Recuperarea Mainii Reumatoide in Stadiile II Si III

8/17/2019 Recuperarea Mainii Reumatoide in Stadiile II Si III

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______________________________________________________Recuperarea mâinii reumatoide în stadiile II şi III

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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2/98


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$s,"$( (+/%$( a (+$

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as(&!a+< +%a!< /(&!a+< (&,a%a,< %&+/!/g$(.

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Ca&>a 9/!$$ s, %(&%/s(&,< a+ s pa+ ( ?$s, / (/"9$%a-$ ;a(,/+$

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;a"$!$a! a 9/!$$ '$ p+>%-a a%,$g%!/+ )$s,/(/"pa,$9$!$,a,.

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p/!$a+,+$,$ +&"a,/$ % p/p&!a-$a a(,$ 0


4/98


Capitolul I

ANAT%#IA #&INII

'('( %asele mâinii

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,+ap>/$&!< (ap$,a,&! '$ /s&! (& (#+!$g.

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s"$($!$%+$(< "a$ !a, (#, %a!, p+>%,#% pa,+& ;-:

@;a-a a%,+$/a+H

@;a-a p/s,+$/a+H

@;a-a s&p+$/a+H

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;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&%, % ;!?$.

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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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5/98


@;a!a%ga p+/?$"a!H

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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;

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s s&p+ap&% '$ $%sp+ s&p+a;a- sp+ p+/;&%>$" s&%, +p+>%,a-$ :

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as(&!a+$>a-$a: $% +a"&+$ (/!a,+a! a! a+,+$ +a$a!H

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6/98


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",a(a+p$a%&!&$ p (a+ '$ a& /+$g$%a.

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O+$g$%a: p ;a-a ",a(a+p$%!/+ (a+ !$"$,a> spa-$$! I


7/98


$%,+/s/s&!&$ /+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 "&'()$!/+ $%,+/s/'$:

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a+,+! ",a(a+p$% sa& $%,+/s/as pa!"a+ '$ /+sa!.

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P+/$% $% +a"&! ,+"$%a! p+/;&% a! %+&!&$ &!%a+

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%+&!&$ &!%a+ $%+a> &!,$"$$ /$ !/"9+$(a!$.

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@% 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(&+,

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as(&!a+$>a-$a: p+/$% $% +a"&+$ a! a+,+$ &!%a+H

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8/98


A(-$&%a: ;!?$a ;a!a%g$ p+/?$"a! p ",a(a+p$% '$ ?,%s$a ;a!a%g!/+ "$=!/($$ '$

$s,a!H

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as(&!a+$>a-$a: p+/$% $% a+(a! pa!"a+H

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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

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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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9/98


9 Mijloacele de unire: s&%, +p+>%,a, (aps&!a a+,$(&!a+ %,+$,

!$ga"%,< (a+ s&%, % +ap/+, $+(, (& ,($! ,%/a%!/+ ;!?/+$!/+ '$ ?,%s/+$!/+

g,!/+.

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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!.

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s(a;/$&!&$.

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&!%a+< $a+ $s,a! s ,+"$% p+$% /& ;as($(&! (a+ s $%s+ p p$+a"$a! '$ p$s$;/+".

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(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!.

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$+(, a! %+$!/+ "$a! '$ &!%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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10/98


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&!%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!.

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a+,$(&!a-$$ '$ p+$% ;$9+! !/+ s&p+;$($a! a=&%g p ;a-a s&p+$/a+< a+,$(&!a+ a (/%$!&!&$

(a+p$a%.

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,+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%.

_______________________________________________________________________________________ 10


11/98


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$%.

_______________________________________________________________________________________ 11


12/98


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.

_______________________________________________________________________________________ 12


13/98


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/@

_______________________________________________________________________________________ 13


14/98


;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!.

_______________________________________________________________________________________ 14


15/98


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,+$/+


16/98


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%.

_______________________________________________________________________________________ 16


17/98


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%


18/98


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!.

_______________________________________________________________________________________ 18


19/98


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


20/98


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+$ (/"&%$<

_______________________________________________________________________________________ 20


21/98


+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


22/98


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


23/98


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+$(a!$.

_______________________________________________________________________________________ 23


24/98


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,!/+.

_______________________________________________________________________________________ 24


25/98


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$g.2 P/>$-$a +pa&s a "#$%$$ F$g.3 P/>$-$a ;&%(-$&% a "#$%$$

_______________________________________________________________________________________ 25


26/98


,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+,.

9 P/!$(! s a'a> % p/>$-$ ;&%(-$/%a! %: s"$;!?$ 1000 % ",a(a+p/@

;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

"#$%$$ +&"a,$( p$% as/+$ $$,/+&! ;&%(-$/%a! a! "#$%$$.

_______________________________________________________________________________________ 26


27/98


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 .

_______________________________________________________________________________________ 27


28/98


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+$%+: % (a%/,a=< )a!,+< s(+$"<

,(.

@p+$%+a p+$% a&(-$ a p/!$(!&$< (a+ s ap!$( p "a+g$%a ?,+% a $%?&!&$

;(&, (#+!$g. As,;! s p/, p+$% /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

$s(-$.

_______________________________________________________________________________________ 28


29/98


@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

_______________________________________________________________________________________ 29


30/98


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

@&% a+( !/%g$,&&%a!H

@a+(&+$! /9!$(.

O9$(,$&! s%-$a! a! +(&p++$$ p+)%s$&%$$ s, +(/%s,$,&$+a a+(&+$!/+ 9/!-$$

(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!&!

;&%(-$/%a! a! "#$%$!/+.

_______________________________________________________________________________________ 30


31/98


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$% as/+$

$$,/+&! ;&%(-$/%a! a! "#$%$$.

_______________________________________________________________________________________ 31


32/98


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-

/ s,$"&!a+ a%,$g%$( ?,+$/a+ p+/9a9$! %a,&+ $%;(-$/as ( $%(+$"$%a> ;a(,/+$$

g%,$($ $%;(-$/'$ a&,/$"&%$.

% +a!$>a+a P.R. s,&$&! p/%+$$ +$,-$$ s, 9/ga, % ;ap, /9s+a-$

p$"$/!/g$(< (!$%$( '$ 9$/!/g$(< s,&$&! "a++$!/+ g%,$($ '$ (a+$/,$p$>a+.

_______________________________________________________________________________________ 32


33/98


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.

S,&$$! +(%, a& a+,a, / as/($+ ap+/?$"a,$ ,+$ /+$ "a$ "a+ %,+

;%/,$p&! 5LA@D4 '$ P.R. % (/"pa+a-$ (& "a+,/+$$. S@a (/%s,a,a, % (a+&! a(s,/+

a%,$g% )$s,/(/"pa,$9$!$,a, ( a%&"$, a%,$g% %s/-s( ;/+" 9%$g% 9/a!

$a+ a!,! %s/-s( ;/+" %/&!a+ '$ s+/!/g$( s+. C&%/a',+a !/+ a+ $%;!&%-a

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+.

F+(%-a "a$ "a+ a 9/!$$ !a ;"$ p&% p+/9!"a +/!&!&$ ;a(,/+$!/+ %/(+$%$ %g%>a s&;+$%-$.

A!&+a $%;!a"a,/+$ a "a%$;s,+$!/+ a+,$(&!a+ '$ s$s,"$( $% (a+&! P.R. s$%/$,

(& !>$&%$ g+a%&!/"a,/as< a%/@sp!%/"ga!$< ;9+< !&(/($,/>< ,a)$(a+$<

a((!+a+a S5@&!&$ '$ a!, "/$;$(+$ ;a> a(&, s&%, (/"pa,$9$! (& ?$s,%-a &%&$

p+/(s $%;(-$/s.

A& ;/s, $%(+$"$%a-$ as,;! ;a(,/+$ (a: $%;(-$a 9a(,+$a% (& s,+p,/(/( )"/!$,$(<

s,a;$!/(/(< %,+/(/(< 9a($!&! K/()< ,(.< "$(/p!as"!< $%;(-$a (& !$s,+$$< $%;(-$$ $+a!.

S@a (/%s,a,a, (!$%$( '$ ?p+$"%,a! ( P.R. (/+sp&% %,+@&% "/ ;+apa%,

(+$,+$$!/+ !a9/,a, Ma(a p%,+& ;$%$+a 9/!$!/+ a&,/$"&%.

a P+>%-a a%,$(/+p$!/+ sp($;$($H

9 P+/!$;+a+a !$";/p!as"/($,a+H

( 5$p+g!/9&!$%"$aH

Dp/>$,a+a $"&%/g!/9&!$% %a,&+a, % $%,+s,$-$$H

E;(,&! ;a/+a9$! a! (/+,$(/,+ap$$H

; As/($+a (& a!, 9/!$ (& "(a%$s" s$"$!a+ p+s&p&s sa& /$,.

_______________________________________________________________________________________ 33


34/98


;(.( Anatomie patolo0ic,

P+$%($pa!! !>$&%$ % P.R. s&%, !/(a!$>a, !a %$!&! a+,$(&!a-$$!/+ "/9$!.% g%+a!

"a%$;s,+$! s$s,"$( s&%, "a$ p&-$% ?p+$"a, '$ "a$ +a+ %,#!%$,< a,+g#% %s

a,%-$a as&p+a $%,+s+$$ $;&> a -s&,&!&$ (/%=&%(,$.D$% p&%(, + (!$%$( (#, '$

"/+;/@pa,/!/g$(< a+,$(&!a-$a s, s,+&(,&+a a%a,/"$( '$ p+/"$%a%, $%,+sa, %

p+/(s&! "/+9$. As,;! s p/, s(+$:

'(Le6iuni articulare

I%;!a"a-$a a+,$(&!a+ $% P.R. s, $%$-$a, % ""9+a%a s$%/$a! &% s

+p+(&,a> % "/ s$"$!a+ as&p+a (a+,$!a=&!&$ a+,$(&!a+ '$ ap/$ as&p+a /s&!&$ s&9(/%+a!

&(#% % (! $% &+" !a a%()$!/> (& ;/+"+$ a+,$(&!a+.

a S$%/$,a s (a+a(,+$>a> p+$% ,+$ "/$;$(+$ p+$%($pa!: @?&a-$a

@$%;$!,+a-$a (!&!a+

@;/+"a+a -s&,&!&$ g+a%&!a-$.

E?&a-a s, (/%s($%-a $+(, a (/%gs,$$ (ap$!a+ '$ a ,&!9&++$!/+

p+"a9$!$,a,. C/%gs,$a '$ "&! $%,+sa> (& p+(+ p/+-$&%a $% $"$a,a

($%,a, a "a+g$%$!/+ (a+,$!a=!/+.

9 Ca+,$!a=&! a+,$(&!a+ Na,&+a "(a%$s"&!&$ a!,+a+ a (a+,$!a=&!&$ a+,$(&!a+ % P.R. %& s, (&%/s(&,

(& ?a(,$,a,. S pa+ ( / a%&"$, %>$" p+/&s !&(/($,! p/!$%&(!a+ sa&

s$%/$/($, s&%, (apa9$! s a!,+> p+/p+$,-$! s,+&(,&+a! '$ "(a%$( a! (a+,$!a=&!&$<

/+$(&" p+/(s&! $s,+&g+ %(p !a p+$;+$a (a+,$!a=&!&$ '$ s ;a( (/%(%,+$(<

a!,+#% % p+$"&! +#% s&9s,a%-a ;&%a"%,a! a (a+,$!a=&!&$.

( Os&! s&9(/%+a!

M/$;$(+$! )$s,/!/g$( !a %$!&! p$;$>!/+ /as!/+ !&%g$ s&%, as"%,/a+ (!/+

$% ""9+a%a s$%/$a! '$ s p/a, /9s+a / (/%,$%&a+ a -s&,&!&$ ;/+"a, a$($. P+$%

(/%gs,$ !/(a! apa+ &% %&"+ (+s(&, /9s,a(/! (a+ &( !a apa+$-$a &%/+ >/%

%+g&!a, sa& ($+(&"s(+$s /s,/!$>< (a+ ?p!$( p$++a +a$//pa($,-$$

p$;$>!/+ '$ asp(,&! ps&/()$s,$( +a$/!/g$(.

_______________________________________________________________________________________ 34


35/98


A%()$!/>a '$ ;/+"+$! a+,$(&!a+

s&,&! g+a%&!a-$ ;/+"a, % s,+a, (/%,$%&& !a %$!&! a"9!/+ s&p+a;-

a+,$(&!a+ s&;+ (& ,$"p&! &% p+/(s ;$9+/>a+ (a+ (+a> p&%-$ a+%-$a! %,+

p!a%&+$! "/9$! a;!a, % (/%,a(,.

% a(s, a+%- p/a, ap+a -s&, (a+,$!ag$%/s sa& /s/s +a!$>#% a%()$!/>a.

D;/+"+$! a+,$(&!a+ s p+/&( s&9 a(-$&%a "a$ "&!,/+ ;a(,/+$: s!9$+a apa+a,&!&$

(aps&!/@!$ga"%,a+< +,+a(-$$ '$ +&p,&+$ ,%$%/as< ;/+-!/+ "(a%$( ?+($,a,

,+a(-$&%$ "&s(&!a+< sp($;$(&! &%/+ a+,$(&!a-$$.

)( Le6iuni e3traarticulare

a odulii reumatoi"i s&%, (/%s$+a-$ +p, "a%$;s,a+a ?,+aa+,$(&!a+ (a "a$

(a+a(,+$s,$( p%,+& P.R. A(',$a p+>$%, (%,+a! / >/% %(+/> $a+ !a p+$;+$ &%

-s&, g+a%&!a-$ $%,%s as(&!a+$>a,.

9 endoanele şi ligamentele s&%, a;(,a, &% p+/(s $%;!a"a,/+ %(a+a(,+$s,$(

(a+ p/a, "+g p#% !a ;/+"a+a !>$&%$ %/&!a+ as"%,/a+ %/&!$!/+

s&9(&,a%a-$< !/( &% s p/a, p+/&( +&p,&+a ,%$%/as (a+ (/%,+$9&$ !a +a!$>a+a

;/+"+$!/+.

( Musculatura striată a;(,a, p+$% $%;$!,+a, !$";/p!as"/($,a+ "$%$".

lte organe

@L>$&%$ Gp/!$"/+; ,$p ?&a,$ '$ %(+/>a%,

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@L>$&%$ p&!"/%a+@p!&+$,< p%&"/pa,$$.

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;($/!/g$( ,+"$%a, +/>$&%$!

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;ap, (a+ a+,$(&!a-$$ &% asp(, ;&s$;/+". A(as, ;/+"a+ a+,$(&!a+ p/a, s apa+

!a %(p&,&! 9/!$$< %s s, ap+/ap (/%s,a%, &p &% a% /!&-$. Ds/+$ s&%,

p+$%s s$"&!,a% '$ s$",+$( a+,$(&!a-$$! ",a(a+p/;a!a%g$%. % ,$"p< $s,+&(-$a

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37/98


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as(&!&$,$(. D /9$($ "a%$;s,+$! ?,+aa+,$(&!a+ apa+ % (a>&+$! "a$ s+ 9/a!.

Tg&"%,! p/, p+>%,a %/&!$ +&"a,/$>$< !"%, p&+p&+$(< ,&!9&++$

,+/;$(.

;(=( Ta5lou clinic

De5utul P(R(

P.R. p/a, s apa+ !a /+$( #+s,a< $%($%-a s$,%&@s %,+ 20@0 a%$ (&

/& %, p%,+& / p+$/a a+$a9$! ,$"p: @as,%$H

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@$;+$, $%;(-$$.

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A+,$(&!a-$$! $%,+sa, s&%, &++/as< ,&";$a, '$ (a!< +a!$>#% &% asp(, _______________________________________________________________________________________ 37


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% ,$"p&! >$!$< ap/$ s $%,%s$;$( sp+ sa+ '$ % (&+s&! %/p-$$. % a;a+a

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p/>$,$ $ag%/s,$(: ;$?$,a,< p+s$s,%- % ,$"p '$ !/(a!$>a+ asa s$",+$(.

R/a+a "a,$%a! p+!&%g$, s, &% s$"p,/" p+(/( % P.R. p&,#% p+(a (& !&%$

>$! $%s,a!a+a a+,+$,$ p+/p+$&@>$s.

Perioada de stare a P(R(

D&p (#,a >$!< !&%$ &%/+$ ()$a+ &% a% !a 9&,< 9/a!a $%,+ % p+$/aa

s,a+ % (a+ s$"p,/"a,/!/g$a a+,$(&!a+ s a((%,&a> p+$% p&s&+$ a(&, s&((s$<

(a+ a%,+%a> ;/+"+$! (a+a(,+$s,$( '$ a!,++$! (a+,$!ag$%/as $++s$9$!. %a(!a'$ ,$"p s&;+$%-a s ?,$% % a%sa"9!&! s,+&(,&+$!/+ ">%()$"a! a!

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a) #emne articulare

Ta9!/&! (!$%$( a! &%$ p/!$a+,+$, (+/%$( ;/+"a%, '$ a%()$!/>a%, s +a!$>a> %

(a+&! P.R.< % ;&%(-$ (a>< % $%,+a! ,$"p $;+$,.

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;a!a%g$%!/+< $%,+;a!a%g$%!/+ p+/?$"a!< $%,+;a!a%g$%!/+ $s,a!< +a$/(a+p$a%< (&

,&";$+ s$s,"$(.

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39/98


(a+a(,+$s,$( a,/+a, a!,++$$ (a+,$!ag$%/as '$ (aps&!a+< (a+ % (! $% &+" s

;$?a> p+$% apa+$-$a a%()$!/>$ ;$9+/as. A;(,a+a p+$a+,$(&!a+ s, as&p+a "&'()$!/+ '$

,%/a%!/+.

b) ipuri le"ionale ale m'inii determinate de ,./.

M#%a s, ;+(%, a;(,a, % (&+s&! P.R. %(#, s p/a, /+9$ / p+$!(-$

!>$/%a! a 9/!$$ p%,+& "#%.

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'$ s ;/+"a> s&9 a(-$&%a ;/+"!/+ "&s(&!a+< $a+ pa+,$(&!a+$,-$! ;&%(-$/%a! a!

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A;(,a+a ,%/a%!/+ s,&! ;+(%, (/%,+$9&$ a!,&+$ a+,+$,! "#$%$$ !a

$;$(a+a &%/+ ,$p&+$ !>$/%a!.

Le6iuni i de"orma!ii la ni7elul pumnului

P&"%&! p/a, ;$ s$&! &%/+ !>$&%$ a+$a,< $%,+s#% a+,$(&!a-$$! '$ ,%/a%!:

a+,+$,! +a$/@(a+p$%< ,%/s$%/$,a /+sa! a p&"%&!&$< ,%/s$%/$,a (a%a!&!&$ (a+p$a%.

a) umefac$ia pumnului < % s,a$&! p+(/(< /+sa! '$ /!a+< % (a+ (/%,+$9&-$a

a+,$(&!a-$$!/+ '$ ,%/a%!/+ s, &%/+$ g+& $;+%-$a,. S$%/$,a +a$/@(a+p$a%

+a!$>a> / "as $%;!a"a,/+$ ,+a%s+sa!< ,%/s$%/$,a ?,%s/a+< / ,&";a(-$

,+ap>/$a! (a+ (/9/a+ p#% !a 9a>a ",a(a+p$%!/+.

b) #indromul de cap cubital : p+/$"$%%-a s,$!/$$ (&9$,a! (a+ s, s&9!&?a,

p/s,+$/+ p+$% a+,+$,a +a$/@(&9$,a! $%;+$/a+ '$ $s,+&(-$a !$ga"%,&!&$ ,+$&%g)$&!a+.

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g,! I '$ < p+$% ;+(a+a !a %$!&! s,$!/$$ (&9$,a! s&9!&?a, p/s,+$/+ '$ a%,&a!

+/a,.

c) enosino+ita canalului carpian: s, / ,&";a(-$ a p&"%&!&$ % +g$&%a /!a+<

as/($a, % &%! (a>&+$ & &% s$%+/" (/"p+s$&% a! %+&!&$ "$a% ,&!9&++$

s%s$9$!$,a,< s"%&! T$%!< a,+/;$ ,%a+$a%< p+,&+9a-$$ EM.

d) /edoarea pumnului : p/s$9$! % +(,$,&$%< a+ "a$ a!s % ;!?$ s&9 a(-$&%a

p+p/%+%, a ;!?/+$!/+H $%$-$a! s&9!&?a-$a pa!"a+< &!,+$/a+ as/($a, asa (&

$a-$ +a$a! a p&"%&!&$.

_______________________________________________________________________________________ 39


40/98


De7ia!ia >> cu5ital,? a de0etelor

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s,a$$ p+(/(.

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;a!a%g$%< ($ (& / >/% (a+,$!a= ",a(a+p$a% "+& ?p&sH

@s$%/$a!a +;!(,a, @a !&%g&! g#,&!&$ ",a(a+p$a% ;/+"a> ?pa%s$&%$

s$%/$a!< +;!(,a+ "a$ $"p/+,a%, /+sa! '$ (&9$,a!H

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(a+,$!a=H

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@$%,+/s/'$$ pa+,a (&9$,a! "a$ p&,+%$( !ga-$ ,%/%&! ?,%s/+ ps,

",a(a+p/@;a!a%g$% (#, ,%/a%! $%,+/s/'$!/+ +a$a!$ a$ !/"9+$(a!$!/+H

@(aps&!a a+,$(&!a+ (& >/!,a+a sp($a! % >/%a /!a+H

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( Ma+a s/!$($,a+ a "#$%$$ % gs,&+$! $-$$ >$!%$(< ()$a+ '$ (! "a$ s$"p!H

D$a-$a +a$a! a p&"%&!&$H

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a+,$(&!a-$$! ",a(a+p/@;a!a%g$%.

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$a-$a (&9$,a! a g,!/+< a+ s, p/s$9$! s&9!&?a-$a a%,+$/a+ ;+ $a-$a

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S&9!&?a-$a apa+ !a %(p&, %&"a$ !a a(,&! p+)%s$&%$$.

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"$ a g,!/+ apa+ $a-$a (&9$,a!.

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$%,+/s/'$!/+.

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as"%a a%,+%a-$ % $a-$a (&9$,a!< p+ss( p+/"/%,/+$&! ",a(a+p/;a!a%g$a%<

a=&%g#% % spa-$&! $%,+",a(a+p$a% ;a!a%g$a% '$ $% $%;$($%-$< (a % +&p,&+$!

,%$%/as.

De7ia!ia în >> 0ât de le5,d, @ a de0etelor

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a+ +/! $"p/+,a%,.

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