Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29465/1539/
1Ö29 
WRIST-JOINT (Abnormal Anatomy). 
above the annular ligament), while the fingers 
of the opposite hand are placed on the other 
extremity, which is placed beneath this 
fibrous band, we readily perceive a “frotte¬ 
ment ” which is quite peculiar. This “ frotte¬ 
ment ” is caused by the passage to and fro, 
under the true annular ligament of the wrist, 
of small foreign bodies which are not unlike 
barley grains or those of boiled rice. Their 
forms are exceedingly variable. They are 
usually of a white colour, and have a polished 
surface. They are found in vast numbers in 
the same cyst, mixed with a more or less con¬ 
siderable quantity of glairy synovial liquid. 
They are ordinarily free from all adhesions to 
the parietes of the bursa. 
Many theories have been formed as to the 
origin of these little bodies found loose in the 
bursa, about the wrist, and elsewhere. 
Dupuytren thought he had established the 
theory that they were hydatids. Laennec and 
Raspail agreed with him in this view ; but 
Bose, to whom Dupuytren referred, dissented. 
The last-mentioned naturalist looked upon 
them as concretions of lymph of an adipo- 
cerous nature. He says, “ They are not to 
be considered as ‘ hydatids,’ because they 
have not given any sign of life on escaping 
from the cyst.” On dividing these bodies, he 
found them uniform throughout, whilst that 
of hydatids are always hollow ; and again, 
because submitted to a strong lens, they have 
appeared to him to be nothing else than an 
inorganic mass, whether he examined them 
when recent or dried.” 
Sir Benjamin Brodie’s opinion now seems 
generally to prevail. It is adopted by 
Nelaton * and other French physiologists : — 
“ There seems to be no doubt but that these 
loose bodies have their origin in the coagu¬ 
lated lymph which was effused in the early 
stages of the disease ; and I had opportuni¬ 
ties, by the examination of several cases, to 
trace the steps of their gradual formation. At 
first the coagulated lymph forms irregular 
masses of no determined shape, which after¬ 
wards, by the motion and pressure of the 
contiguous parts, are broken down into small 
portions. These by degrees become of a 
regular form, and assume a firmer consist¬ 
ence, and at last are converted into the oval 
bodies above alluded to.” j* 
Examples of these have been seen in the 
synovial sheaths of the radial extensors as 
well as on the back of the wrist in the course 
of the extensors of the fingers. But it is, 
nevertheless, certain that the bursa of the 
flexor tendons, situated in front of the wrist 
and carpus, and behind the true annular liga¬ 
ment of this region, is the special locality in 
which these foreign bodies are most frequently 
found. 
Painful Crepitation of Tendons around the 
Wrist. —We notice, sometimes, around the 
carpus and in the inferior extremity of the 
* En 1819 M. Brodie donna une interpretation 
satisfaisante de leur étiologie en les rattachant aux 
epanchemens sero-albumeux. (Nelaton, Pathologie 
Chirurgicale.') 
f Brodie on the Diseases of the Joints. 
forearm, a swelling which is peculiar in this, 
that, whenever the tendons around which the 
swelling forms are moved, there is thereby 
elicited a very peculiar crepitation. 
This crepitation is noticed along the course 
of the extensor carpi radialis longior and 
brevior, and in that of the long abductor and 
short extensor of the thumb. This swelling 
is not globular, nor is it so well defined as a 
ganglion, but may be said to represent in its 
form a portion of a spiral which, parting from 
the dorsal surface of the forearm, soon turns 
round the external part of the radius to gain 
the root of the first metacarpal bone. 
This swelling seems to be of an inflamma¬ 
tory nature, and is occasionally accompanied 
with a superficial redness of the skin ; and 
pressure on this part becomes painful to the 
patient. If the surgeon places his thumb or 
fingers on the postero-external surface of the 
forearm, near to the wrist-joint, where the ob¬ 
long swelling exists, and at the same time de¬ 
sires the patient to move the hand by flexing 
and extending the wrist-joint, or exert the 
muscles, the peculiar crepitation which cha¬ 
racterises this lesion is soon perceived. 
It is not very easy to convey an idea of this 
crepitation ; but it has been compared by 
many to that produced by the crushing to¬ 
gether, with our fingers, portions of finely 
powdered starch, or to the effect which we 
feel produced when we walk over snow. 
When once recognised, it is perceived to be 
quite different from that crepitation which is 
produced by the movement on each other of 
the fragments of broken bones or the rubbing 
together of roughened articular surfaces. 
This disease has for its anatomical seat the 
fibro-synovial sheaths of the tendons already 
mentioned. These extensor tendons, namely, 
the two extensor radialis longior and brevior, 
as well as those of the long abductor and short 
extensor of the thumb, cross each other, each 
in special sheaths or canals formed on the back 
part and external edge of the lower extremity 
of the radius ; and if inflammation attack the 
lining membrane of these fibro-synovial 
sheaths, it is plain that, in this anatomical 
arrangement, there may be seen many circum¬ 
stances to favour the development of this 
crepitation. 
This affection has not, we believe, ever 
been observed to have come on sponta¬ 
neously, but generally to have arisen from 
some violent and continued efforts of the 
wrist and hand. 
It has been noticed in soldiers and masons, 
and in those who are in the habit of twisting 
the forearm, as in the act of forced pronation 
of the forearm of washerwomen in wringing 
clothes. The tumefaction, the swelling, pain 
and heat, and the crepitation also, once com¬ 
menced, augment generally for four, six, or 
eight days ; and if the patient be guilty of 
any imprudence, the evil is maintained to the 
same degree even to the twelfth or fourteenth 
day, after which it ordinarily terminates in 
resolution. 
(Robert Adams.)
        

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