pag. *.. C/%(!&>$$ ................................................................................ pag. BIBLIORAFIE ............................................................................ pag. 100
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INTR%DUCERE
P/!$a+,+$,a +&"a,/$ s, / a;(-$&% $%;!a"a,/+$ s$s,"$( (+/%$( a (+$
(a+a(,+$s,$( p+$%($pa! s, a;(,a+a a+,$(&!a-$$!/+ s$%/$a!.
P+/(s&! $%;!a"a,/+ p/a, a;(,a -s&,&+$! "/$:,%/a%< ;as($$< !$ga"%,< "&'()$
'$ s p/a, ?,$% !a /s< p+//(#% /s,/p/+/> '$ +/>$&%$. Ca+a(,+&! g%+a!$>a, a!
$%;!a"a'$$ ;a( p/s$9$! a;(,a+a s$s,"$( (& !>$&%$ p!&+/@p&!"/%a+< (a+$/@
as(&!a+< +%a!< /(&!a+< (&,a%a,< %&+/!/g$(.
B/a!a apa+ "a$ ;+(%, %,+ 20@40 a%$ '$ a;(,a> 2@3 /+$ "a$ s ;"$!(#, 9+9a-$$.
Ca&>a 9/!$$ s, %(&%/s(&,< a+ s pa+ ( ?$s, / (/"9$%a-$ ;a(,/+$
%/g%$ %,+ (a+ (/!ag%&! '$ $"&%g!/9&!$%! '$ ?/g%$ "$(+//+ga%$s" (a+
$%,+a(-$/%a> p &% ;/% s&s(p,$9$!$,a, g%,$(< ;ap, "/%s,+a, ag+ga+a
;a"$!$a! a 9/!$$ '$ p+>%-a a%,$g%!/+ )$s,/(/"pa,$9$!$,a,.
T%$%-a sp+ /!&,$$,a, '$ ag+ga+ =&s,$;$( ap!$(a+a (/%(p-$$ p+/;$!a?$
s(&%a+< $a+ (a $%;$+"$,a, p (! +(&p+a+.
D/a+ %(+(a+a a a"!$/+a $%;$+"$,a,a !a %$!&! $%$$ %& s, s&;$($%, ($
(! "a$ "&!, /+$ s, %(sa+ s s "/$;$( "$&! $% =&+&! 9/!%a&!&$ p%,+& a
;a($!$,a a(,$$,-$! a(s,&$a ( a+ %$ $"p/s$9$! sa& /s9$, $;$($! % "$&! s&
$a-< ,/a, % s(p&! "9&%,-$+$$ (a!$,-$$ $-$$ pa($%,&!&$.
P+/(&pa+a p%,+& a(',$ 9/!%a$ %& s, =&s,$;$(a, /a+ s+$,a,a
$s;&%(-$/%a! a "a%$;s,+$!/+ (!$%$( a! 9/!$$< ($ '$ ;+(%-a s,&! "a+ a
p/!$a+,+$,$ +&"a,/$ % p/p&!a-$a a(,$ 0
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Capitolul I
ANAT%#IA #&INII
'('( %asele mâinii
M#%a s, ;/+"a, $% 26 /as $sp&s % ,+$ g+&p: carpul < metacarpul '$
oasele degetelor (falangele.Carpul s, ;/+"a, $% /p, /as s(&+, $sp&s p /& +#%&+$. U% +#%
s&p+$/+< p+/?$"a! sa& a%,9+a)$a! '$ %(p#% !a p/!$( % $+(-$a g,&!&$ "$( s
gss( pa,+& /as: s(a;/$&!< s"$!&%a+&!< p$+a"$a!&! '$ p$s$;/+"&!. % a! /$!a +#%<
$%;+$/+< $s,a! sa& (a+p$a%< s gss( % a($a'$ /+$% a!, pa,+& /as: ,+ap>&!<
,+ap>/$&!< (ap$,a,&! '$ /s&! (& (#+!$g.
% a%sa"9!&! !/+ ;/+"a> &% "as$ /s/s %&"$, "as$&! (a+p$a% (& ;/+"a G
s"$($!$%+$(< "a$ !a, (#, %a!, p+>%,#% pa,+& ;-:
@;a-a a%,+$/a+H
@;a-a p/s,+$/a+H
@;a-a s&p+$/a+H
@;a-a $%;+$/a+H
Metacarpu! (/%s,$,&$ s()!,&! pa!"$ '$ /s&! "#$%$$.Es, ;/+"a, $% ($%($ /as
!&%g$ %&"$, ",a(a+p$%.N&"+/,a+a !/+ s ;a( !a,+/@"$a!< !a I@. E! s
a+,$(&!a> s&p+$/+ (& /as! (!&$ a! /$!a +#% (a+p$% $a+ $%;+$/+ (& p+$"!
;a!a%g a! g,!/+.M,a(a+p$%! s&%, /as !&%g$ '$ p+(). E! p+>$%, &% (/+p< / 9a> '$ &%
(ap. M,a(a+p$%! p+"$, $%sp(-$a '$ pa!pa+a (a+p&!&$ (#% g,! s&%, % ;!?$.
Oasele degetelor s %&"s( ;a!a%g. % ,/,a! s gss( 14 ;a!a%g< ;$(a+ g,
a#% ,+$ ;a!a%g (& ?(p-$a p/!$(!&$ (a+ a+ %&"a$ /& ;a!a%g.
D$%sp+ ",a(a+p sp+ ?,+"$,a,a g,&!&$ ;a!a%g! s&%,:
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@;a!a%ga p+/?$"a!H
@;a!a%ga "$=!/($H
@;a!a%ga $s,a!H
Oas! ssa"/$
A(s, /as "$($ a& ;/+"a g+&%-!/+ s&sa%< &%! ;$$% s$,&a, % g+/s$"a
&%/+ ,%/a%< a!,! % ($%,a,a &%/+ a+,$(&!a-$$ a! "#$%$$. D/& $% a(s, /as a&
s$&! p ;a-a pa!"a+ a a+,$(&!a-$$ ",a(a+p/;a!a%g$% a p/!$(!&$. E?$s, %s
ssa"/$ '$ !a %$!&! a+,$(&!a-$$ ",a(a+p/;a!a%g$% a! $%?&!&$ '$ g,&!&$ "$(.
'()( #uc*ii mâinii
M&'()$$ "#$%$$ s "pa+, % trei grupe:
@grupa laterală;
-grupa mijlocie;
-grupa medială;
+rupa lateral, s, ;/+"a, $% pa,+& "&'()$ s$,&a-$ % pa+,a !a,+a! a "#$%$$. E$
s s&p+ap&% '$ $%sp+ s&p+a;a- sp+ p+/;&%>$" s&%, +p+>%,a-$ :
a M&'()$&! s(&+, a9&(,/+ a! p/!$(!&$O+$g$%a: p !$ga"%,&! ,+a%s+s a! (a+p&!&$H
I%s+-$a: p ;a-a !a,+a! a ;a!a%g$ p+/?$"a! a p/!$(!&$H
A(-$&%: a9&(-$ '$ +/,a-$ !a,+a! a p/!$(!&$H
as(&!a+$>a-$a: $% +a"&+$ (/!a,+a! a! a+,+$ +a$a!H
I%+a-$a: $% +a"&! ,+"$%a! a! %+&!&$ "$a%.
9 M&'()$&! /p/>a%, a! p/!$(!&$
O+$g$%a: p !$ga"%,&! ,+a%s+s a! (a+p&!&$ '$ p ,&9+(&!&! ,+ap>&!&$H
I%s+-$a: p ;a-a !a,+a! a p+$"&!&$ ",a(a+p$a%H
A(-$&%: ;!?$ '$ +/,a-$ "$a% a p+$"&!&$ ",a(a+p$a%< "$'(+$ p+$% (a+
p/!$(! p/a, s s /p&% (!/+!a!, g,H
as(&!a+$>a-$a: ;$$% as$g&+a, +a"&+$ $% a+,+a +a$a!H
I%+a-$a: as$g&+a, +a"&! ,+"$%a! a! %+&!&$ "$a%H
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( M&'()$&! s(&+, ;!?/+ a! p/!$(!&$
O+$g$%a: p !$ga"%,&! ,+a%s+s a! (a+p&!&$ '$ p+$% a!,&! p /as!: ,+ap>< ,+ap>/$<
/s&! "a+ '$ 9a>a p+$"&!&$ ",a(a+p$a%H
I%s+-$a: p ;a-a !a,+a! a p+$"$ ;a!a%g a p/!$(!&$H
A(-$&%: &( p/!$(! a%,+/@"$a! ;$$% "a$ a!s a&sH
as(&!a+$>a-$a: ;$$% $% +a"&+$ a! a+,+$ +a$a!H
I%+a-$a: ;as($(&!&! s&p+;$($a! s, $%+a, +a"&! ,%a+$a% a! %+&!&$ "$a%<
;as($(&!&! p+/;&% s, $%+a, +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+.
M&'()$&! a&(,/+ a! p/!$(!&$
O+$g$%a: p+$% (ap,&! /9!$( p /s&! "a+ '$ 9a>a ",a(a+p$%!/+ III '$ IH
I%s+-$a: p+$%,+@&% ,%/% (/"&% p ;a-a "$a! a ;a!a%g$ p+/?$"a! a p/!$(!&$<
"p+&% (& p+$"&! "&'()$ $%,+/s/s pa!"a+H A(-$&%a: ;$$% a&(-$ a p/!$(!&$H
as(&!a+$>a-$a: p+/$% $% a+,+a +a$a! '$ $% a+(aa pa!"a+ p+/;&%H
I%+a-$a: as$g&+a, +a"&! p+/;&% a! %+&!&$ &!%a+H
+rupa mi-locie ;/+"a, $% "&'()$$ interosoşi '$ lombricali .
a M&'()$$ $%,+/s/'$ /(&p spa-$$! $%,+",a(a+p$% '$ &p s$,&a-$a !/+ s
"pa+, %:
@muşcii interosoşi palmari in nr.de trei
O+$g$%a: p ;a-a ",a(a+p$a%&!&$ (a+ p+$', sp+ a?&! "$a% a! "#$%$$H
I%s+-$: p+$%,+@&% ,%/% s&9-$+ p ap/%+/>a /+sa! a g,&!&$ (/+sp&%>,/+
",a(a+p$a%&!&$ p (a+ '$ a& /+$g$%a.
@muşcii interosoşi dorsali
O+$g$%a: p ;a-a ",a(a+p$%!/+ (a+ !$"$,a> spa-$$! I
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$%,+/s/s&!&$ /+sa!< (ap&! s&p+;$($a! ,+"$% / a9&(-$ a $%?&!&$ a,&%($ (#%
;a!a%ga s, % ?,%s$ p ",a(a+p$%.T/,/a, ;$9+! sa! p+/?$"a! a& / a(-$&%
;!?$< (ap&! p+/;&% ;$$% +sp/%sa9$! ;!?$a ;a!a%g$ p ",a(a+p$%
as(&!a+$>a-$a "&'()$!/+ $%,+/s/'$:
Es, as$g&+a, +a"&+$ (/!a,+a! a! a+(a$ pa!"a+ p+/;&% '$ a%&"
a+,+! ",a(a+p$% sa& $%,+/s/as pa!"a+ '$ /+sa!.
I%+a-$a "&'()$!/+ $%,+/s/'$:
P+/$% $% +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+
9 M&'()$$ !/"9+$(a!$: % %&"+ pa,+& $% (a+ 2 !a,+a!$ '$ 2 "$a!$.
O+$g$%a: p+$"$$ 2 !a,+a!$ p ;a-a !a,+a! '$ &!,$"$$ 2 "$a!$ p a"9! ;- a!
,%/a%!/+ ;!?/+&!&$ p+/;&%.
I%ss+-$a: p ap/%+/>a /+sa! a g,!/+ 2@*. A(-$&%a: ;a( ;!?$a p+$"$ ;a!a%g '$ ?,%s$a (+/+!a!, /&.
as(&!a+$>a-$a: p+/$% $% a+(aa pa!"a+ p+/;&%.
I%+a-$a: %+&! "$a% $%+a> p+$"$$ /$ !/"9+$(a!$ $a+ +a"&! p+/;&% ,+"$%a! a!
%+&!&$ &!%a+ $%+a> &!,$"$$ /$ !/"9+$(a!$.
+rupa medial,
M&'()$$ g+&p$ "$a! s&%, % %&"+ pa,+& $sp&'$ p trei planuri :
@% p+$"&! p!a%< muşciul palmar scurt .
@% p!a%&! /$< muşciul fle!or scurt al degetului mic '$ muşciul abductor al degetului
mic.
@% p!a%&! ,+$< muşciul opo"ant al degetului mic .
a M&'()$&! pa!"a+ s(&+,
O+$g$%a: p ap/%+/>a pa!"a+H
I%s+-$a: p p$!a "a+g$%$$ "$a! a "#$%$$H
A(-$&%a: p!$sa> p$!a "$%%-$ )$p/,%a+H
as(&!a+$>a-$a: p+/$% $% +a"&+$ a! a+,+$ &!%a+H
I%+a-$a: as$g&+a, &% ;$!, (/!a,+a! $% +a"&! ,+"$%a! s&p+;$($a! a! %+&!&$
&!%a+.
9 M&'()$&! ;!?/+ s(&+, a! g,&!&$ "$(
O+$g$%a: p !$ga"%,&! ,+a%s+s a! (a+p&!&$ '$ p (#+!$g&! /s&!&$ (& (#+!$gH
I%s+-$a: p ;a-a a%,+$/a+ a 9a>$ ;a!a%g$% p+/?$"a!H
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A(-$&%a: ;!?$a ;a!a%g$ p+/?$"a! p ",a(a+p$% '$ ?,%s$a ;a!a%g!/+ "$=!/($$ '$
$s,a!H
as(&!a+$>a-$a: p+/$% $% a+(a! pa!"a+H
I%%+a-$a: as$g&+a, +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+.
( M&'()$&! a9&(,/+ a! g,&!&$ "$(
O+$g$%a: p /s&! p$s$;/+" '$ !$ga"%,&! ,+a%s+s a! (a+p&!&$H
I%s+-$a: p ;a!a%ga p+/?$"a! a g,&!&$ "$(H
A(-$&%a: ;a( a9&('$a '$ ;!?$a g,&!&$ "$(H
as(&!a+$>a-$a: p+/$% $% a+(a! pa!"a+H
I%+a-$a: as$g&+a, +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+.
M&'()$&! /p/>a%, a! g,&!&$ "$(
O+$g$%a: p !$ga"%,&! ,+a%s+s a! (a+p&!&$ '$ p (#+!$g&! /s&!&$ (& (#+!$gHI%s+-$a: p "a+g$%a "$a! a ",a(a+p$a%&!&$ a! @!aH
A(-$&%a: p+/$(,a> g,&! "$( a%,+$/+ '$ !a,+a!H
as(&!a+$>a-$a: p+/$% $% a+(aa pa!"a+ p+/;&%H
I%+a-$a: as$g&+a, +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+.
'(.( Articula!iile mâinii
Articula!ia pumnului /radiocarpian,
Es, a+,$(&!a-$ !$ps/$a! (a+ &%', a%,9+a-&! (& "#%a.
a #uprafe$ele articluare: !a %$!&! a%,9+a-&!&$ s, / (a$,a, +(p-$ %&"$,
'$ (a$,a,a g!%/$ a a%,9+a-&!&$. Ea s, "p+-$, (+as,a a%,+/@p/s,+$/a+ %/& s&p+a;-: &%a !a,+a! (a+ s a+,$(!&a> (& s(a;/$&! '$ a!,a "$a! (a+ s
a+,$(&!a> (& s"$!&%a+&!. S&p+a;a-a (a+p$a% s, +p+>%,a, ;-! a+,$(&!a+
s&p+$/a+ a! s(a;/$&!&$< s"$!&%a+&!&$ '$ p$+a"$a!&!&$. A(s,a $% &+" s a+,$(&!a>
(& !$ga"%,&! ,+$&%g)$&!a+. C! ,+$ /as ;/+"a> (/%$!&! (a+p$a%< a(/p+$, (a+,$!a=
)$a!$%.
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9 Mijloacele de unire: s&%, +p+>%,a, (aps&!a a+,$(&!a+ %,+$,
!$ga"%,< (a+ s&%, % +ap/+, $+(, (& ,($! ,%/a%!/+ ;!?/+$!/+ '$ ?,%s/+$!/+
g,!/+.
Caps&!a a+,$(&!a+ s $%s+ a,#, p+/?$"a! (#, '$ $s,a! !a p+$;+$a s&p+a;-!/+
a+,$(&!a+ '$ p "a+g$%a a%,+$/a+ '$ p/s,+$/a+ a !$ga"%,&!&$ ,+$&%g)$&!a+< p+/?$"a!
(/%,$%%&@s (& (aps&!a a+,$(&!a-$$ +a$/&!%a+ $s,a!.
L$ga"%,! s&%, % %&"+ pa,+&: anterior% posterior% medial şi lateral .
&igamentul anterior s, ;/+"a, $% /& ;as($(&!:
@;s($(&!&! +a$/(a+p$a% !$ga"%,&! /9!$(<
@;s($(&!&! &!%/(a+p$a% !$ga"%,&! /+$>/%,a!.
&igamentul posterior s $%s+ p+/?$"a! p "a+g$%a p/s,+$/a+ a s&p+a;-$
a+,$(&!a+ a +a$&s&!&$< &% ;as($(&!&! s ,+"$% p ;a-a p/s,+$/a+ a p$+a"$a!&!&$.U%/+$ p/a, ?$s,a ;as($(&! a((s/+$&< ;as($(&!&! +a$/s(a;/$$a% /+sa!.
&igamentul lateral s %,$% !a #+;&! s,$!/$$ +a$a! !a pa+,a !a,+a! a
s(a;/$&!&$.
&igamentul medial s $%s+ p+/?$"a! p #+;&! '$ p ;a-a "$a! a s,$!/$$
&!%a+< $a+ $s,a! s ,+"$% p+$% /& ;as($(&! (a+ s $%s+ p p$+a"$a! '$ p$s$;/+".
S$%/$a!a a(/p+ ;a-a p+/;&% a s(a;/$&!&$ ;$9+/s '$ s ,+"$% !a p+$;+$a
(a+,$!a=&!&$ )$a!$% (a+ a(/p+ s&p+a;-! a+,$(&!a+. as(&!a+$>a-$a s, as$g&+a,
a+,+! $%,+/s/as a%,+$/a+ '$ p/s+$/a+ '$ $% +a"&+$! (a+p$% a! a+,+!/+ &!%a+
'$ +a$a!.
I%+a-$a p+/$% $% %+$$ $%,+/s/'$ a%,+$/+ '$ p/s,+$/+< p+(&" '$ $% ;$9+
$+(, a! %+$!/+ "$a! '$ &!%a+.
Articula!iile intercarpiene
A(s, a+,$(&!a,$$ (&p+$%:
@articula$iile oaselor din primul r'nd%
-articula$iile oaselor din r'ndul doi%
-articula$ia mediocarpiană ( (a+ &%', (! /& +#%&+$ %,+ !.
Articulaţiile oaselor din rândul întâi (proximal)
C&p+$% a+,$(&!a-$$! $%,+ (! ,+$ /as (a+ ;/+"a> (/%$!&! (a+p$a%: s(a;/$<
s"$!&%a+< p$+a"$a! '$ a+,$(&!a-$a p$s/p$+a"$a!.
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A+,$(&!a-$$! /as!/+ (/%$!&!&$ (a+p$a% s&%, a+,$(&!a-$$! s(a;/@&!%a+ '$ p$+a"$/@
&!%a+ a+,$(&!a-$$ p!a%$;/+".
a S&p+a;-! a+,$(&!a+ s&%, ap+/ap p!a% '$ s&%, a(/p+$, (& &% s,+a, s&9-$+
(a+,$!a= )$a!$%.
9 M$=!/a(! &%$+: ;$(a+ $% a(s, a+,$(&!a-$$ p+>$%, &% !$ga"%, $%,+/s/s<
&%&! pa!"a+ '$ &%&! /+sa!.
L$ga"%,! $%,+/s/as s&%, s$,&a, % pa+,a s&p+$/a+ a $%,+!$%$$ ;$(+$
a+,$(&!a-$$ '$ p+$% ;$9+! !/+ s&p+;$($a! a=&%g p ;a-a s&p+$/a+< a+,$(&!a+ a (/%$!&!&$
(a+p$a%.
L$ga"%,! pa!"a+ '$ !$ga"%,! /+sa! s&%, ;as($(&! s(&+, /+$%,a,
,+a%s+sa!. P ;a-a /+sa! a (/%$!&!&$ s gs', !$ga"%,&! s(a;/p$+a"$a!.
S$%/$a!! (!/+ /& a+,$(&!a-$$ s&%, p+!&%g$+$ a! s$%/$a!$ a+,$(&!a-$$ "$/@(a+p$%.
rticula$ia pisopiramidală
P$s$;/+"&! s a+,$(&!a> (& p$+a"$a!&! p+$%,+@/ a+,$(&!a-$ p!a%,$;/+"
a S&p+a;-! a+,$(&!a+: p$s$;/+"&! p+>$%, / s&p+a;a- p!a% sa& &'/+
(/%(a< $a+ p$+a"$a!&! / s&p+a;a- &'/+ (/%?. A(as, a+,$(&!a-$ s, (/%$!$a%<
s&p+a;-! a+,$(&!a+ ;$$% a(/p+$, &% (a+,$!a= )$a!$%.
9 M$=!/a(! &%$+: (aps&!a a+,$(&!a+ s, !a?< %,+$, !$ga"%, (a+
s p/, "p+-$ % /& g+&p: &%! s&9-$+$ %,+s( p+-$! !a,+a! a! (aps&!$< $a+ a!,!<
s$,&a, !a $s,a%- (aps&! s %,$% !a p$s$;/+" !a /as! ($%.
A(s,a $% &+" s&%,: @!$ga"%,&! s&p+$/+<
@!$ga"%,&! $%;+/!a,+a!<
@!$ga"%,&! $%;+/"$a!.
Articulaţiile oaselor carpiene din rândul al doilea (distal .
T+ap>&!< ,+ap>/$&!< /s&! (ap$,a, '$ /s&! )a"a, s &%s( %,+ ! ;/+"#% ,+$
a+,$(&!a,$$ p!a%,$;/,".
a S&p+a;-! a+,$(&!a+: s&%, p!a% '$ a(/p+$, &% s,+a, s&9-$+ (a+,$!a=
)$a!$%.
9 M$=!/a(! &%$+: ;$(a+ a+,$(&!a-$ p+>$%, &% !$ga"%, $%,+/s/s< &%
!$ga"%, pa!"a+ '$ &%&! /+sa!.
S$%/$a!! a(s,/+ ,+$ a+,$(&!a-$$ s&%, p+!&%g$+$ a! s$%/$a!$ a+,$(&!a-$$ "$/(a+p$a%.
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Articulaţia mediocarpiană
Es, / a+,$(&!a-$ &9!& (/%$!$a% '$ &%', (! ,+$ /as a! (/%$!&!&$ (a+p$a%
(& (! pa,+& /as a! +#%&!&$ a! /$!a /as (a+p$%.
a S&p+a;-! a+,$(&!a+:
@pa+,a !a,+a! s, / a+,$(&!a-$ (/%$!$a% s,a9$!$, %,+ ;a-a $%;+$/a+ a
s(a;/$&!&$ '$ s&p+a;-! s&p+$/a+ a! ,+ap>&!&$ '$ ,+ap>/$&!&$.
@pa+,a "$a! s, as"%a / a+,$(&!a-$ (/%$!$a%. Fa-a "$a! a
s(a;/$&!&$ '$ ;-! $%;+$/a+ a! s"$!&%a+&!&$ '$ p$+a"$a&!&$< ;/+"a> / (a$,a,
g!%/$.
9 M$=!/a(! &%$+:
Caps&!a a+,$(&!a+ s $%s+ !a p+$;+$a s&p+a;-!/+ a+,$(&!a+< ;$$% s&9-$+ '$ !a?.
Caps&!a s, %,+$, p+$% !$ga"%, $sp&s palmar% dorsal < lateral şi medial. &igamentul palmar s, &% !$ga"%, p&,+%$( (& #+;&! !a (/!&! /s&!&$ (ap$,a,.
Ra"&+a !a,+a! s $%s+ p s(a;/$ '$ ,+ap>/$< $a+ +a"&+a "$a! p p$+a"$a! '$
/s&! )a"a,.
&igamentul dorsal s %,$% %,+ ;a-a /+sa! a p$+a"$a!&!&$ '$ ;a-a /+sa! a
,+ap>&!&$ '$ ,+ap>/$&!&$.
&igamentul medial s %,$% !a p$+a"$a! !a (#+!$g&! /s&!&$ )a"a,.
&igamentul lateral s $%s+ p+/?$"a! p ,&9+(&!&! s(a;/$&!&$ '$ $s,a! p ;a-a
!a,+a! a ,+ap>&!&$.
S$%/$a!a "$/(a+p$a% "$, p+!&%g$+$ s&p+$/+ '$ $%;+$/+< (a+ (/%s,$,&$
s$%/$a!! a+,$(&!a-$$!/+ /as!/+ $% p+$"&! '$ a! /$!a +#% (a+p$%.
Ca$,a,a a+,$(&!a+ a a+,$(&!a-$$!/+ (a+p$% (/"&%$( (& (a$,a,a a+,$(&!a+
(a+p/",a(a+p$a%.
as(&!a+$>a-$a s, as$g&+a, +a"&+$ $% a+(aa pa!"a+ p+/;&% p+(&" '$
$% a+,+! (a+p$% a! +a$a!$ '$ &!%a+$.
I%+a-$a p+/$% $% %+$$ &!%a+ '$ "$a%.
Articula!iile carpometacarpiene
M,a(a+p$%! s &%s( (& /as! (!&$ a! /$!a +#% (a+p$a% p+$% /&
a+,$(&!a-$$ $s,$%(,: &%a (a+ &%', p+$"&! ",a(a+p$a% '$ a!,a (/"&% p%,+& &!,$"!
pa,+& ",a(a+p$%.
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rticula$ia carpometacarpiană a policelui
a S&p+a;-! a+,$(&!a+: s&%, a(/p+$, (& &% (a+,$!a= )$a!$%. T+ap>&! p+>$%, /
s&p+a;a- a+,$(&!a+ pa,+&!a,+ (/%? a%,+/@p/s,+$/+ (/%(a ,+a%s+sa!. Ba>a
",a(a+p$a%&!&$ I p+>$%, / s&p+a;a- a+,$(&!a+ (/%? ,+a%s+sa! '$ (/%(a a%,+/@
p/s,+$/+.
9 M$=!/a( &%$+:
Caps&!a a+,$(&!a+: (a+ s $%s+ !a p+$;+$a s&p+a;-!/+ a+,$(&!a+< a+ / "a+
!a?$,a, s,+a,&! ;$9+/s ;$$% "a$ %s % pa+,a p/s,+$/a+ '$ !a,+a!. Ea s, %,+$,
!$ga"%,< (! "a$ $"p/+,a%, ;$$% !$ga"%,&! p/s,+/@"$a!.
S$%/$a!a s, a"p! '$ !a+g (a '$ (aps&!a ;$9+/as p (a+ / &9!a>.
Articulaţiile carpometacarpiene ale celorlalte degete
U!,$"! pa,+& ",a(a+p$% s&%, !ga, /as! ",a(a+p$% $s,a! p+$%(#, / a+,$(&!a-$ p!a%,$;/+".
a S&p+a;-! a+,$(&!a+: a! /$!a ",a(a+p$a% s a+,$(&!a> (& ,+ap>&!<
,+ap>/$&! '$ /s&! (ap$,a,< &p / !$%$ s$%&as % ;/+" M< a! ,+$!a ",a(a+p$a% s
a+,$(&!a> (& /s&! (ap$,a,< a! pa,+&!a ",a(a+p$a% s a+,$(&!a> (& /s&! )a"a,.
9 M$=!/a(! &%$+: &!,$"! pa,+& ",a(a+p$% s&%, &%$, (a+p p+$%,+@/
(aps&! a+,$(&!a+ s&9-$+ (a+ s $%s+ !a p+$;+$a s&p+a;-!/+ a+,$(&!a+ ;$$% %,+$,
!$ga"%, pa!"a+ /+sa! '$ $%,+/s/as.
S$%/$a!a (/"&%$( (& (a a a+,$(&!a-$$ "$/(a+p$% !a %$!&! a+,$(&!a-$$
$%,+ ,+ap>< ,+ap>/$ '$ /s&! (ap$,a,.
Articula!iile intermetacarpiene
C& ?(p-$a p+$"&!&$ ",a(a+p$a% (a+ s, $%p%%,< (! pa,+&
",a(a+p$% s&%, &%$, %,+ ! !a %$!&! ?,+"$,-$!/+ $s,a! p+$%,+@&% !$ga"%,
,+a%s+s.
Articulaţiile extremităţilor proximale
a S&p+a;-! a+,$(&!a+: a(/p+$, &% (a+,$!a= )$a!$% s&%, s$,&a, p ;-!
!a,+a! a! 9a>$ ",a(a+p$%!/+.
9 M$=!/a( &%$+:@(aps&!a a+,$(&!a+ s (/%,$%& s&p+$/+ (& (aps&!a
a+,$(&!a-$$ (a+p/",a(a+p$% a &!,$"!/+ pa,+& g,. L$ga"%,! a+,$(&!a+ %,+s(
(aps&!a ;$9+/as '$ s&%,: ,+$ !$ga"%, pa!"a+< ,+$ /+sa! '$ ,+$ $%,+/s/as.
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S$%/$a!a s, / p+&%g$+ a s$%/$a!$ a+,$(&!a-$$ (a+p/",a(a+p$%.
Unirea extremităţilor distale ale metacarpienelor
A(s,a s&%, &%$, p+$%,+@/ 9a% ;$9+/as (a+ s %,$% !a a! /$!a !a a!
($%($!a ",a(a+p$a% %&"$, !$ga"%,&! ",a(a+p$a% ,+a%s+s p+/;&%. E! s, % +ap/+,
'$ (& ;as($$! pa!"a+ '$ /+sa! a "#$%$$.
Articula!iile de0etelor
Fa!a%g! s&%, a+,$(&!a, %,+ ! p+$% a+,$(&!a-$$ $%,+;a!a%g$%. P+$"a ;a!a%g a
;$(+&$ g, s a+,$(&!a> (& ",a(a+p$a%&! (/+sp&%>,/+ ;/+"#% a+,$(&!a-$a
",a(a+p/@;a!a%g$a%.
Articulaţiile metacarpo –falangiene
S&%, a+,$(&!a-$$ ,$p (/%$!$a%. a S&p+a;-! a+,$(&!a+: s&%, +p+>%,a, (ap&! ",a(a+p$a%&!&$ '$
(a$,a,a g!%/$ a ?,+"$,-$$ p+/?$"a! a p+$"$ ;a!a%g. S&p+a;a-a ",a(a+p$a% (&
asp(, s;+< s p+!&%g', '$ p ;a-a pa!"a+ a (ap&!&$ ",a(a+p$a%&!&$. D
;$(a+ pa+, a s&p+a;-$ a+,$(&!a+ s gs', &% ,&9+(&! '$ s&9,&! !&$ /
p+s$&% +&g/as< ,+"$%a, $%s+-$a !$ga"%,&!&$ (/!a,+a!.
Ca$,a,a g!%/$ a ;a!a%g$ a+ / s&p+a;a- (/%(a< !$p,$(< (& a?&! "a+
,+a%s+sa!. A$($ ?$s, &% ,&9+(&! p%,+& $%s+-$a $%;+$/a+ a !$ga"%,&!&$ (/!a,+a!.
S&p+a;-! a+,$(&!a+ s&%, a(/p+$, (a+,$!a= )$a!$%< (a$,a,a g!%/$ p+>$%, &%
;$9+/(a+,$!a= (a+ s ;$?a> p ;a-a pa!"a+ '$ % p/+-$&%a %($%a, a ;-!/+ !a,+a!
a! ?,+"$,-$$ p+/?$"a! a ;a!a%g$< ;$$% $%s+a, p pa+,a a%,+$/a+ sa& pa!"a+ a
s&p+a;-$ a+,$(&!a+ ",a(a+p$%.
9 M$=!/a( &%$+: ;$(a+ a+,$(&!a-$ ",a(a+p/@;a!a%g$a% p+>$%, /
(aps&! '$ !$ga"%,< a+,$(&!a-$$! &!,$"!/+ g, ;$$% &%$, %,+ ! p+$% !$ga"%,&!
,+a%s+s p+/;&% a! ",a(a+p&!&$.
Caps&!a a+,$(&!a+ s&9-$+ '$ !a? s $%s+ p ;a-a p/s,+$/a+ a a+,$(&!a-$$.
L$ga"%,! pa!"a+ s&%, +p+>%,a, ;$9+/(a+,$!a= g!%/$$%< (a+ s
$%s+ "a$ !a? p ",a(a+p$% '$ "a$ s,+#%s p 9a>a ;a!a%g$. P ;a-a !/+ pa!"a+
p+>$%, &% 'a%- +,$(a! p+$% (a+ a!&%( ,%/a%! ;!?/+$!/+.
L$ga"%,! (/!a,+a! s $%s+ p ,&9+(&!&! '$ p p+s$&%a (ap&!&$
",a(a+p$%!/+< &% $+g % a%,a$ '$ s ,+"$% p+$% ;as($(&!&! ",a(a+p/@
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;a!a%g$a% a! !$ga"%,&!&$ (/!a,+a! '$ p+$% ;as($(&!&! ",a(a+p/@g!%/$$a% a! !$ga"%,&!&$
(/!a,+a!.
S$%/$a!a s $%s+ !a $s,a%- s&p+a;-! a+,$(&!a+< s +;!(, !a %$!&!
$%s+-$$ (aps&!a+ p+!&%g$%&@s p ?,+"$,-$! /s/as p#% !a %$!&! (a+,$!a=&!&$
)$a!$%.
Articulaţia metacarpo-falangiană a policelui
A+ a($a'$ /+ga%$>a+ (a '$ a+,$(&!a-$$! ",a(a+p/@;a!a%g$% a! &!,$"!/+ pa,+&
g,< a+ p+>$%, (#,a pa+,$(&!a+$,-$:
@s&p+a;a-a a+,$(&!a+ a p+$"&!&$ ",a(a+p$a% p+>$%, / p/+-$&% ;a!a%g$a% '$ /
p/+-$&% a%,+$/a+< ssa"/$.
@;$9+/(a+,$!a=&! a%,+$/+ p+>$%, % g+/s$"a sa /& /as ssa"/$.
@;$9+! a%,+$/a+ a! !$ga"%,!/+ (/!a,+a! s ,+"$% % "a+ pa+, pssa"/$ '$ ;/+"a> &% !$ga"%, ",a(a+p/@ssa"/$$a%.
Articula!iile inter"alan0iene
Dg,! "#$%$$ p+>$%, (#, /& a+,$(&!a-$$ $%,+;a!a%g$%< &%a p+/?$"a! '$
a!,a $s,a!< (& ?(p-$a p/!$(!&$ (a+ p+>$%, / s$%g&+ a+,$(&!a-$. A(s, a+,$(&!a-$$
s&%, ,$p ,+/)!a%.
a S&p+a;-! a+,&(&!a+:
@s&p+a;a-a p+/?$"a! s, +p+>%,a, p+$% ?,+"$,-$! $s,a! a! p+$"$ '$ a!
(!$ a /&a ;a!a%g (a+ p+>$%, / ,+/)! (& /& p+s$&%$ % (a+ s /+ $%s+a
!$ga"%,! (/!a,+a!.
@s&p+a;a-a $s,a! s, +p+>%,a, ?,+"$,-$! p+/?$"a! a! (!$ a
/&a '$ a ,+$a ;a!a%g< p !a,&+$! (a$,-$!/+ a;!#%&@s (#, / "$( ,&9+/>$,a, p%,+&
$%s+-$a !$ga"%,!/+ (/!a,+a!.
9 M$=!/a( &%$+: (aps&!a< !$ga"%,! '$ s$%/$a!! a& a(!a'$ (a+a(,+$s,$($<
(aps&!a ;$$% %,+$, &% !$ga"%, pa!"a+ '$ /& !$ga"%, (/!a,+a!.
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Capitolul II
1I%#ECANICA #&INII
)('( 1iomecanica 0âtului mâinii
#,&! "#$%$$ s, a!(,&$, $% /p, /as s(&+,< ;/+" %+g&!a, (&9/$:
/as! (a+p$%< a+,$(&!a, %,+ ! p+$% a+,+/$$< %,+g&! "as$ a+,$(&!#%&@s p+/?$"a!
(& sg"%,&! a%,9+a)$a! p+$% a+,$(&!a-$a +a$/(a+p$a% '$ $s,a! (& ",a(a+p$%! p+$%
a+,$(&!a-$$! (a+p/@",a(a+p$%. C/"p!?&! /s,/a+,$(&!a+ a! g#,&!&$ "#$%$$ s, as,;! s,+&(,&+a, %(#, s p+"$,
;(,&a+a "$'(+$!/+ : ;!?$@?,%s$< a9&(-$@a&(-$ '$ ($+(&"&(-$.
A+,$(&!a-$$! (+/+a ! +$% +/!&! (! "a$ $"p/+,a%, s&%,: a+,$(&!a-$a +a$/(a+p$a%<
a+,$(&!a-$a (/%$!$a% (& /& g+a !$9+,a, '$ a+,$(&!a-$a "$/(a+p$a%.
T/a, "$'(+$! g#,&!&$ "#$%$$ s ;(,&a> p+$%,+@/ p!asa+ % ,a= a
sg"%,!/+ +g$&%$$. A! /$!a +#% (a+p$a% s p!asa> p p+$"&!< $a+ p+$"&! +#%
(a+p$a% s p!asa> p sg"%,&! a%,9+a)$a!. M$'(+$! g#,&!&$ "#$%$$ s ;(,&a> % =&+&! &%&$ (%,+& (a+ p/a, ;$ (/%s$+a,
( s, /s&! "a+< p$/,&! (%,+a! % =&+&! (+&$a s p!asa> (!!a!, /as (a+p$%.
F!?$a@?,%s$a s ?(&, % p!a% sag$,a! % =&+&! &%&$ a? ,+a%s+sa!< (a+ ,+(
p+$% (ap&! /s&!&$ "a+. M$'(+$! ;!?$@?,%s$ a& / a"p!$,&$% "$ 1* /< $a+
(! pas$ 16*/.
A9&(-$a@a&(-$a s ?(&, % p!a% ;+/%,a!< % =&+&! &%&$ a? a%,+/@p/s,+$/+
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A"p!$,&$%a "$'(a+ p$% a,#, p/>$-$a "#$%$$ ;a- a%,9+a-< (#, '$
p/>$-$a g,!/+. F!?$a s, "a?$" (#% "#%a s, %(!$%a, (&9$,a! '$ g,!
?,$%s< $a+ ?,%s$a s, "a?$" (#% "#%a s, %(!$%a, +a$a! '$ g,! s&%,
;!(,a,.
M$'(a+a ;!?$ s, ?(&,a, &+",/+$$ "&'()$: "a+! pa!"a+< "$(&!
pa!"a+ '$ (&9$,a!&! a%,+$/+< a=&,a-$ ;!?/+&! (/"&% s&p+;$($a! a! g,!/+< ;!?/+&!
(/"&% p+/;&% a! g,!/+ '$ !&%g&! ;!?/+ p+/p+$& a! p/!$(!&$.
M$'(a+a ?,%s$ s, ?(&,a, &+",/+$$ "&'()$: p+$"&! +a$a! ?,+%<
a! /$!a +a$a! ?,+%< (&9$,a!&! p/s,+$/+< ?,%s/+&! (/"&% a! g,!/+< ?,%s/+&!
p+/p+$& a! g,&!&$ "$(< !&%g&! ?,%s/+ a! p/!$(!&$< s(&+, ?,%s/+ a! p/!$(!&$ '$
?,%s/+&! p+/p+$& a! $%?&!&$.
52 #icarea de a5duc!ie4adduc!ie
S ;a( % =&+&! &%&$ a? a%,+/@p/s,+$/+ (a+ ,+( p+$% (%,+&! /s&!&$ "a+.
M&'()$$ "/,/+$ (a+ +a!$>a> a&(-$a s&%,: (&9$,a!&! p/s,+$/+ '$ (&9$,a!&! a%,+$/+.
M&'()$$ "/,/+$ (a+ ?(&, %(!$%a-$a +a$a! s&%,: "a+! pa!"a+< p+$"&! +a$a! ?,+%<
a! /$!a +a$a! ?,+%< !&%g&! a9&(,/+ a! p/!$(!&$< !&%g&! ?,%s/+ a! p/!$(!&$ '$ s(&+,&!
?,%s/+ a! p/!$(!&$.
c2 #icarea de circumduc!ie
R>&!, $% ,+(+a s&((s$ p+$% p/>$-$$! ;!?$< a9&(-$< ?,%s$<
a&(-$ sa& $%+s. La ?(&,a+a "$'(+$$ pa+,$($p ,/-$ "&'()$$ ;!?/+$< ?,%s/+$<
a9&(,/+$ '$ a&(,/+$ a$ "#$%$$.
)()( 1iomecanica ultimelor patru de0ete
U!,$"! pa,+& g, ;a( "$'(+$ : ;!?$@?,%s$< "$'(+$ !a,+a!$,a, '$
($+(&"&(-$.
A+,$(&!a-$$! $%,+",a(a+p/;a!a%g$% '$ a! &!,$"!/+ pa,+& g, s&%,
a+,$(&!a-$$ ,$p (/%$!$a%.
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F!?$a@?,%s$a s ?(&, % p!a% sag$,a! % =&+&! &%&$ a? ,+a%s+sa!< (a+ ,+(
p+$% (/%$!$$ ",a(a+p$%!/+< %a$%,a $%s+-$$ s&p+$/a+ a!$ga"%,!/+ !a,+a!.
%(!$%a+a !a,+a! a g,!/+ s ?(&, % p!a% ;+/%,a! % =&+&! &%/+ a? a%,+/@
p/s,+$/a+ (a+ ,+( p+$% (%,+&! (/%$!$!/+ ",a(a+p$%!/+.
A"p!$,&$%a "$ %/+"a! a ;!?$$@?,%s$$ s, 1200 p%,+& a+,$(&!a-$$!
$%,+;a!a%g$% p+/?$"a! '$ 00 p%,+& a+,$(&!a-$$! $%,+;a!a%g$% $s,a!.
a2 #ic,rile de înclinare lateral, a de0etelor a& !/( p+$% a!&%(a+a
,+a%s+sa! a 9a>$ p+$"$ ;a!a%g p (/%$!$$ (ap,!/+ ",a(a+p$%. Ap+/p$+a '$
p+,a+a a?&! "#$%$$ s, ;(&, $%,+/s/'$. A"p!$,&$%a "$'(+$ %,+ p&!pa
$%?&!&$ '$ (a a $%!a+&!&$ '$ %,+ p&!pa $%?&!&$ '$ (a a a&+$(&!a+&!&$ p/a, ;$
"s&+a, % (%,$",+$.
52 #ic,rile de "le3ie4e3tensie ale de0etelor a& !/( ;$ $>/!a,< ;$ s$"&!,a% !a
(! ,+$ %$!&+$ a+,$(&!a+: ",a(a+p/;a!a%g$a%
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c2 #icarea de circumduc!ie +>&!, $% ,+(+a g,!/+ p+$% (! pa,+&
p/>$-$$ s(+$s a%,+$/+: ;!?$< a&(-$< ?,%s$< a9&(-$ sa& $%+s.
)(.( 1iomecanica policelui
P/!$(! $sp&% p/s$9$!$,-$ a"p! "$'(a+< "$'(+$ p (a+ %& ! ;a(
%&"a$ p/!$(! ($ %,+aga +a> ?,+% a "#$%$$. % ?(&,a+a "$'(+$!/+ /+ $%,+%$
a+,$(&!a-$$!: +a$/@s(a;/$$a%< ",a(a+p/;a!a%g$a% '$ $%,+;a!a%g$a% a p/!$(!&$.
a2 #ic,rile de "le3ie4e3tensie s ?(&, % =&+&! &%&$ a? /9!$( %a$%, '$
%a;a+< (a+ ,+( p+$% 9a>a p+$"&!&$ ",a(a+p$a%. M$'(a+a ;!?$ s, ?(&,a, s(&+,&! a9&(,/+ a! p/!$(!&$< s(&+,&! ;!?/+ a! p/!$(!&$< /p/>a%,&! '$ ;!?/+&! p+/p+$& a!
p/!$(!&$. M$'(a+a ?,%s$ s, ;(,&a, !&%g&! ?,%s/+ '$ s(&+,&! ?,%s/+
a! p/!$(!&$.
52 #ic,rile de a5duc!ie i adduc!ie p!asa> '$ ap+/p$ p+$"&! ",a(a+p$a%
a! /$!a< "$'(a+a s ?(&, % =&+&! &%&$ a? a%,+/@p/s,+$/+ s$,&a, % (%,+&!
,+ap>&!&$. L&%g&! a9&(,/+ a! p/!$(!&$ ;a( a9&(-$a $a+ a&(,/+&! p/!$(!&$ a&(-$a.
c2 #ic,rile de circumduc!ie (/%s,a& % ,+(+a p+$% ,/a, (! pa,+& p/>$-$$
a"$%,$,.
d2 #icarea de opo6i!ie s ;a( p+$% ap+/p$+a a(,$ a (/!/a%$ p/!$(!&$
&!,$"! pa,+& g,.
+&p! "&s(&!a+ "/,/+$$ ?,+$%s($ '$ $%,+$%s($ (a+ p&% % ;&%(-$ p/!$(! '$
p+$"s( $%+a-$a !a ($ ,+$ %+$ $"p/+,a%-$ a$ ""9+&!&$ s&p+$/+: +a$a!< "$a! '$
(&9$,a!.
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Capitolul III
ASPECTE T%P%+RA$ICE
M#%a +p+>$%, sg"%,&! ,+"$%a! a! ""9+&!&$ s&p+$/+ '$ s, p&,+%$(
,&+,$, /+s/@pa!"a+< a#% ;/+"a &%$ pa!,. Ea a+ !a /" (a+a(,+$s,$($ apa+, p+$$%
"/9$!$,a,a '$ s%s$9$!$,a,a< as,;! %(#, +p+>$%, &%&! $% (a+a(,+! sp($;$( &"a%.
M#%a s, s$&! ;+(%, a! &%/+ ,+a&"a,$s" sa& &%/+ p+/(s s&p&+a,$.
% a%sa"9!&< "#%a p/a, ;$ "p+-$, % /& p/+-$&%$: &%a p+/?$"a!@"#%a
p+/p+$@>$s G( (/+sp&% s()!,&!&$ (a+p/",a(a+p$a%H a!,a $s,a! +p+>%,a, (! ($%($ g,< (/+sp&%>,/a+ s()!,&!&$ ;a!a%g$a%.
M#%a p+/p+$&@>$s s s&9"pa+, !a +#%&! $ %,+@/ +g$&% pa!"a+ '$ &%a
/+sa!< p+$%+,@&% p!a% ( ,+( "$a! p+$% !$%$a ( &%', p$s$;/+"&! (& "a+g$%a
"$a! a g,&!&$ "$(H !a,+a! p!a%&! ,+( p+$% ,&9+(&!&! s(a;/$&!&$< p+$% +($%a
p/!$(!&$ '$ ap/$ p+$% "a+g$%a !a,+a! a $%?&!&$.
.('(Re0iunea palmar, a mâinii
A+ / ;/+" (/%(a< (& / p+s$&% (%,+a! !$"$,a, %,+ "$%%-a ,%a+@
% pa+,a +a$a!< '$ (a )$p/,%a+@% pa+,a &!%a+.
Pielea
Es, g+/as< p&-$% "/9$!< !$ps$, (/"p!, p+ '$ g!a% s9a(< % s()$"9
(& "&!, g!a% s&/+$pa+. Ea s, p+>&, (& / s+$ 'a%-&+$ !/%g$,&$%a!<
,+a%>+sa! '$ /9!$(. P!$(! a& / $"p/+,a%- ()$+&+g$(a!< +p+>%,#% +ap/+,&+$ p%,+&
!$%$$! $%,+a+,$(&!a+ '$ p%,+& as.
Planul su5cutanat
P+>$%, ,+a(,&+$ ;$9+/as p+$% (a+ p$!a a+ p!a%&! &+",/+ '$ (a+
!$"$,a> "$($ spa-$$ % (a+ s, $%g!/9a, / g+s$" a+/!a+ % (a%,$,a, +!a,$ "a+.
A(as, g+s$" (/"&%$( (& -s&,&! (/%=&%(,$ !a? a! +g$&%$$ /+sa!< (a ( p+"$, _______________________________________________________________________________________ 19
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p+/paga+a +ap$ a $%;(-$$ % (a>&! &%/+ s&p&+a-$$ pa!"a+. La %$!&! "$%%-$
)$p/,%a+< p!a%&! (/%-$% "&'()$&! pa!"a+ s(&+,< "&'()$&! (&,a%a,< a'>a, ,+a%>+sa!.
L$";a,$(! ;/+"a> / +-a 9/ga,< a%/s,/"/>a, (& (!!a!, !$";a,$( a! "#$%$$.
N+$$ a(s,&$ p!a% s&%, +p+>%,a-$ +a"&+$! pa!"a+ a! "$a%&!&$ '$ (,+
%+&! pa!"a+.
Planul "ascial
Es, +p+>%,a, ;as($a pa!"a+ s&p+;$($a!. S&9-$+ % p/+-$&%a !a,+a! '$
"$a!< a s, "&!, "a$ g+/as % p/+-$&%a "$=!/($ &% a!(,&$', ap/%+/>a
pa!"a+. A(as,a a+ ;/+"a ,+$&%g)$&!a+ (& #+;&! p+/?$"a! &% (/%,$%& ,%/%&!
"&'()$&!&$ pa!"a+ !&%g.
Planul pro"und super"icial
Es, a!(,&$, $% /& s,+a,&+$< &%&! "&s(&!/@,%$%/s '$ a!,&! "&s(&!a+ $%,+/s/sS,+a,&! "&s(&!/@,%$%/s s&9;as($a! s, $sp&s % trei loje palmare:
a) &oja laterală (tenară)* (&p+$% ($ pa,+& "&'()$ a$ p/!$(!&$< a'>a-$ % ,+$
s,+a,&+$:
@s,+a,&! s&p+;$($a! ;/+"a, $% a9&(,/+&! s(&+,H
@s,+a,&! "$=!/($& ;/+"a, % pa+,a !a,+a! a "&'()$&!&$ /p/>a%, a! p/!$(!&$H
@s,+a,&! "$a! ;/+"a, ;!?/+&! s(&+,H
P+$% (! /& ;as($(&! a! ;!?/+&!&$ !&%g ,+( ,%/%&! ;!?/+&!&$ !&%g a! p/!$(!&$.
S,+a,&! p+/;&% s, a!(,&$, $% ;as($(&!&! /9!$( a! a&(,/+&!&$H "&'()$$ p+$"s( +a"&+$
$% "$a% (& ?(p-$a a&(,/+&!&$ $%+a, $% +a"&+a p+/;&% a &!%a+&!&$.
b) &oja medială (ipotenară) (/%-$% ($ ,+$ "&'()$ a$ g,&!&$ "$(< a'>a-$ %
/& s,+a,&+$. % s,+a,&! s&p+;$($a! a9&(,/+&! % pa+,a "$a! '$ ;!?/+&! s(&+, % pa+,a
!a,+a!< s,+a,&! p+/;&% s, ;/+"a, /a+ $% "&'()$&! /p/>a%,. T/-$ s&%, $%+a-$ $%
&!%a+.
c) &oja mijlocie (me"o-tenară) s, a!(,&$, ,/, $%,+@&% s,+a, s&p+;$($a! '$ &%&!
p+/;&%. P+$"&! s,+a, (&p+$% ,%/a%! ;!?/+&!&$ s&p+;$($a! a! g,!/+< $a+ a! /$!a<
p (! a! ;!?/+&!&$ p+/;&%< (a+ s&%, a%?a-$ ($ pa,+& "&'()$ !/"9+$(a!$.
% a(as, !/= s gss( !"%, as(&!/@%+/as $"p/+,a%,.
I"$a, s&9 ap/%+/>a pa!"a+ s, $sp&s a+(aa a+,+$a! pa!"a+ s&p+;$($a!. D$%
(/%?$,a,a $ p/+%s( pa,+& a+,+ $g$,a! pa!"a+ (/"&% (a+ /+ $+$ga g,! II@
. I"$a, p+/;&% ;a- a+(a! as(&!a+ s a;! %+$$ $g$,a!$ pa!"a+$ (/"&%$<
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+a"&+$ ,+"$%a! a! "$a%&!&$ '$ &!%a+&!&$. T/a, a(s, !"%, as(&!/@%+/as
s&%, (&p+$%s %,+@&% spa-$& (!&!/s s&p+;$($a!< !$"$,a, %,+ ap/%+/> '$ ,%/a%.
%,+ ,%/a%! ;!?/+$!/+ '$ &+",/+&! s,+a, a! p!a%&!&$ p+/;&% a! pa!"$< s gs', &%
a! /$!a spa-$& (!&!/s< (! p+/;&%.
S,+a,&! "&s(&!a+ $%,+/s/s s, +p+>%,a, % /+$% : fascia muşcilor
interosoşi% +asele şi ner+ii% muşcilor interosoşi .
Fas($a< ;/a+, s&9-$+< s $%s+ p "a+g$%$! a%,+$/a+ a! ",a(a+p$%!/+ (&
?(p-$a (!&$ a! ,+$!a.
U+",/a+! !"%, s&%, +p+>%,a, a+(a! as(&!/@%+/as< a+(aa
a+,+$a! pa!"a+ p+/;&%< $% (/%?$,a,a (+$a p/+%s( pa,+& a+,+ ",a(a+p$%
pa!"a+. A+(aa a+,+$a! ;&+%$>a> '$ +a"&+$ p+;/+a%, ( s,+9a, "&'()$$ $%,+/s/'$ '$
s a%as,/"/>a> (& a+,+! ",a(a+p$% /+sa!. T/a, a+,+! s&%, %s/-$, % (/"$,a%, '$ as !$";a,$( p+/;&%.
M&'()$$ $%,+/s/'$< ,+$ pa!"a+$ '$ pa,+& /+sa!$< s&%, a'>a-$ % spa-$$!
$%,+",a(a+p$%.
.()( Re0iunea dorsal, a mâinii
Es, / +g$&% &'/+ (/%? % s%s ,+a%s,sa!< p+>%,#% % pa+,a $s,a!
asp(, a+$a, % ;&%(-$ p/>$-$a g,!/+.
a2 Pielea s, ;/a+, s&9-$+< "/9$! a(/p+$, % "/ a+$a9$! (& p+< !as s s
a p+$% ,+a%spa+%-a $ +-a&a %/as s&p+;$($a!.
52 Planul su5cutanat s, !a? ap+/ap !$ps$, g+s$". C/%-$%: +-a&a
%+/as /+sa! a "#$%$$< ;/+"a, p+$% a%as,/"/>a+a %!/+ ",a(a+p$% /+sa!H
as! !$";a,$(H %+$$ $g$,a!$ /+sa!$< a(',$a $% &+" p+/$% % pa+,a "$a! $%
+a"&+a /+sa! a &!%a+&!&$< $a+ % pa+,a !a,+a! $% +a"&+a s&p+;$($a! a +a$a!&!&$.
c2 Planul "ascial s, +p+>%,a, ;as($a /+sa! a "#$%$$< (a+ s (/%,$%&
p+/?$"a! (& +,$%a(&!&! ?,%s/+$!/+.
d2 Planul pro"und (! ,%$%/s< s, a!(,&$, $% ,%/a%! %,#!%$, '$ !a g#,&!
"#$%$$. % /+$% +a$/@&!%a+ s gss(: !&%g&! a9&(,/+ a! p/!$(!&$< s(&+, ?,%s/+ a! _______________________________________________________________________________________ 21
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p/!$(!&$< ($ /$ ?,%s/+$ +a$a!$ a$ (a+p&!&$< !&%g ?,%s/+ a! p/!$(!&$< ?,%s/+&!
$%?&!&$< (! pa,+& ,%/a% a! ?,%s/+&!&$ g,!/+< ?,%s/+&! g,&!&$ "$(<
?,%s/+&! &!%a+ a! (a+p&!&$. T%/a%! s,$%a, g,!/+ III@ s&%, !ga, %,+ !
p+$% p&%-$ ;$9+/as ,+a%s+sa!. P+/;&% ;a- a(s, ,%/a% ,+( (! ,+$ a+,+
",a(a+p$% /+sa!. % pa+,a !a,+a!< a+,+a +a$a! s($% @a !&%g&! p+$"&!&$
spa-$& $%,+/s/s p (a+ ! p+;/+a>< ,+(#% ap/$ !a pa!"H $% a p/+%', a+,+a
",a(a+p$a% /+sa! a p+$"&!&$ spa-$&. A+,+! s&%, %s/-$, % (/"$,a%, '$
as !$";a,$(.
.(.(De0etele mâinii
Rp+>$%, ($%($ ap%$( ,+"$%a! a! "#$%$$< (& +/! /s9$, $"p/+,a%, %
$;+$, a(,$$,-$.
L$"$,a ;a- "#%a p+/p+$&@>$s s, +p+>%,a, !$%$a (&+9 (& (/%(a$,a,a
p+/?$"a!< (a+ ,+( p+$% p!$($! $g$,/@pa!"a+< $a+ /+sa! p+$% (/"$s&+$! $%,+$g$,a!.
A#% / ;/+" ap+/ap ($!$%+$(< g,!/+ !$ s s(+$& / +g$&% pa!"a+ '$
&%a /+sa!< spa+a, p+$% p!a%&+$! ;/+/%,a! &s p+$% a?&! ;a!a%g!/+
Re0iunea palmar, a de0etelor
a2 Pielea: s, g+/as< 9/ga, % g!a% s&/+$pa+ '$ +(p,/+$ %+/'$< p+>$%,
% +p,&! a+,$(&!a-$$!/+ $%,+;a!a%g$%< 'a%-&+$ ,+a%s+sa!. P p&!pa ;a!a%g$ $s,a!
p$!a p+>$%, (+s, pap$!a+ ;/+, 9$% $>$9$! '$ (a+a(,+$s,$( ;$(+&$ $%$$< (a+
;/+"a> a"p+%,! $g$,a!.
52 Planul su5cutanat s, +!a,$ g+/s '$ a+ a(!a'$ (a+a(,+$s,$($ (a '$ %
+g$&%a pa!"a+ a "#$%$$. E! (/%-$% p%,+& ;$(a+ g, /& "%&%()$&+$ as(&!/@
%+/as pa!"a+< s$,&a, p ;-! "a+g$%a! a! g,!/+H ;/+"a, $% a+(a!
$g$,a! pa!"a+ p+/p+$$< +a"&+$ 9$;&+(a-$ a! $g$,a!!/+ pa!"a+ (/"&%. %! s&%,
,+$9&,a+ +-!$ %+/as pa!"a+ s&p+;$($a! a "#$%$$H as !$";a,$(< %+$ $s,a!$
pa!"a+$ p+/p+$$ p+/%$-$ $% ($ (/"&%$.
c2 Planul "i5ros s, +p+>%,a, ,($! ;$9+/as a! ;!?/+$!/+< (a+ "p+&%
(& ;a!a%g! ;/+"a> ,&%! /s,/@;$9+/as p%,+& ,%/a%. _______________________________________________________________________________________ 22
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d2 Planul tendinos s, a!(,&$, (,+ /& ,%/a% p%,+& ;$(a+ g,.
P 9a>a ;a!a%g$ p+/?$"a! a p/!$(!&$ s $%s+ ;!?/+&! s(&+,< a9&(,/+&! '$ a&(,/+&!
p/!$(!&$H p 9a>a ;a!a%g$ $s,a! a p/!$(!&$ s ,+"$% ,%/%&! ;!?/+&!&$ !&%g a!
a(s,&$ g,. T%/a%! p/!$(!&$ '$ a g,&!&$ "$( s&%, (&p+$%s % ,($ $g$,/@
(a+p$%< ,%/a%! g,!/+ II@I s&%, (&p+$%s % ,($! s$%/$a! $g$,a!.
Re0iunea dorsal, a de0etelor
a2 Pielea @ "a$ s&9-$+ '$ "a$ "/9$! (#, % +g$&%a pa!"a+< p+>$%, ;$+
p+ '$ p!$&+$ ,+a%s+sa!. La %$!&! ;a!a%g!/+ $s,a! s a;! &%g)$$!< a%? a! p$!$$< (&
/ pa,/!/g$ $+s.
52 Planul su5cutanat @ s, "a$ +&s (#, (! pa!"a+< (/%-$% a+,+! $g$,a!
/+sa!< +a"&+$ a! ",a(a+p$%!/+ /+sa!< as !$";a,$( '$ %+$$ $g$,a!$ /+sa!$p+/%$-$: p+$"$$ ($%($ $% +a$a!< $a+ &!,$"$$ ($%($ $% &!%a+.
c2 Planul tendinos @ s, +p+>%,a, ,%/a%! ?,%s/+$!/+. T%/%&!
?,%s/+&!&$ $%?&!&$ '$ (! a! ?,%s/+&!&$ g,&!&$ "$( s &%s( % +p,&! a+,$(&!a-$$!/+
",a(a+p/@;a!a%g$% (& ,%/a%! s,$%a, a(s+/+ g, $% "&'()$&! ?,%s/+ a!
g,!/+. T%/a%! ?,%s/+$!/+ g,!/+ s !-s( % +p,&! ;a!a%g$ p+/?$"a! a
g,!/+ II@I< ;/+"#% ap/%,/>a /+sa! a g,!/+< ( a+ ,/a, ,+$ ;a!a%g.
P "a+g$%$! a(s,/+ ap/%+/> s $%s+ '$ ,%/a%! "&'()$!/+ $%,+/s/'$ '$
!/"9+$(a!$.
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Capitolul IVCARACTERISTICILE ARHITECTURALE ALE #&INII
C&%/a',+a (a+a(++$s,$(!/+ a+)$,(,&+a! a! "#$%$!/+< a a%a,/"$$ ;&%(-$/%a! '$
a ,$p&+$!/+ ;$>$/!/g$( p+)%s$&% s&%, $%$sp%sa9$! p%,+& a!&a+a ,&!9&++$!/+
9$/"(a%$( (a&>a, $+s! ,$p&+$ !>$/%a!< (a '$ p%,+& ,s,a+a (apa($,-$$
;&%(-$/%a! +s,a%,< s,a9$!$+a &%&$ p+/g%/s,$( ;&%(-$/%a! '$ !a9/+a+a p!a%&!&$ +(&p+a+.
% p!a% a+)$,(,&+a! "#%a s, ;/+"a, $% ($%($ +a> ;/+"a, $% ;a!a%g '$
",a(a+p$%. M,a(a+p$a%&! a! II@!a '$ a! III@!a s&%, ;+" &%$, (& a+(&! (a+p$a%<
a!(,&$% "p+&% !"%,&! a+)$,(,&+a! ;$? a! "#$%$$. A?a "$"$$ +p+>%,a, p+$% /s&!
"a+< a! III@!a ",a(a+p$a% '$ "$&s&!< s, % p+!&%g$+a a?$ a%,9+a-&!&$.
La ap&(a+a &%&$ /9$(,< "#%a s aap,a> ;/+"#% / 9/!, (& ,+$ a+(&+$ /&
,+a%s+sa! '$ &% a+( !/%g$,&$%a! !a (a+ s aa&g a+(&+$! /9!$( +a!$>a, p+$%
/p/>$-$a p/!$(!&$ (& (!!a!, g,.
As,;! s s(+$&:
a2 Un arc trans7ersal "i3< (a+ (/+sp&% p+-$$ $s,a! a (a+p&!&$< a+( %,+$, p+$%
!$ga"%,&! $%!a+ a%,+$/+ a! (a+p&!&$. A+(&! (a+p$a% ;$? s (/%,$%& p+$%,+@/ pa+, "/9$!
+p+>%,a, p+$% a+(&! ",a(a+p$a% /,a, (& / "a+ (apa($,a, aap,a+ g+a-$
"/9$!$,-$$ ",a(a+p$%!/+ p+$;+$( (a+ s +/,s( % =&+&! !"%,&!&$ ;$? (/%s,$,&$, $%
",a(a+p$a%&! a! /$!a '$ a! ,+$!a. P+$"&! ",a(a+p$a% +"#% $%p%%, '$ a+
"$'(+$ a"p! !a %$!&! a+,$(&!a-$$ (& ,+ap>&!&$< (a ( p+"$, a9&(-$a@a&(-$a '$/p/>$-$a p/!$(!&$.
52 Un arc lon0itudinal carpo4meracarpo4"alan0ian (&p+$%>#% as"%a /
pa+, ;$? (a+p&! '$ ",a(a+p$%! 2 '$ 3 '$ / pa+, "/9$! ;a!a%g!!. C)$a 9/!,
a a(s,&$ a+( s, s$,&a, !a %$!&! a+,$(&!a-$$ ",a(a+p/;a!a%g$%. L>$&%$! a(s,$
a+,$(&!a-$$ a%,+%a> >()$!$9+ "&s(&!a+ '$ ;/+"a-$$ a! g,!/+.
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c2 Arcurile o5lice +a!$>a, p+$% p/>$-$a p/!$(!&$ (& g,! ;$g.1
F$g.1 A+(&+$! "#$%$$
O9$(,$&! s%-$a! a! +(&p++$$ p+)%s$&%$$ s, +(/%s,$,&$+a a+(&+$!/+ 9/!-$$
(a+p/@;a!a%g$% '$ a p%s$ p/!$($$ $g$,a! '$ % sp($a! a p%s$p/!$(@$%?< (a+ a+
(a "a$ a+$a, '$ ;+(%, &,$!$>a+ % gs,&a!$,a,a &>&a! '$ p+/;s$/%a!.
% s,&$&! %,+p+$%s as&p+a "#$%$$ +&"a,$( a" ;/s, ;+apa-$ $"p/+,a%-a
!>$&%$!/+ '$ "a+a ;+(%- (& (a+ $+s ;/+" a;(-$&%$ +&"a,$( (/"p+/"$,
a+"/%$a '$ $%,g+$,a,a a%a,/"/@;&%(-$/%a! a a+(&+$!/+ 9/!-$$ '$ a p%s$ p/!$(@$g$,a!<
$"$%% ;/+-a '$ (apa($,a,a aap,a+ a "#$%$$ % ;&%(-$ ;/+"a '$ $"%s$&%$!
/9$(,!/+ ap&(a,< !$"$,#% p!as+$! gs,&a! % $+s p!a%&+$ g/",+$(.
O+$(a+ a+ ;$ p!a%&! ,+a,a"%, +(&p+a,/+$& ;/!/s$,< ,/,a&%a &+"+$" s
as$g&+" / p/>$- ;&(-$/%a! p%,+& $+s sg"%, (a+ (/"p&% a%sa"9!& ;&%(-$/%a!
a! "#$%$!/+.
P+s/%a!&! a&?$!$a+ $% ()$pa +(&p+a,/+$ ,+9&$ s (&%/as( 9$% $s,$%(-$a
%, $%,+ p/>$-$a a%,a!g$(< +pa&s a "#$%$$ '$ p/>$-$a ;&%(-$&%. C& ?(p-$a
a+,$(&!a-$$!/+ ",a(a+p/;a!a%g$% '$ $%,+;a!a%g$% p%,+& (a+ (! /& p/>$-$$ (/$%($<
p%,+& (!!a!, a+,$(&!a-$$ ! s&%, ;/a+, $;+$,.
,o"i$ia de repaus sau antalgică a m'inii ;$g.2 s, (& p&"%&! % ;!?$ &'/a+
asa (& %(!$%a+ (&9$,a! "/+a,< $a+ g,! % p/>$-$ $%$;+%, s"$;!?$.
T/%&s&! a%,ag/%$',$!/+ s, as,;! ()$!$9+a, $a+ >/%a (aps&!/@!$ga"%,a+ a+,$(&!a+ s,
+!a?a,.
F$g.2 P/>$-$a +pa&s a "#$%$$ F$g.3 P/>$-$a ;&%(-$&% a "#$%$$
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,o"i$ia de func$iune a m'inii ;$g.3 a'a> $;+$, sg"%, % s$,&a-$a (a "a$
;a/+a9$! p%,+& / gs,&a!$,a, ;$(a(. Ds(+$+a a(s,$ p/>$-$$ $;+ !a &% a&,/+ !a
a!,&!< (a ( a+a, ( ;ap, ?$s, %& / p/>$-$ s,a%a+ ($ "a$ "&!, p/>$-$$ ;&%(-$/%a!
% +ap/+, (& gs,&a!$,a,a p+p/%+%, '$ % +ap/+, (& s$,&a-$$ (/"p!, $;+$,< (a
"/9$!$>a+a ,"p/+a! sa& $"/9$!$>a+a ;$%$,$. As,;! &p .O!$+< R.T&9$a%a '$
J.5. La"< pa+a",+$$ sg"%,a+$ ($ "a$ =&$($/'$ s&%, &+",/+$$:
a P&"%&! a+ (a p/>$-$ ;&%(-$&% p%,+& / $"/9$!$>a+ ,"p/+a!< / ?,%s$
/+sa! 2*G4*0 . A(as, p/>$-$ p+"$, ;&%(-$/%a!$,a,a /p,$" %& %&"a$ p%,+&
p&"%< a+ '$ p%,+& g,< $a+ / a%()$!/> % a(as, p/>$-$ a%,+%a> / $%(apa($,a,
"a$ +&s. % (a>&! a+,+/>$ s ;$?a> p&"%&! % ?,%s$ 20G2*0 '$ % %(!$%a-$
(&9$,a! *@100%&"a$ a( ;&%(-$a p+)%s$&% $g$,a! %& s, (/"p+/"$sH as,;!<
/ ;$?a+ a p&"%&!&$ % ;!?$ s, ;&%(-$/%a! "a$ &,$!. Da( 9/!%a&! "+g sp+$=$%$, %9as,/a%< a,&%($ s p+;+ ;!?$a % +(,$,&$%. P%,+& a+,+/>a 9$!a,+a! s
+(/"a% ;$?a+a % 100 ?,%s$< p%,+& "#%a /"$%a%, '$ 1000 ;!?$
(a!a!, pa+,.
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;a!a%g$a% '$ 1000 % $%,+;a!a%g$a% '$ (& ,+ap>/@",a(a+p$a% % a%,;!?$ "a?$"H
a9&(-$ (& (/"$s&+a s()$s !a "a?$"&" '$ &'/a+ +/,a-$ $%,+% ($ %
s"$/p/>$-$ %a$%,a p!a%&!&$ pa!"a+< as,;! %(#, $%?&! '$ "$&s&! %& a& ?(&,a,
(#, / &'/a+ ;!?$ p%,+& a %,#!%$ p/!$(! $"/9$!$>a, % 9&% p/>$-.
U!,$"! pa,+& g, s p&% % (a> $"/9$!$>a+ ,"p/+a+ % p/>$-$ ;&%(-$/%a!
s"$;!?$ '$ a%&": / ;!?$ *0@00 % ",a(a+p/;a!a%g$%< / ;!?$ 10@400 %
$%,+;a!a%g$% p+/?$"a! '$ 10@200 % $%,+;a!a%g$%! $s,a!. % (a> $"/9$!$>a+
;$%$,$ s ;$?a> $%?&! % ;!?$ a ",a(a+p/;a!a%g$%$ 30@3*0 $a+ a&+$(&!a+&!
*00 % ;!?$a $%,+;a!a%g$a% p+/?$"a! 3*0p%,+& $%?< 400 "$&s< 4*0 $%!a+ '$ 3*0
a&+$(&!a+H / ;!?$ a $%,+;a!a%g$%$ $s,a! 1*0 p%,+& $%?< 200 "$&s< 300 $%!a+ '$
400 a&+$(&!a+. Ds$g&+< % +ap/+, (& (apa($,a,a ;&%(-$/%a! +>$&a! a (!/+!a!, a+,$(&!a-$$
'$ (& gs,&a!$,a,a p+/;s$/%a!< a(s, p/>$-$$ ;&%(-$&% /+ p&,a s&;+$ &%!
"/$;$(+$ '$ aap,+$ !a (a> !a (a>. D "/&! (&" ;(,&" p+a(,$( $"/9$!$>a+a
"#$%$$ +&"a,$( p$% as/+$ $$,/+&! ;&%(-$/%a! a! "#$%$$.
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Capitolul V
TIPURI DE PREHENSIUNE A #&INII
S a(/+ / a,%-$ sp($a! (/$;$(+$$ '$ a%a!$>$ ,$p&+$!/+ p+)%s$&% (! "a$
a;(,a, p+$% !>$&%$! +&"a,$s"a! a! "#$%$!/+.
M#%a /"&!&$ s, a+)$,(,&+a! '$ ;&%(-$/%a! as,;! >/!,a, % (#, s p/a,
$sp&% ,+$ ;/+" p+$%($pa! p+)%s$&%:
a p+)%s$&%a $%,+ /& $% &!,$"! pa,+& g,
9 p+)%s$&%a $%,+ &!,$"! pa,+& g, "p+&% sa& $>/!a, '$ p/&! pa!"$.
( p+)%s$&%a $%,+ (/!/a%a p/!$(!&$< +s,&! g,!/+ '$ pa!"$. Preensiunea dintre ultimele patru degete s ;(,&a> (,+ /& g,
(a+ =/a( +/!&! 9+a-!/+ p%s< ap+/p$$%&@s '$ p+,#%&@s &%&! (!!a!, p+$%
"$'(a+a a&(-$ '$ a9&(-$ p (a+ / p+"$, a+,$(&!a-$$! !/+ ",a(a+p/@
;a!a%g$%< s&9 a(-$&%a $%,+/s/'$!/+ pa!"a+$ (a+ ! ap+/p$ '$ a$ $%,+/s/'$!/+ /+sa!$
(a+ ! p+,a>. La ap+/p$+a g,!/+ (/%,+$9&$ '$ ;!?/+&! (/"&% a! g,!/+ '$
?,%s/+&! p+/p+$& a! $%?&!&$< $a+ !a p+,a+a !/+ (/%,+$9&$ '$ ?,%s/+&! (/"&% a!
g,!/+ '$ ?,%s/+&! p+/p+$& a! g,&!&$ "$(.
Preensiunea între ultimele patru degete !i podul palmei s, p/s$9$! p+$%a(-$&%a ;!?/+&!&$ (/"&% p+/;&%< (a+ ;!(,a> ;a!a%g! $s,a! '$ a ;!?/+&!&$ (/"&%
s&p+;$($a!< (a+ ;!(,a> ;a!a%g! "$=!/($$ '$ p+/?$"a!. S&9 a(-$&%a a(s,/+ "&'()$$<
g,! s s,+#%g s ap+/p$ '$ p/, s a,$%g< p+$% ;-! !/+ pa!"a+< p/&!
pa!"$.A(s,a s, "/&! p+$% (a+ "#%a a+ p/s$9$!$,a,a a ag-a< %$% &% ;!
(#+!$g (a+ p/a, s -$% /9$(,! ?. &(+a &%$ g!-$ (& ap .
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Preensiunea cu a"utorul #coloanei policelui$ s, "a$ (/"p!? '$ "a$ &,$!.
C/!/a%a p/!$(!&$ $sp&% p/s$9$!$,-$ "$'(a+ a+$a, ;a- +s,&! "#$%$$. P/!$(!
s ;!(,a> s&9 a(-$&%a !&%g&!&$ ;!?/+ '$ s ?,$% s&9 a(-$&%a !&%g&!&$ '$ s(&+,&!&$
?,%s/+< s p/a, %p+,a $%? s&9 a(-$&%a !&%g&!&$ a9&(,/+< a !&%g&!&$
?,%s/+ '$ s(&+,&!&$ a9&(,/+ '$ s p/a, ap+/p$a s&9 a(-$&%a a&(,/+&!&$ '$ % pa+,<
a ?,%s/+&!&$ !&%g '$ a !&%g&!&$ ;!?/+< "$'(a+a ;(,%&@s $% a+,$(&!a-$a ,+ap>/@
",a(a+p$a%.
M&'()$$ "#$%$$ s "pa+, % /& "a+$ g+&p: grupa muşcilor de atitudine< (&"
s&%,: ?,%s/+$$ g,!/+< a9&(,/+&! p/!$(!&$ '$ "&'()$$ /p/>a%-$H '$ grupa muşcilor de
for$ă< (&" s&%,H ;!?/+$$ g,!/+ '$ a&(,/+&! p/!$(!&$ (a+ ?(&, p+$%+a p+/p+$&@
>$s.
E?$s, "a$ "&!, ;!&+$ p+$%+:
@p+$%+a (& %,+aga "#% a /9$(,!/+ g+!< (&" a+ ;$: ($/(a%&!< sapa< ,(. %
p+a(,$(a &%/+ sp/+,&+$< %,#!%$" &% as"%a ,$p p+$%+: % (a%/,a=< )a!,+< s(+$"<
,(.
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;(&, (#+!$g. As,;! s p/, p+$% /9$(, !a,< s&9-$+$ '$ !&%g$ sp+ ?. )-&+$! ,(.
@p+$%+a (& p%sa (&+9 p/!$(@$%?< (a a,&%($ (#% p+$%" &% a( (&s&,
sa& &% a( s+$%g< s, / p+$%+ p+($>$ a+ ;+a ;/+-.
@p+$%+a (& p%sa !&%g p/!$(@$%?< (a a,&%($ (#% s p+$% / p%s
$s(-$.
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@p+$%+a (& p+$"! ,+$ g, %,$%s< /9$(,&! ;$$% p+$%s %,+ !< % ,$"p (
$%?&! '$ ! %,$%s s+', (/%&(,/+. E?"p!& p+$%+a &%&$ 9$s,&+$&.
A!, "$'(+$ a! "#$%$$:
M#%a "a$ $sp&% '$ p/s$9$!$,a,a a s&s-$% '$ a "p$%g.
S&s-$%+a s p/a, ;a( ;$ (& ;a-a /+sa!< ;$ (& ;a-a pa!"a+ a "#$%$$< a+ %
sp($a! (& (a pa!"a+.
"p$%g+a s ;(,&a> (& p/&! pa!"$< (a+ ;$$% a(/p+$, (& -s&,&+$ "/$
,%a+ '$ )$p/,%a+< p+"$, ,+a%s"$,+a &%$ ;/+- %s"%a, sp+ /9$(,&! "p$%s<
;+ (a a(s,a s p+//a( ,&!9&++$ sa& s,+$$+$.
% a;a+a p+)%s$&%$$< s&s-$%+$$ '$ "p$%g+$$< ""9+&! s&p+$/+ "a$ a+
p/s$9$!$,a,a a !/$ '$ a a+&%(a.
P/>$-$$! a,#+%a, '$ sp+$=$%$, s&%, as"%a p/s$9$! ,/, p+$% $%,+a+a % a(-$&% a"(a%$s"!/+ p+)%s$&%$$.
Capitolul VI
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1A8ELE 1I%#ECANICE ALE RECUPER9RII #I:C9RIL%R
#&INII
M#%a /"&!&$ a (/%s,$,&$, /9$(,&! a %&"+/as s,&$$ pa!%,/!/g$< a%,+/p/!/g$
'$ "9+$/!/g$. Da( $% p&%(, + "/+;/!/g$( "#%a ps,+a> s,$g$$ a%a,/"$(
a%(s,+a!< % s()$"9 $% p&%(, + ;&%(-$/%a! "#%a s, ap/g&! /!&-$. La
+$$(a+a p+$"a,&!&$ s&p+$/+ % /+,/s,a,$s"< "#%a a s&;+$, (#,a ,+a%s;/+"+$
a%a,/"$(:
@,g&"%,! ;-$ pa!"a+ s@a& "9/g-$, % (/+p&s(&!$ s%>/+$a!$H
@"#%a $% &% /+ga% p+(p-$< +!a-$H
@"#%a a /!&a, pa+a!! (& (+$+&! s,$"&!#%&@s +($p+/(. I"p/+,a%-a ;&%(-$/%a! a "#$%$!/+ p%,+& $a-a s/($a! '$ p+/;s$/%a! a /"&!&$ s,
(/%s$+a9$!. A%sa"9!&! ($9+%,$( /9$(,! $% =&+ '$ s $%,+p+,>
$%;/+"a-$$! $>&a!.
S,a,$s,$(! $% %&"+/as -+$ s(/, % $%- ( !>$&%$! "#$%$!/+ +p+>$%, &%a
$% p+$%($pa!! ;/+" $%a!$$,a,.
P p!a% a+)$,(,&+a!< "#%a s, (/"p&s $% ($%($ +a> ;/+"a, $% ;a!a%g '$
",a(a+p$%. La ap&(a+a &%&$ /9$(,< "#%a s aap,a> ;/+"#% / 9/!, (& ,+$
a+(&+$ !a (a+ s aa&g a+(&+$! /9!$( +a!$>a, p+$% /p/>$-$a p/!$(!&$ (& (!!a!,. As,;!
s s(+$&:
@&% a+( ,+a%s+sa! ;$? H
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(a+p/@",a(a+p/@;a!a%g$% '$ a p%s$$ p/!$(@$g$,a!.
O+$(a+ a+ ;$ p!a%&! ,+a,a"%, +(&p+a,/+$& ;/!/s$, ,/,a&%a &+"+$" s
as$g&+" / p/>$-$ ;&%(-$/%a! p%,+& $+s sg"%, (a+ (/"p&% a%sa"9!&!
;&%(-$/%a! a! "#$%$!/+.
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P&"%&! a+ (a p/>$-$ ;&%(-$&% p%,+& / $"/9$!$>a+ ,"p/+a+< / ?,%s$
/+sa! 2*@4*0. A(as, p/>$-$ p+"$, / ;&%(-$/%a!$,a, /p,$" %& %&"a$ p%,+&
p&"%< a+ '$ p%,+& g,. % (a>&! &%$ a+,+/> s ;$?a> p&"%&! % ?,%s$
20@2*0< a( p/>$-$a p+)%s$&% $g$,a! %& s, (/"p+/"$s.
P/!$(! s a'a> % p/>$-$a ;&%(-$/%a!: s"$;!?$< a9&(-$ '$ &'/a+ +/,a-$
$%,+%.
U!,$"! pa,+& g, s p&% % (a> $"/9$!$>a+ ,"p/+a+ % p/>$-$ ;&%(-$/%a!
s"$;!?$: ;!?$ *0@00 % ",a(a+p/;a!a%g$%< / ;!?$ 10@400 %
$%,+;a!a%g$%! p+/?$"a! '$ 10@200 % $%,+;a!a%g$%! $s,a!. % (a> $"/9$!$>a+ s
;$?a> $%?&! % ;!?$ a ",a(a+p/;a!a%g$% 30@3* 0< $a+ a&+$(&!a+&! !a *00H % ;!?$a
$%,+;a!a%g$a% p+/?$"a! 3*0 p%,+& $%?< 400 "$&s< 4*0 $%!a+ '$ 3*0 a&+$(&!a+H/
;!?$ a $%,+;a!a%g$%$ $s,a! 1*0 p%,+& $%?< 200 "$&s< 300 $%!a+ '$ 400
a&+$(&!a+.
D "/&! (&" ;(,&" p+a(,$( $"/9$!$>a+a "#$%$$ +&"a,/$ p$% as/+$
$$,/+&! ;&%(-$/%a! a! "#$%$$.
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Capitolul VII
P%LIARTRITA REU#AT%ID9
;('( +eneralit,!i
P/!$a+,+$,a +&"a,/$P.R. '$ 9/!$! %+&$, (& a< +$$( (! "a$ "a+$ p+/9!"
as$s,%- '$ +(&p+a+ % sp($a!. Ea +p+>$%, / a;(-$&% a -s&,&!&$ (/%=&%(,$< (&
/!&-$ (+/%$(< (a+a(,+$>a, (!$%$( p+$% a+,+$, p+$;+$(< asa s$",+$(< p+s$s,%,<
%s&p&+a,$< (& /!&-$$ sp+ ;/+"+$ '$ a%()$!/> ,$/!/g$$ %(&%/s(&,.
Ca+a(,+$s,$(a 9/!$$ s, / p/!$s$%/$, (+/%$( %s&p&+a,$ a a+,$(&!a-$$!/+ p+$;+$(.B/a!a a+ / /!&-$ %!&%ga, (& p&s&+$ a(&,< !/(a!$>a, (& p+$!(-$ !a a+,$(&!a-$$!
"$($ a! ?,+"$,-$!/+< s$",+$( '$ 9$!a,+a! (& "/$;$(+$ +a$/!/g$( /s,/p/+/> '$
,s, p/>$,$ p%,+& ;a(,/+$$ +&"a,/$>$.
P+a!%-a 9/!$$ !a a&!-$ s, 1@3. Es, "a$ ;+(%, % -+$! (& (!$"a, +( '$
&". F+(%-a "9/!%$+$$ p s? s, %, % ;a/a+a s?&!&$ ;"$%$%< +ap/+,&!
;$$% 3:1 !a p/p&!a-$ a&!,< (& ,%$%-a ga!$>a+ % ;/+"a =&%$! sa& (& 9&, !a
#+s,%$($. #+s,a /9$'%&$, 9&, s, 2*@3*< a+ s p/a, a,#, "a$ +" (#, '$"a$ ,#+>$&.
;()(Etiopato0enia
E,$/pa,/g%$a P.R. s, %(&%/s(&, ;$$% p+/9a9$! / ,$/!/g$ "&!,$;a(,/+$a!. S@a
sp+$%s / $ 9a>a, p (&%/',$%-! a(,&a! ( P.R. s, (/%s($%-a $%,+%-$$ &%&$
a%&"$, ;/% g%,$( $%$$&a! ( ,+"$% pa+,$(&!a+$,-$ +sp&%s $"&%/!/g$( ;a-
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p$"$/!/g$(< (!$%$( '$ 9$/!/g$(< s,&$&! "a++$!/+ g%,$($ '$ (a+$/,$p$>a+.
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A#% / $s,+$9&-$ g/g+a;$( $;&> %& s@a /9s+a, %$($ / $;+%- %,+
p+a!%-a a(s,&$a % $;+$, a+$$ g/g+a;$(. U% +/! $"p/+,a%, % ,/a, ;/+"!
+&"a,$s" ! =/a( +$,a,a< $a+ P.R. a ;/s, (/%s$+a, "&!, / 9/a! ;a"$!$a! as,;!
+$,-$$ ,+9&$ s $s /;+ &% (a+a(,+ p+$sp/>$-$ % apa+$-$a P.R.
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;%/,$p&! 5LA@D4 '$ P.R. % (/"pa+a-$ (& "a+,/+$$. S@a (/%s,a,a, % (a+&! a(s,/+
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a,$,&$%a ,+ap&,$( $%,+#% % (a!(&!a+a &%&$ $%$( p+$(,$ as&p+a /!&-$$ 9/!$$.
F%/"%&! 5LA@D4 s, "a$ ;+(%, % P.R. '$ p+>$%, ag+ga+ ;a"$!$a! (&
PR 5LA@D2 s as/($a> (& ;%/"% (!$%$( s+/!/g$( s+.
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;(.( Anatomie patolo0ic,
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