The phalanges of the fingers of the human upper limbs consist of three parts - proximal, middle (main) and distal (final). The distal part of the phalanx has a clearly visible nail tuberosity. All fingers of the human hand are formed by three phalanges - nail, middle and main. If we talk about the thumb, it consists of two phalanges. The longest phalanges form the middle fingers, and the thickest ones form the thumbs.

Structure

The phalanges of the fingers of the upper extremities are short tubular bones that have the shape of a small elongated bone, in the form of a cylinder, with its convex part facing the back of the palms. Almost each end of the phalanges has articular surfaces that take part in the formation of interphalangeal joints. These joints have a block-like shape. They perform two functions - flexion and extension of the fingers. The interphalangeal joints are strengthened by collateral ligaments.

Diseases contributing to deformity

Very often, with chronic ailments of the internal organs, the phalanges of the fingers of the upper extremities are modified. They, as a rule, take on the appearance of “drum sticks” (a spherical thickening is observed on the terminal phalanges). As for the nails, they resemble “hour hands”. Similar modifications of the phalanges are observed in the following diseases:

• heart defects;
• cystic fibrosis;
• lung diseases;
• infective endocarditis;
• diffuse goiter;
• Crohn's disease;
• lymphoma;
• cirrhosis of the liver;
• esophagitis;
• myeloid leukemia.

Causes of pain in the phalanges of the fingers

The interphalangeal joints (the smallest joints in the human body) can be affected by diseases that impair their mobility. These diseases are in most cases accompanied by excruciating pain. The main causes of impaired mobility of the interphalangeal joints are:

• deforming osteoarthritis;
• gouty arthritis;
• rheumatoid arthritis;
• psoriatic arthritis.

If these ailments are not treated, then after some time they will lead to severe deformation of the diseased joints, complete disruption of their motor function, as well as atrophy of the hands and muscles of the fingers. The clinical picture of the above ailments is very similar, but their treatment is different.

Fracture of the phalanx of the finger

Fracture of the phalanges of the fingers usually occurs as a result of a direct blow. If we talk about a fracture of the nail plate, it is almost always splintered. Such fractures are accompanied by severe pain in the area of ​​injury, swelling and limited function of the broken finger.

Treatment of non-displaced fractures is conservative. In this case, traumatologists apply a plaster cast or an aluminum splint for three weeks, after which they prescribe therapeutic massage, physical education and physiotherapeutic procedures. In case of a displaced fracture, reposition (comparison of bone fragments) is performed under local anesthesia. A plaster cast or metal splint is applied for a month.

Bumps on the phalanges of the fingers

Bumps on the phalanges of the fingers are manifestations of many diseases, the main ones of which are:

• gout;
• arthritis;
• arthrosis;
• osteoarthritis;
• salt deposits.

Bumps that appear on the fingers of the upper extremities are accompanied by unbearable pain, which intensifies at night. In addition, there is a characteristic compaction, leading to immobility of the joints, as well as limitation of their flexibility.

As for the treatment of these bumps, it consists of drug therapy, therapeutic and preventive gymnastics, massage, physiotherapeutic procedures and applications.

The human hand has a complex structure and performs a variety of subtle movements. It is a working organ and, as a result, is more often damaged than other parts of the body.

Introduction.

The structure of injuries is dominated by industrial (63.2%), household (35%) and street (1.8%) types of injuries. Industrial injuries are usually open and account for 78% of all open injuries of the upper extremities. Damage to the right hand and fingers is 49%, and to the left – 51%. Open injuries of the hand in 16.3% of cases are accompanied by combined damage to tendons and nerves due to their close anatomical location. Injuries and diseases of the hand and fingers lead to disruption of their function, temporary loss of ability to work, and often to disability of the victim. The consequences of injuries to the hand and fingers account for more than 30% of the disability structure due to damage to the musculoskeletal system. The loss of one or more fingers leads to professional and psychological difficulties. The high percentage of disability as a result of injuries to the hand and fingers is explained not only by the severity of the injuries, but also by incorrect or untimely diagnosis and choice of treatment tactics. When treating this group of patients, one should strive to restore not only the anatomical integrity of the organ, but also its function. Surgical treatment of injuries is carried out according to an individual plan and in accordance with the principles outlined below.

Features of treatment of patients with injuries and diseases of the hand.

Anesthesia.

The main condition for performing fine intervention on the hand is adequate pain relief. Local infiltration anesthesia can only be used for superficial defects; its use is limited on the palmar surface of the hand due to low skin mobility.

In most cases, during hand surgeries, conduction anesthesia is performed. Blocking the main nerve trunks of the hand can be carried out at the level of the wrist, elbow joint, axillary and cervical region. For finger surgery, anesthesia according to Oberst-Lukashevich or a block at the level of the intermetacarpal spaces is sufficient (see Fig. 1)

Fig. 1 Points of injection of anesthetic during conduction anesthesia of the upper limb.

At the level of the fingers and wrist, it is necessary to avoid the use of prolonged anesthetics (lidocaine, marcaine), since, due to prolonged resorption of the drug, compression of the neurovascular bundles and the occurrence of tunnel syndromes, and in some cases, necrosis of the finger, may occur. For severe hand injuries, anesthesia should be used.

Bleeding of the surgical field.

Among blood-soaked tissues, it is impossible to differentiate the vessels, nerves and tendons of the hand, and the use of tampons to remove blood from the surgical field causes harm to the gliding apparatus. Therefore, bleeding is mandatory not only for major interventions on the hand, but also when treating minor injuries. To bleed the hand, an elastic rubber bandage or a pneumatic cuff is applied to the upper third of the forearm or lower third of the shoulder, in which pressure is injected to 280-300 mm Hg, which is more preferable, as it reduces the risk of nerve paralysis. Before using them, it is advisable to apply an elastic rubber bandage to a previously raised arm, which helps to force out a significant part of the blood from the arm. To operate on a finger, it is enough to apply a rubber tourniquet at its base. If the surgical intervention lasts more than 1 hour, then it is necessary to release the air from the cuff for a few minutes with the limb elevated, and then fill it again.

Skin incisions on the hand.

The epidermis on the hand forms a complex network of lines, the direction of which is determined by various movements of the fingers. On the palmar surface of the skin of the hand there are many furrows, wrinkles and folds, the number of which is not constant. Some of them, which have a specific function and are landmarks of deeper anatomical formations, are called primary skin formations (Fig. 2).

Fig. 2 Primary skin formations of the hand.

1-distal palmar groove, 2-proximal palmar groove. 3-interphalangeal grooves, 4-palmar carpal grooves, 5-interdigital folds, 6-interphalangeal folds

From the base of the main grooves, connective tissue bundles extend vertically to the palmar aponeurosis and to the tendon sheaths. These grooves are the “joints” of the skin of the hand. The groove plays the role of an articular axis, and adjacent areas perform movements around this axis: approaching each other - flexion, moving away - extension. Wrinkles and folds are reservoirs of movement and contribute to an increase in skin surface.

A rational skin incision should be subject to minimal stretching during movement. Due to constant stretching of the edges of the wound, hyperplasia of the connective tissue occurs, the formation of rough scars, their wrinkling and, as a result, dermatogenous contracture. Incisions perpendicular to the grooves undergo the greatest change with movement, while incisions parallel to the grooves heal with minimal scarring. There are areas of the hand skin that are neutral in terms of stretching. Such an area is the midlateral line (Fig. 3), along which stretching in opposite directions is neutralized.

Fig. 3 Medial lateral line of the finger.

Thus, the optimal incisions on the hand are those parallel to the primary skin formations. If it is impossible to provide such access to damaged structures, it is necessary to select the most correct permissible type of incision (Fig. 4):

1. the incision parallel to the furrows is complemented by a straight or arcuate one of the wrong direction,

2. the incision is made along the neutral line,

3. an incision perpendicular to the grooves is complemented by a Z-shaped plastic,

4. The incision crossing the primary skin formations should be arcuate or Z-shaped to redistribute tensile forces.

Rice. 4A-Optimal cuts on the hand,B-Z-plastic

For optimal primary surgical treatment of hand injuries, it is necessary to widen the wounds through additional and lengthening incisions in the correct direction. (Fig. 5)

Fig. 5 Additional and lengthening incisions on the hand.

Atraumatic surgical technique.

Hand surgery is surgery of sliding surfaces. The surgeon must be aware of two dangers: infection and trauma, which ultimately lead to fibrosis. To avoid it, a special technique is used, which Bunnel called atraumatic. To implement this technique, it is necessary to observe the strictest asepsis, use only sharp instruments and thin suture material, and constantly moisturize the tissue. Trauma to tissues with tweezers and clamps should be avoided, since micronecrosis forms at the site of compression, leading to scarring, as well as leaving foreign bodies in the wound in the form of long ends of ligatures and large nodes. It is important to avoid the use of dry swabs to stop bleeding and tissue preparation, and also to avoid unnecessary wound drainage. The skin edges should be joined with minimal tension and without interfering with the blood supply to the flap. The so-called “time factor” plays a huge role in the development of infectious complications, since too long operations lead to “fatigue” of tissues and a decrease in their resistance to infection.

After atraumatic intervention, the tissues retain their characteristic luster and structure, and during the healing process only a minimal tissue reaction occurs

Immobilization of the hand and fingers.

The human hand is in constant motion. A stationary state is unnatural for the hand and leads to serious consequences. The idle hand assumes a resting position: slight extension at the wrist joint and flexion at the finger joints, abduction of the thumb. The hand takes a resting position lying on a horizontal surface and hanging (Fig. 6)

Fig.6 Hand in rest position

In the functional position (position of action), extension in the wrist joint is 20, ulnar abduction is 10, flexion in the metacarpophalangeal joints is 45, in the proximal interphalangeal joints - 70, in the distal interphalangeal joints - 30, the first metacarpal bone is in a state of opposition, and the great The finger forms an incomplete letter “O” with the index and middle fingers, and the forearm occupies a position midway between pronation and supination. The advantage of the functional position is that it creates the most favorable starting position for the action of any muscle group. The position of the finger joints depends on the position of the wrist joint. Flexion at the wrist joint causes extension of the fingers, and extension causes flexion (Fig. 7).

Fig.7 Functional position of the hand.

In all cases, in the absence of forced circumstances, it is necessary to immobilize the hand in a functional position. Immobilizing the finger in a straight position is an irreparable mistake and leads to stiffness in the finger joints in a short time. This fact is explained by the special structure of the collateral ligaments. They extend distally and palmarly from the rotation points. Thus, in a straightened position of the finger, the ligaments relax, and in a bent position they become tense (Fig. 8).

Fig. 8 Biomechanics of collateral ligaments.

Therefore, when the finger is fixed in an extended position, the ligament shrinks. If only one finger is damaged, the rest should be left free.

Fractures of the distal phalanx.

Anatomy.

Connective tissue septa, stretching from the bone to the skin, form a cellular structure and participate in stabilizing the fracture and minimizing the displacement of fragments. (Fig. 9)

R Fig.9 Anatomical structure of the nail phalanx:1-attachment of collateral ligaments,2- connective tissue septa,3-lateral interosseous ligament.

On the other hand, a hematoma that occurs in closed connective tissue spaces is the cause of a bursting pain syndrome that accompanies damage to the nail phalanx.

The extensor and deep flexor tendons of the finger, attached to the base of the distal phalanx, do not play a role in the displacement of the fragments.

Classification.

There are three main types of fractures (according to Kaplan L.): longitudinal, transverse and comminuted (eggshell type) (Fig. 10).

Rice. 10 Classification of fractures of the nail phalanx: 1-longitudinal, 2-transverse, 3-comminuted.

Longitudinal fractures in most cases are not accompanied by displacement of fragments. Transverse fractures of the base of the distal phalanx are accompanied by angular displacement. Comminuted fractures involve the distal phalanx and are often associated with soft tissue injuries.

Treatment.

Non-displaced and comminuted fractures are treated conservatively. For immobilization, palmar or dorsal splints are used for a period of 3-4 weeks. When applying a splint, it is necessary to leave the proximal interphalangeal joint free (Fig. 11).

Fig. 11 Splints used to immobilize the nail phalanx

Transverse fractures with angular displacement can be treated both conservatively and surgically - closed reduction and osteosynthesis with a thin Kirschner wire (Fig. 12).

Fig. 12 Osteosynthesis of the nail phalanx with a thin Kirschner wire: A, B - stages of the operation, C - Final type of osteosynthesis.

Fractures of the main and middle phalanges.

The displacement of phalangeal fragments is primarily determined by muscle traction. With unstable fractures of the main phalanx, the fragments are displaced at an angle towards the rear. The proximal fragment assumes a bent position due to the traction of the interosseous muscles attached to the base of the phalanx. The distal fragment does not serve as an attachment point for the tendons and its hyperextension occurs due to the traction of the central portion of the extensor tendon of the finger, which is attached to the base of the middle phalanx (Fig. 13).

Fig. 13 The mechanism of displacement of fragments in fractures of the main phalanx

In case of fractures of the middle phalanx, it is necessary to take into account two main structures that influence the displacement of fragments: the middle portion of the extensor tendon, attached to the base of the phalanx from the rear, and the superficial flexor tendon, attached to the palmar surface of the phalanx (Fig. 14)

Fig. 14. Mechanism of displacement of fragments in fractures of the middle phalanx

Particular attention should be paid to fractures with rotational displacement, which must be eliminated especially carefully. In a bent position, the fingers are not parallel to each other. The longitudinal axes of the fingers are directed towards the scaphoid bone (Fig. 15)

When the phalanges are fractured with displacement, the fingers intersect, which makes functioning difficult. In patients with phalangeal fractures, flexion of the fingers is often impossible due to pain, so rotational displacement can be determined by the location of the nail plates in a semi-flexed position of the fingers (Fig. 16)

Fig. 16 determination of the direction of the longitudinal axis of the fingers for phalangeal fractures

It is extremely important that the fracture heals without permanent deformation. The sheaths of the flexor tendons pass in the palmar groove of the phalanges of the fingers and any irregularity prevents the tendons from sliding.

Treatment.

Non-displaced or impacted fractures can be treated using so-called dynamic splinting. The damaged finger is fixed to the neighboring one and early active movements begin, which prevents the development of stiffness in the joints. Displaced fractures require closed reduction and fixation with a plaster cast (Fig. 17)

Fig. 17 use of a plaster splint for fractures of the phalanges of the fingers

If after reposition the fracture is not stable, the fragments cannot be held using a splint, then percutaneous fixation with thin Kirschner wires is necessary (Fig. 18)

Fig. 18 Osteosynthesis of the phalanges of the fingers using Kirschner wires

If closed reduction is impossible, open reduction is indicated, followed by osteosynthesis of the phalanx with knitting needles, screws, and plates. (Fig. 19)

Fig. 19 Stages of osteosynthesis of the phalanges of the fingers with screws and a plate

For intra-articular fractures, as well as comminuted fractures, the best treatment result is provided by the use of external fixation devices.

Fractures of the metacarpal bones.

Anatomy.

The metacarpal bones are not located in the same plane, but form the arch of the hand. The arch of the wrist meets the arch of the hand, forming a semicircle, which is completed to a full circle by the first finger. This way the fingertips touch at one point. If the arch of the hand flattens due to damage to bones or muscles, a traumatic flat hand is formed.

Classification.

Depending on the anatomical location of the damage, there are: fractures of the head, neck, diaphysis and base of the metacarpal bone.

Treatment.

Fractures of the metacarpal head require open reduction and fixation with thin Kirschner wires or screws, especially in the case of an intra-articular fracture.

Metacarpal neck fractures are a common injury. The fracture of the neck of the fifth metacarpal bone, as the most common, is called the “boxer’s fracture” or “fighter’s fracture.” Such fractures are characterized by displacement at an angle open to the palm and are unstable due to destruction of the palmar cortical layer (Fig. 20)

Fig. 20 Fracture of the metacarpal neck with destruction of the palmar cortical plate

With conservative treatment by immobilization with a plaster splint, it is usually not possible to eliminate the displacement. The bone deformation does not have a significant effect on the function of the hand; only a small cosmetic defect remains. To effectively eliminate displacement of fragments, closed reduction and osteosynthesis with two intersecting Kirschner wires or transfixation with wires to the adjacent metacarpal bone are used. This method allows you to start early movements and avoid stiffness in the joints of the hand. The wires can be removed 4 weeks after surgery.

Fractures of the diaphysis of the metacarpal bones are accompanied by significant displacement of fragments and are unstable. With direct force, transverse fractures usually occur, and with indirect force, oblique fractures occur. Displacement of fragments leads to the following deformations: formation of an angle open to the palm (Fig. 21)

Fig. 21 The mechanism of displacement of fragments during a fracture of the metacarpal bone.

Shortening of the metacarpal bone, hyperextension in the metacarpophalangeal joint due to the action of the extensor tendons, flexion in the interphalangeal joints caused by displacement of the interosseous muscles, which, due to the shortening of the metacarpal bones, are no longer able to perform the extension function. Conservative treatment in a plaster splint does not always eliminate displacement of fragments. For transverse fractures, transfixation with pins to the adjacent metacarpal bone or intramedullary seosynthesis with a pin is most effective (Fig. 22)

Fig. 22 Types of osteosynthesis of the metacarpal bone: 1- with knitting needles, 2- with plate and screws

For oblique fractures, osteosynthesis is performed using AO miniplates. These methods of osteosynthesis do not require additional immobilization. Active movements of the fingers are possible from the first days after surgery after swelling subsides and pain decreases.

Fractures of the base of the metacarpal bones are stable and do not pose difficulties for treatment. Immobilization with a dorsal splint reaching the level of the heads of the metacarpal bones for three weeks is quite sufficient for healing of the fracture.

Fractures of the first metacarpal bone.

The unique function of the first finger explains its special position. Most fractures of the first metacarpal are base fractures. By Green D.P. These fractures can be divided into 4 types, and only two of them (Bennett’s fracture-dislocation and Rolando’s fracture) are intra-articular (Fig. 23)

Rice. 23 Classification of fractures of the base of the first metacarpal bone: 1 - Bennett fracture, 2 - Rolando fracture, 3,4 - extra-articular fractures of the base of the first metacarpal bone.

To understand the mechanism of injury, it is necessary to consider the anatomy of the first carpometacarpal joint. The first carpometacarpal joint is a saddle joint formed by the base of the first metacarpal bone and the trapezium bone. Four main ligaments are involved in stabilizing the joint: anterior oblique, posterior oblique, intermetacarpal and dorsal radial. (Fig. 24)

Fig. 24 Anatomy of the first metacarpophalangeal joint

The volar portion of the base of the first metacarpal is somewhat elongated and is the site of attachment of the anterior oblique ligament, which is key to the stability of the joint.

For the best visualization of the joint, radiography is required in the so-called “true” anterior-posterior projection (Robert projection), when the hand is in the position of maximum pronation (Fig. 25)

Fig.25 Robert's projection

Treatment.

Bennett's fracture-dislocation results from direct trauma to the subflexed metacarpal. At the same time it happens
dislocation, and a small triangular-shaped volar bone fragment remains in place due to the force of the anterior oblique ligament. The metacarpal bone is displaced to the radial side and to the rear due to the traction of the abductor longus muscle (Fig. 26).

Fig. 26 Bennett's fracture-dislocation mechanism

The most reliable method of treatment is closed reduction and percutaneous fixation with Kirschner wires to the second metacarpal or to the trapezius bone or trapezium bone (Fig. 27)

Fig. 27 Osteosynthesis using Kirschner wires.

For reposition, traction is performed on the finger, abduction and opposition of the first metacarpal bone, at the moment of which pressure is applied to the base of the bone and reposition. In this position, the needles are inserted. After the operation, immobilization is performed in a plaster splint for a period of 4 weeks, after which the splint and wires are removed and rehabilitation begins. If closed reduction is not possible, they resort to open reduction, after which osteosynthesis is possible using both Kirschn wires and thin 2 mm AO screws.

Rolando's fracture is a T- or Y-shaped intra-articular fracture and can be classified as a comminuted fracture. The prognosis for restoration of function with this type of injury is usually unfavorable. In the presence of large fragments, open reduction and osteosynthesis with screws or wires are indicated. To preserve the length of the metacarpal bone, external fixation devices or transfixation to the second metacarpal bone are used in combination with internal fixation. In case of compression of the base of the metacarpal bone, primary bone grafting is necessary. If it is impossible to surgically restore the congruence of the articular surfaces, as well as in elderly patients, a functional method of treatment is indicated: immobilization for a minimum period for pain to subside, and then early active movements.

Extra-articular fractures of the third type are the most rare fractures of the first metacarpal bone. Such fractures respond well to conservative treatment - immobilization in a plaster splint in a hyperextension position in the metacarpophalangeal joint for 4 weeks. Oblique fractures with a long fracture line may be unstable and require percutaneous osteosynthesis with wires. Opening reduction for these fractures is used extremely rarely.

Scaphoid fractures

Scaphoid fractures account for up to 70% of all wrist fractures. They occur when falling on an outstretched hand due to hyperextension. According to Russe, horizontal, transverse and oblique fractures of the scaphoid are distinguished. (fig28)

Recognizing these fractures can be quite difficult. Local pain when pressing on the area of ​​the anatomical snuffbox, pain when dorsiflexing the hand, as well as radiography in a direct projection with some supination and ulnar abduction of the hand are important.

Conservative treatment.

Indicated for fractures without displacement of fragments. Plaster immobilization in a bandage covering the thumb for 3-6 months. The plaster casts are changed every 4-5 weeks. To assess consolidation, it is necessary to conduct staged radiographic studies, and in some cases MRI (Fig. 29).

Fig. 29 1- MRI picture of a scaphoid fracture,2- immobilization for scaphoid fractures

Surgical treatment.

Open reduction and screw fixation.

The scaphoid bone is exposed through access along the palmar surface. Then a guide pin is passed through it through which a screw is inserted. The most commonly used screw is Herbert, Acutrak, AO. After osteosynthesis, plaster immobilization for 7 days (Fig. 30)

Fig. 30 Osteosynthesis of the scaphoid bone with a screw

Nonunion of the scaphoid bone.

For nonunions of the scaphoid bone, bone grafting according to Matti-Russe is used. Using this technique, a groove is formed in the fragments into which cancellous bone taken from the iliac crest or from the distal radius is placed (D.P. Green) (Fig. 31). Plaster immobilization 4-6 months.

Fig. 31 Bone grafting for nonunion of the scaphoid.

Screw fixation with or without bone grafting can also be used.

Damage to small joints of the hand.

Damage to the distal interphalangeal joint.

Dislocations of the nail phalanx are quite rare and usually occur on the dorsal side. More often, dislocations of the nail phalanx are accompanied by avulsion fractures of the attachment sites of the tendons of the deep flexor or extensor of the finger. In fresh cases, open reduction is performed. After reduction, lateral stability and the nail phalanx hyperextension test are checked. If there is no stability, transarticular fixation of the nail phalanx is performed with a pin for a period of 3 weeks, after which the pin is removed. Otherwise, immobilization of the distal interphalangeal joint in a plaster splint or a special splint for 10-12 days is indicated. In cases where more than three weeks have passed since the injury, it is necessary to resort to open reduction, followed by transarticular fixation with a pin.

Injuries to the proximal interphalangeal joint.

The proximal interphalangeal joint occupies a special place among the small joints of the hand. Even if there is no movement in the other joints of the finger, with preserved movements in the proximal interphalangeal joint, hand function remains satisfactory. When treating patients, it is necessary to take into account that the proximal interphalangeal joint is prone to stiffness not only with injuries, but also with prolonged immobilization of even a healthy joint.

Anatomy.

The proximal interphalangeal joints are block-shaped in shape and are strengthened by collateral ligaments and the palmar ligament.

Treatment.

Damage to collateral ligaments.

Injury to the collateral ligaments occurs as a result of the application of lateral force to a straightened toe, most commonly seen during sports. The radial radial ligament is injured more often than the ulnar ligament. Collateral ligament injuries diagnosed 6 weeks after injury should be considered old. It is important to check lateral stability and perform stress radiography to make a diagnosis. When assessing the results of these tests, it is necessary to focus on the amount of lateral movement of healthy fingers. To treat this type of injury, the elastic splinting method is used: the injured finger is fixed to the adjacent one for 3 weeks in case of partial ligament rupture and for 4-6 weeks in case of complete rupture, then sparing of the finger is recommended for another 3 weeks (for example, avoiding sports activities). (Fig. 32)

Fig. 32 Elastic splinting for injuries of collateral ligaments

During the period of immobilization, active movements in the joints of the injured finger are not only not contraindicated, but are absolutely necessary. In the treatment of this group of patients, it is necessary to take into account the following facts: full range of motion is restored in the vast majority of cases, while pain persists for many months, and the increase in joint volume in some patients lasts a lifetime.

Dislocations of the middle phalanx.

There are three main types of dislocations of the middle phalanx: dorsal, palmar and rotational (rotatory). For diagnosis, it is important to take x-rays of each damaged finger separately in direct and strictly lateral projections, since oblique projections are less informative (Figure 33)

Fig. 33 X-ray for dorsal dislocations of the middle phalanx.

The most common type of injury is dorsal dislocation. It is easy to eliminate, often done by the patients themselves. Elastic splinting for 3-6 weeks is sufficient for treatment.

With a palmar dislocation, damage to the central portion of the extensor tendon is possible, which can lead to the formation of a “boutonniere” deformity (Fig. 34)

Fig. 34 Boutonniere finger deformity

To prevent this complication, a dorsal splint is used that fixes only the proximal interphalangeal joint for 6 weeks. During the period of immobilization, passive movements are performed in the distal interphalangeal joint (Fig. 35)

Fig. 35 Prevention of boutonniere-type deformation

Rotational subluxation is easily confused with palmar subluxation. On a strictly lateral radiograph of the finger, you can see the lateral projection of only one of the phalanges and the oblique projection of the other (Fig. 36)

Fig. 36 Rotational dislocation of the middle phalanx.

The reason for this damage is that the condyle of the head of the main phalanx falls into a loop formed by the central and lateral portions of the extensor tendon, which is intact (Fig. 37).

Fig. 37 rotational dislocation mechanism

Reduction is carried out according to the Eaton method: after anesthesia, the finger is flexed at the metacarpophalangeal and proximal interphalangeal joint, and then carefully rotated the main phalanx (Fig. 38)

Fig. 38 Reduction of rotatory dislocation according to Eaton

In most cases, closed reduction is not effective and it is necessary to resort to open reduction. After reduction, elastic splinting and early active movements are performed.

Fractures and dislocations of the middle phalanx.

As a rule, a fracture of the palmar fragment of the articular surface occurs. This joint-destructive injury can be successfully treated if diagnosed early. The simplest, non-invasive and effective method of treatment is the use of a dorsal extension locking splint (Fig. 39), applied after reduction of the dislocation and allowing active flexion of the finger. Full reduction requires flexion of the finger at the proximal interphalangeal joint. Reduction is assessed using a lateral radiograph: the adequacy of reduction is assessed by the congruence of the intact dorsal part of the articular surface of the middle phalanx and the head of the proximal phalanx. The so-called V-sign, proposed by Terri Light, helps in assessing the radiograph (Fig. 40)

Fig. 39 Dorsal extension blocking splint.

Fig.40 V-sign for assessing the congruence of the articular surface.

The splint is applied for 4 weeks, and is extended weekly by 10-15 degrees.

Damage to the metacarpophalangeal joints.

Anatomy.

Metacarpophalangeal joints are condylar joints that allow, along with flexion and extension, adduction, abduction and circular movements. The stability of the joint is provided by the collateral ligaments and the palmar plate, which together form a box shape (Fig. 41)

Fig. 41 Ligamentous apparatus of the metacarpophalangeal joints

Collateral ligaments consist of two bundles - proper and accessory. The collateral ligaments are more tense during flexion than during extension. The palmar plates of fingers 2-5 are connected to each other by the deep transverse metacarpal ligament

Treatment.

There are two types of finger dislocation: simple and complex (irreducible). For the differential diagnosis of dislocations, it is necessary to remember the following signs of a complex dislocation: on the radiograph, the axis of the main phalanx and metacarpal bone are parallel, the sesamoid bones may be located in the joint, and there is a depression of the skin on the palmar surface of the hand at the base of the finger. A simple dislocation can be easily corrected by applying gentle pressure to the main phalanx without requiring traction. Elimination of a complex dislocation is possible only surgically.

Damage to the nail bed.

The nail gives the distal phalanx hardness when gripping, protects the fingertip from injury, plays an important role in the function of touch and in the perception of the aesthetic appearance of a person. Injuries to the nail bed are among the most common injuries of the hand and accompany open fractures of the distal phalanx and injuries to the soft tissues of the fingers.

Anatomy.

The nail bed is the layer of dermis that lies beneath the nail plate.

Rice. 42 Anatomical structure of the nail bed

There are three main zones of tissue located around the nail plate. The nail fold (roof of the matrix), covered with an epithelial lining - eponychium, prevents uncontrolled growth of the nail upwards and to the sides, directing it distally. In the proximal third of the nail bed there is the so-called germinal matrix, which ensures nail growth. The growing part of the nail is delimited by a white crescent - a hole. If this area is damaged, the growth and shape of the nail plate are significantly disrupted. Distal to the socket is a sterile matrix that fits tightly to the periosteum of the distal phalanx, allowing the advancement of the nail plate as it grows and thus playing a role in the formation of the shape and size of the nail. Damage to the sterile matrix is ​​accompanied by deformation of the nail plate.

The nail grows at an average rate of 3-4 mm per month. After injury, distal advancement of the nail stops for 3 weeks, and then nail growth continues at the same rate. As a result of the delay, a thickening forms proximal to the injury site, persisting for 2 months and gradually becoming thinner. It takes about 4 months before a normal nail plate forms after an injury.

Treatment.

The most common injury is a subungual hematoma, which is clinically manifested by the accumulation of blood under the nail plate and is often accompanied by severe pain of a pulsating nature. The treatment method is to perforate the nail plate at the site of the hematoma with a sharp instrument or the end of a paper clip heated over a fire. This manipulation is painless and instantly relieves tension and, as a result, pain. After evacuation of the hematoma, an aseptic bandage is applied to the finger.

When part or all of the nail plate is torn off without damaging the nail bed, the separated plate is processed and placed in place, secured with a suture. (Fig. 43)

Fig. 43 Refixation of the nail plate

The nail plate is a natural splint for the distal phalanx, a conductor for the growth of new nails and ensures healing of the nail bed with the formation of a smooth surface. If the nail plate is lost, it can be replaced with an artificial nail made from a thin polymer plate, which will provide painless dressings in the future.

Wounds of the nail bed are the most complex injuries, leading in the long term to significant deformation of the nail plate. Such wounds are subject to careful primary surgical treatment with minimal excision of soft tissue, precise comparison of fragments of the nail bed and suture with thin (7\0, 8\0) suture material. The removed nail plate is refixed after treatment. In the postoperative period, immobilization of the phalanx is required for 3-4 weeks to prevent its injury.

Tendon damage.

The choice of tendon reconstruction method is made taking into account the time that has passed since the injury, the prevalence of scar changes along the tendons, and the condition of the skin at the operation site. A tendon suture is indicated when it is possible to connect the damaged tendon end to end and the soft tissue in the area of ​​surgery is in normal condition. There is a primary tendon suture, performed within 10-12 days after the injury in the absence of signs of infection in the wound area and its incised nature, and a delayed suture, which is applied within 12 days to 6 weeks after the injury under less favorable conditions (lacerations and bruises). wounds). In many cases, in a later period, suturing is impossible due to muscle retraction and the occurrence of significant diastasis between the ends of the tendon. All types of tendon sutures can be divided into two main groups - removable and immersed (Fig. 44).

Fig. 44 Types of tendon sutures (a - Bunnell, b - Verdun, c - Cuneo) d - application of an intra-trunk suture, e, f - application of adapting sutures. Stages of suturing in the critical zone.

Removable sutures, proposed in 1944 by Bunnell S., are used to fix the tendon to the bone and in areas where early movements are not so necessary. The suture is removed after the tendon has fused sufficiently firmly with the tissue at the point of fixation. Immersion seams remain in the tissues, bearing a mechanical load. In some cases, additional sutures are used to ensure a more perfect alignment of the ends of the tendons. In old cases, as well as with a primary defect, tendon plasty (tendoplasty) is indicated. The source of tendon autograft is tendons, the removal of which does not cause significant functional and cosmetic disturbances, for example, the tendon of the palmaris longus muscle, the superficial flexor of the fingers, the long extensor of the toes, and the plantaris muscle.

Damage to the finger flexor tendons.

Anatomy.

Flexion of 2-5 fingers is carried out due to two long tendons - superficial, attached to the base of the middle phalanx and deep, attached to the base of the distal phalanx. Flexion of the 1st finger is carried out by the tendon of the long flexor of the 1st finger. The flexor tendons are located in narrow, complex-shaped osteo-fibrous canals that change their shape depending on the position of the finger (Fig. 45)

Fig. 45 Change in the shape of the osteo-fibrous canals of the 2-5 fingers of the hand when they are bent

In places of greatest friction between the palmar wall of the canals and the surface of the tendons, the latter are surrounded by a synovial membrane that forms the sheath. The deep digital flexor tendons are connected through the lumbrical muscles to the extensor tendon apparatus.

Diagnostics.

If the deep digital flexor tendon is damaged and the middle phalanx is fixed, flexion of the nail is impossible; with combined damage to both tendons, flexion of the middle phalanx is also impossible.

Rice. 46 Diagnosis of flexor tendon injuries (1, 3 – deep, 2, 4 – both)

Flexion of the main phalanx is possible due to contraction of the interosseous and lumbrical muscles.

Treatment.

There are five zones of the hand, within which anatomical features influence the technique and results of the primary tendon suture.

Fig.47 Brush zones

In zone 1, only the deep flexor tendon passes through the osteofibrous canal, so its damage is always isolated. The tendon has a small range of motion, the central end is often retained by the mesotenon and can be easily removed without significant expansion of the damaged area. All these factors determine good results from applying a primary tendon suture. The most commonly used transosseous tendon suture is removed. It is possible to use immersed seams.

Throughout zone 2, the tendons of the superficial and deep flexor fingers intersect; the tendons are tightly adjacent to each other and have a large range of motion. The results of tendon suture are often unsatisfactory due to scar adhesions between the sliding surfaces. This zone is called critical or “no man’s land.”

Due to the narrowness of the osteofibrous canals, it is not always possible to suture both tendons; in some cases, it is necessary to excise the superficial flexor tendon of the finger and apply a suture only to the deep flexor tendon. In most cases, this avoids finger contractures and does not significantly affect flexion function.

In zone 3, the flexor tendons of adjacent fingers are separated by neurovascular bundles and lumbrical muscles. Therefore, tendon injuries in this area are often accompanied by damage to these structures. After suture of the tendon, suture of the digital nerves is necessary.

Within zone 4, the flexor tendons are located in the carpal tunnel along with the median nerve, which is located superficially. Tendon injuries in this area are quite rare and are almost always combined with damage to the median nerve. The operation involves dissecting the transverse carpal ligament, suturing the deep digital flexor tendons, and excising the superficial flexor tendons.

Throughout zone 5, the synovial sheaths end, the tendons of adjacent fingers pass close to each other and, when the hand is clenched into a fist, they move together. Therefore, cicatricial fusion of the tendons with each other has virtually no effect on the amount of finger flexion. The results of tendon suture in this area are usually good.

Postoperative management.

The finger is immobilized using a dorsal plaster splint for a period of 3 weeks. From the second week, after the swelling subsides and the pain in the wound decreases, passive flexion of the finger is performed. After removing the plaster splint, active movements begin.

Damage to the extensor tendons of the fingers.

Anatomy.

The formation of the extensor apparatus involves the tendon of the common extensor finger and the tendon of the interosseous and lumbrical muscles, connected by many lateral ligaments, forming a tendon-aponeurotic stretch (Fig. 48, 49)

Fig. 48 Structure of the extensor apparatus of the hand: 1 - Triangular ligament, 2 - attachment point of the extensor tendon, 3 - lateral connection of the collateral ligament, 4 - disc above the middle joint, 5 - spiral fibers, 5 - middle bundle of the long extensor tendon, 7 - lateral bundle of the long extensor tendon, 8 - attachment of the long extensor tendon on the main phalanx, 9 - disc above the main joint, 10 and 12 - long extensor tendon, 11 - lumbrical muscles, 13 - interosseous muscles.

Rice. 49 Extensors of the fingers and hand.

It must be remembered that the index finger and little finger, in addition to the common one, also have an extensor tendon. The middle bundles of the extensor tendon of the fingers are attached to the base of the middle phalanx, extending it, and the lateral bundles are connected to the tendons of the small muscles of the hand, attached to the base of the nail phalanx and perform the function of extending the latter. The extensor aponeurosis at the level of the metacarpophalangeal and proximal interphalangeal joints forms a fibrocartilaginous disc similar to the patella. The function of the small muscles of the hand depends on the stabilization of the main phalanx by the extensor finger. When the main phalanx is bent, they act as flexors, and when extended, together with the extensor fingers, they become extensors of the distal and middle phalanges.

Thus, we can speak of perfect extension-flexion function of the finger only if all anatomical structures are intact. The presence of such a complex interconnection of elements to some extent favors the spontaneous healing of partial damage to the extensor apparatus. In addition, the presence of lateral ligaments of the extensor surface of the finger prevents the tendon from contracting when damaged.

Diagnostics.

The characteristic position that the finger takes depending on the level of damage allows you to quickly make a diagnosis (Fig. 50).

Fig. 50 Diagnosis of damage to the extensor tendons

extensors at the level of the distal phalanx, the finger assumes a flexion position at the distal interphalangeal joint. This deformity is called a “mallet finger.” In most cases of fresh injuries, conservative treatment is effective. To do this, the finger must be fixed in a hyperextended position at the distal interphalangeal joint using a special splint. The amount of hyperextension depends on the patient’s level of joint mobility and should not cause discomfort. The remaining joints of the finger and hand must be left free. The immobilization period is 6-8 weeks. However, the use of splints requires constant monitoring of the position of the finger, the condition of the elements of the splint, as well as the patient’s understanding of the task facing him, therefore, in some cases, transarticular fixation of the nail phalanx with a knitting needle is possible for the same period. Surgical treatment is indicated when the tendon is torn from its attachment site with a significant bone fragment. In this case, a transosseous suture of the extensor tendon is performed with fixation of the bone fragment.

When the extensor tendons are damaged at the level of the middle phalanx, the triangular ligament is simultaneously damaged, and the lateral bundles of the tendon diverge in the palmar direction. Thus, they do not straighten, but bend the middle phalanx. In this case, the head of the main phalanx moves forward through a gap in the extensor apparatus, like a button passing into a loop. The finger assumes a position bent at the proximal interphalangeal joint and hyperextended at the distal interphalangeal joint. This deformation is called a “boutonniere”. With this type of injury, surgical treatment is necessary - suturing the damaged elements, followed by immobilization for 6-8 weeks.

Treatment of injuries at the level of the main phalanx, metacarpophalangeal joints, metacarpus and wrist is only surgical - primary tendon suture followed by immobilization of the hand in the position of extension in the wrist and metacarpophalangeal joints and slight flexion in the interphalangeal joints for a period of 4 weeks with subsequent development of movements.

Damage to the nerves of the hand.

The hand is innervated by three main nerves: the median, ulnar and radial. In most cases, the main sensory nerve of the hand is the median, and the main motor nerve is the ulnar nerve, innervating the muscles of the eminence of the little finger, interosseous, 3 and 4 lumbrical muscles and the adductor pollicis muscle. Of important clinical significance is the motor branch of the median nerve, which arises from its lateral cutaneous branch immediately after exiting the carpal tunnel. This branch innervates the short flexor of the 1st finger, as well as the short abductor and opponor muscles of the Many. the muscles of the hand have double innervation, which preserves to one degree or another the function of these muscles if one of the nerve trunks is damaged. The superficial branch of the radial nerve is the least significant, providing sensation to the dorsum of the hand. If both digital nerves are damaged due to loss of sensitivity, the patient cannot use the fingers and their atrophy occurs.

The diagnosis of nerve damage should be made before surgery, since this is not possible after anesthesia.

Suturing the nerves of the hand requires the use of microsurgical techniques and adequate suture material (6\0-8\0 thread). In case of fresh injuries, soft and bone tissues are first processed, after which the nerve suture is started (Fig. 51)

Fig. 51 Epineural suture of the nerve

The limb is fixed in a position that provides the least tension on the suture line for 3-4 weeks.

Defects of soft tissues of the hand.

Normal hand function is possible only if the skin is intact. Each scar creates an obstacle to its implementation. The skin in the scar area has reduced sensitivity and is easily damaged. Therefore, one of the most important tasks of hand surgery is to prevent scar formation. This is achieved by placing a primary suture on the skin. If, due to a skin defect, it is impossible to apply a primary suture, then plastic replacement is necessary.

In case of superficial defects, the bottom of the wound is represented by well-supplied tissues - subcutaneous fatty tissue, muscle or fascia. In these cases, transplantation of non-vascularized skin grafts gives good results. Depending on the size and location of the defect, split or full-thickness flaps are used. Necessary conditions for successful graft engraftment are: good blood supply to the bottom of the wound, absence of infection and tight contact of the graft with the receiving bed, which is ensured by applying a pressure bandage (Fig. 52)

Fig52 Stages of applying a pressure bandage

The bandage is removed on the 10th day.

Unlike superficial defects, with deep wounds the bottom of the wound is tissue with a relatively low level of blood supply - tendons, bones, joint capsule. For this reason, the use of non-vascularized flaps is ineffective in these cases.

The most common damage is tissue defects of the nail phalanx. There are many methods for covering them with blood-supplied flaps. When detaching the distal half of the nail phalanx, plastic surgery with triangular sliding flaps, which are formed on the palmar or lateral surfaces of the finger, is effective (Fig. 53)

Fig. 53 Plastic surgery with a triangular sliding flap for a skin defect of the nail phalanx

Fig. 54 Plastic surgery using a palmar digital sliding flap

Triangular areas of skin are connected to the finger by a stalk consisting of fatty tissue. If the soft tissue defect is more extensive, then a palmar digital sliding flap is used (Fig. 54)

For defects in the flesh of the nail phalanx, cross flaps from the adjacent longer finger are widely used (Fig. 55), as well as a skin-fat flap of the palmar surface of the hand.

Fig.55 Plastic surgery using a skin-fat flap from the palmar surface of the hand.

The most severe type of hand tissue defect occurs when the skin is removed from the fingers like a glove. In this case, the skeleton and tendon apparatus can be completely preserved. For the damaged finger, a tubular flap on a pedicel is formed (Filatov’s sharp stem); when skeletonizing the entire hand, plastic surgery is performed using skin-fat flaps from the anterior abdominal wall (Fig. 56).

Fig. 56 Plastic surgery of a scalped wound of the middle phalanx using Filatov’s “sharp” stem

Tendon canal stenosis.

The pathogenesis of degenerative-inflammatory diseases of the tendon canals has not been fully studied. Women aged 30-50 years are most often affected. The predisposing factor is static and dynamic overload of the hand.

De Quervain's disease

1 osteofibrous canal and the tendons of the long abductor pollicis muscle and its short extensor muscle passing through it are affected.

The disease is characterized by pain in the area of ​​the styloid process, the presence of a painful lump on it, a positive Finkelstein symptom: acute pain in the area of ​​the styloid process of the radius, occurring when the hand is abducted ulnarly, with 1 finger pre-bent and fixed. (Fig. 57)

Fig. 57 Finkelstein's symptom

X-ray examination makes it possible to exclude other diseases of the wrist joint, as well as to identify local osteoporosis of the apex of the styloid process and hardening of the soft tissues above it.

Treatment.

Conservative therapy involves local administration of steroid drugs and immobilization.

Surgical treatment is aimed at decompressing 1 canal by dissecting its roof.

After anesthesia, a skin incision is made over the painful lump. Just under the skin is the dorsal branch of the radial nerve; it must be carefully retracted to the rear. By making passive movements with the thumb, 1 canal and the site of stenosis are examined. Next, the dorsal ligament and its partial excision are carefully dissected using the probe. After this, the tendons are exposed and inspected, making sure that nothing interferes with their sliding. The operation ends with careful hemostasis and suturing of the wound.

Stenosing ligamentitis of the annular ligaments.

The annular ligaments of the tendon sheaths of the flexor fingers are formed by thickening of the fibrous sheath and are located at the level of the diaphysis of the proximal and middle phalanges, as well as above the metacarpophalangeal joints.

It is still not clear what is primarily affected - the annular ligament or the tendon passing through it. In any case, it is difficult for the tendon to slide through the annular ligament, which leads to “snapping” of the finger.

Diagnosis is not difficult. Patients themselves show a “snapping finger”; a painful lump is palpated at the level of pinching.

Surgical treatment gives a quick and good effect.

The incision is made according to the rules described in the “access to the hand” section. The thickened annular ligament is exposed. The latter is dissected along a grooved probe, and its thickened part is excised. The freedom of tendon gliding is assessed by flexion and extension of the finger. In case of old processes, additional opening of the tendon sheath may be required.

Dupuytren's contracture.

Dupuytren's contracture (disease) develops as a result of cicatricial degeneration of the palmar aponeurosis with the formation of dense subcutaneous cords.

Mostly elderly men (5% of the population) suffer.

Diagnosis usually does not cause difficulties. The disease usually develops over several years. Strands are formed that are painless, dense on palpation and cause limitation of active and passive extension of the fingers. The 4th and 5th fingers are most often affected, and both hands are often affected. (Fig.58)

Fig. 58 Dupuytren's contracture of 4 fingers of the right hand.

Etiology and pathogenesis.

Not exactly known. The main theories are traumatic, hereditary. There is a connection with the proliferation of endothelial cells of the vessels of the palmar aponeurosis and a decrease in oxygen content, which leads to the activation of fibroplastic processes.

Often combined with Ledderhose disease (scarring of the plantar aponeurosis) and fibroplastic induration of the penis (Peyronie's disease).

Anatomy of the palmar aponeurosis.

1. m. palmaris brevis.2. m. palmaris longus.3. volar carpal ligament communis.4. volar carpal ligament proprius.5. Palmar aponeurosis.6. Tendon of palmar aponeurosis.7. Transverse palmar ligament.8. vaginae and ligaments of mm. flexor muscles.9. tendon of m. flexor carpi ulnaris.10. tendon of m. flexor carpi radialis.

The palmar aponeurosis has the shape of a triangle, the apex of which is directed proximally, and the tendon of the palmaris longus muscle is woven into it. The base of the triangle breaks up into bundles going to each finger, which intersect with the transverse bundles. The palmar aponeurosis is closely connected with the skeleton of the hand and is separated from the skin by a thin layer of subcutaneous fatty tissue.

Classification.

Depending on the severity of clinical manifestations, there are 4 degrees of Dupuytren’s contracture:

1st degree – characterized by the presence of a compaction under the skin that does not limit the extension of the fingers. At this degree, patients usually mistake this lump for “namin” and rarely consult a doctor.

2nd degree. At this degree, finger extension is limited to 30 0

3rd degree. Limitation of extension from 30 0 to 90 0.

4th degree. Extension deficit exceeds 90 0 .

Treatment.

Conservative therapy is ineffective and can be recommended only in the first degree and as a stage of preoperative preparation.

The main method of treating Dupuytren's contracture is surgery.

A large number of operations have been proposed for this disease. The following are of primary importance:

Aponeurectomy– excision of the scarred palmar aponeurosis. It is made from several transverse incisions, which are made according to the rules described in the “incisions on the hand” section. Strands of the altered palmar aponeurosis are isolated and excised subcutaneously. This can damage the common digital nerves, so this step must be performed with extreme care. As the aponeurosis is excised, the finger is gradually removed from the flexion position. The skin is sutured without tension and a pressure bandage is applied to prevent the formation of a hematoma. A few days after the operation, they begin to move the fingers to the extension position using dynamic splints.

Any fracture always means pain, immobility and a long recovery. But in some cases, a fracture becomes a threat not only to health, but also to life.

Basics of corrective palmistry. How to change fate along the lines of the hand Kibardin Gennady Mikhailovich

Phalanges of the thumb

Phalanges of the thumb

Each finger on the human hand is naturally divided into three parts, which are called phalanges (Figure 49). Although, looking at the thumb of our hand, we believe that it has only two phalanges. In fact, the Mount of Venus (the fleshy area of ​​the hand at the base of the thumb, surrounded by the line of Life) hides the third phalanx from us. Ideally, the length of the first and second phalanges of the thumb should be the same (Figure 50).

Rice. 50. Equal length of phalanges

The first phalanx of the thumb, on which the nail grows, symbolizes the will of a person, and the second - his logic.

When both phalanges reach the same length, this indicates that the person has both logic and willpower equally. He is able to generate good ideas and has the necessary will and energy to implement them. If the first phalanx is longer than the second, this indicates the predominance of willpower over logic (Figure 51).

Rice. 51. The upper phalanx is large

Rice. 52. Upper phalanx small

Such a person, moving towards his goal, can make a lot of mistakes. However, these mistakes, even very serious ones, will not force him to abandon his intended goal. Even after the most crushing blow of fate, he will find the strength to rise and continue moving forward. This combination of phalanges of the thumb indicates a person who is extremely purposeful and persistent. He is ready to work hard and long for his goal. At the same time, a person often tends to suppress others and dominate them.

In most people, the second phalanx is longer than the first (Figure 52). This indicates the predominance of logic over willpower. Such a person is full of ideas, but is not able to find the strength to realize at least one of them. He thinks and thinks and thinks. He has everything except motivation and determination. This explains why most of us achieve only a small fraction of what we are capable of. Alas, too much logic, too little will.

From the book Conspiracies of a Siberian healer. Issue 15 author Stepanova Natalya Ivanovna

Trick the enemy around your finger (mischief) Anything can happen in life, and sometimes a person is forced to use cunning just to confuse his enemy and thereby defeat him. Masters of magic know many different ways to help confuse the enemy. All these ways

From the book Encyclopedia of Palmistry: Your destiny is in full view author Makeev A.V.

Zone of the thumb and Mount of Venus The Mount of Venus represents the personification of the third world, that is, the material world. Venus is the goddess of love and beauty, the patroness of the hearth, family and maternal happiness and peace. It carries information about grace

From the book Yoga for Fingers. Mudras of health, longevity and beauty author Vinogradova Ekaterina A.

From the book Palmistry and Numerology. Secret knowledge author Nadezhdina Vera

From the book Basics of Corrective Palmistry. How to change fate along the lines of the hand author Kibardin Gennady Mikhailovich

From the book Yoga for Pregnant Women by Guerra Dorothy

From the book The most necessary book for determining the future. Numerology and palmistry author Pyatnitsyn E.V.

Fingertip Shape The shape of the fingertip is as important as the length of the finger. These two factors must be considered together. The fingertips include the upper phalanges of each finger; There are five types: square, spade, truncated, conical and rounded.

From the author's book

Thumb length The longer the thumb, the more significant success such a person can achieve (Figure 40). It is known that Napoleon had unusually large thumbs. Watch the fingers of people speaking on television. You surely

From the author's book

Shape of the tip of the thumb It can tell you a lot of interesting things about its owner (Figure 43). In general, when the thumb, when viewed from the side of the nail, looks wide, this indicates that a person is capable of a lot to achieve his goal.

From the author's book

Thumb angle The angle of the thumb relative to the index finger (Figure 53) is most often 45°. This indicates a person’s ability and desire to maintain traditional social principles and his moderate conservatism. In general terms, the more

From the author's book

Thumb positioning The thumbs can be positioned at different heights in relation to the palms (Figure 56). Rice. 56. Planting of the thumbTherefore, they are divided into two types: high-set and low-set. The thumb is considered to be set high when

From the author's book

Mobility of the thumb Thumbs are either mobile or immobile in their activity. If the finger bends freely back at the joint, it is considered mobile (Figure 57). Rice. 57. Mobility of the thumb A person with mobile thumbs

From the author's book

Phalanges of the fingers All fingers have three parts (phalanxes). Ideally, all phalanges of one finger should be equal in length. If one of the phalanges is longer than the others, this means that a person will more actively use its energy at the expense of the remaining two. If the phalanx

From the author's book

The phalanges of the little finger characterize your literature. Now let's look at the ratio of the lengths of the three phalanges of the little finger. The upper phalanx of the little finger indicates the activity of a person’s verbal communication. On most people's hands, the upper phalanx is the longest. Long top

From the author's book

From the author's book

Fingertip Shape The shape of the fingertip is as important as the length of the finger. These factors must be considered together. The fingertips include the upper phalanges of each finger; There are five types: square, spade, truncated, conical and rounded.

The interpretation of the thumb plays an important role in palmistry. I have met Indian palmists who made most of their predictions based on thumb analysis, and this is no coincidence. The thumb can tell a lot about a person's character. For example, how he makes decisions and how he implements them.

Man is the only creature in nature endowed with an opposable finger.

Chimpanzees follow closely behind humans, but their fingers are very primitive compared to ours. A unique feature of our fingers is the radial nerve, which is made up of the same nerve fibers as the central part of our brain. The same nerve fibers run through the human spine. The radial nerve gives us a unique ability for analytical thinking, which distinguishes humans from all other living beings on the planet.

THUMB LENGTH

The larger the finger, the more significant success a person can achieve.

It is known that Napoleon had unusually large thumbs, and this is not surprising. There is one useful and exciting exercise: watching the hands of people speaking on television. You will probably notice that many actors play roles that are completely unusual for them in real life. An example of this is an actor with a small thumb playing the role of a financial tycoon. In India, it is believed that the size of the thumb is directly related to the level of success that a person can achieve. This interpretation seems too fatalistic to me, and yet there is no doubt that it is people with large thumbs who are more likely than others to take leading positions in the modern world. The fact is that they are more purposeful, ambitious and persistent than others. Charlotte Wolf conducted a study of the thumbs of highly accomplished people and found that almost all of them had thumb lengths that fell within the average range. It's just that people with long thumbs are much more persistent and persistent in achieving their goals.

If you happen to meet a person with a very long thumb (Fig. 84), know that he is capable of taking on the role of leader in any situation. This person is smart, determined and has tremendous willpower.

People with short thumbs (Fig. 85) usually lack willpower. They can be extremely stubborn, often unreasonably and for no particular reason.

People whose thumbs reach medium length (reach at least the middle of the lower phalanx of the index finger, (Fig. 86)) are fair, independent and can stand up for themselves. They think clearly and have significant willpower.

When the thumb, when viewed from the side of the nail, looks wide (Fig. 87), this indicates that a person is capable of anything to achieve his goal.

A person whose thumb looks fleshy (Fig. 88) is harsh and straightforward and at times may seem tactless and even rude. He is stubborn and strives with all his might to always do everything his own way. He will not stand behind the price when it comes to his own independence.

PHALANGES OF THE THUMB

Each finger on the human hand is divided into three parts, which are called phalanges (Fig. 89), although it seems that the thumb has only two phalanges. The Mount of Venus - a fleshy section of the hand at the base of the thumb, surrounded by the line of life - is its third phalanx.

Ideally, the length of the first and second phalanges of the thumb should be the same (Fig. 90). The first phalanx on which the nail grows symbolizes the will of a person, and the second - his logic. When both phalanges reach the same length, this indicates a person who has both logic and willpower in equal measure. He is able to give birth to a good idea and has the necessary will and energy to implement it.

If the first phalanx is longer than the second (Fig. 91), this indicates the predominance of willpower over logic. Such a person will make a lot of mistakes, but not one of them, no matter how serious, will be able to force him to abandon his intended goal.

Even after the most crushing blow, he will find the strength to rise and continue moving forward. This combination of phalanges indicates a person who is extremely purposeful and persistent. He is ready to work hard and long for his goal. Tends to suppress others and dominate them.

In most people, the second phalanx is longer than the first (Fig. 92). This indicates the predominance of logic over willpower. A person with this combination is full of ideas, but is not able to find the strength to realize at least one of them. He thinks, and thinks, and thinks, and then thinks some more. He has everything except determination and motivation. This explains why most of us achieve only a small fraction of what we are capable of. Too much logic, too little will.

THUMB ANGLE

Most often, the thumb is located at an angle of 45° relative to the hand (Fig. 93). This indicates a person’s ability and desire to maintain traditional social principles and his moderate conservatism. In general terms, the larger the given angle, the more generous the person is.

Accordingly, this angle is sometimes called the “angle of generosity” (Fig. 94).

If the value of this angle is less than 45° (Fig. 95), this indicates that the person is selfish. Most likely, he is cruel, narrow-minded and proud. His view of the world around him is very narrow.

If this angle exceeds 45°, this indicates an energetic, open person, with the ability to charm and influence others.

He loves adventure and always strives to learn something new and unusual. If, in a relaxed state, the thumb is kept at a distance from others, this indicates a calm, open, sociable and carefree person, a practicality angle

The utility angle is the angle formed on the outside of the thumb where it meets the palm (Fig. 96). You will soon discover that most hands do not have this angle, while some people have a noticeable bulge in this place. The larger this convexity, the more practical the person is. These people are what we call jacks of all trades; they are skilled and dexterous and enjoy activities that allow them to actively use their hands. This angle is also known as the time angle because it gives a person a particularly keen sense of time. Such people are always punctual, they know how to seize the right moment and pause brilliantly.

HEIGHT ANGLE

The angle of pitch, or angle of sound, is located at the very base of the palm under the thumb, where it connects to the wrist (Fig. 97). The height angle indicates a person who feels rhythm and has an ear for music.

Gifted musicians, dancers and singers in most cases have pronounced angles of height and practicality. The practicality angle gives them a sense of time and tempo, while the pitch angle gives them an ear for music and a sense of rhythm.

Take a closer look at photographs of the world's leading musicians and performers of all genres, from classical to popular music, and you will notice how obvious these angles are on their hands. The next time you see a photograph of Elvis Presley, pay attention to his hands - they have a very pronounced angle of practicality and angle of height.

THUMB FITTING

The thumbs can be located at different heights in relation to the palms, so they are divided into high-set and low-set.

The thumb is considered high-set (Fig. 98) if it starts high above the wrist. People with such fingers are distinguished by originality, openness and optimism. They are typical extroverts.

People with low-set thumbs (Fig. 99), on the contrary, are reserved and cautious. In most cases, the thumb position falls somewhere between high and low.

TIP OF THUMB

Few modern palmists use D'Arpentigny's hand classification system, but the terms he developed are still actively used in the analysis of fingertips, including the thumb.

If the tip of the thumb is square (Fig. 100), this indicates a practical, simple, down-to-earth and fair person. Such people always try to play fair.

If the tip has a spatula shape (Fig. 101), this indicates a businesslike and active person.

If the tip has a conical shape (Fig. 102), this indicates a sensitive and refined person.

Often the conical tip is combined with a second phalanx that is tapering and concave on both sides (Fig. 103). This indicates a person’s diplomacy and tact. When he says no, he does it so politely, kindly and intelligently that it is impossible to be offended by him.

The pointed tip of the thumb (Fig. 104) indicates a subtle and insightful person who will be able to present even the worst news gently and calmly.

The wide tip (Fig. 105) indicates a cautious, thorough person who has his own convictions.

If the tip is wide and flat, and the upper phalanx resembles a bump, such a finger is called a killer finger (Fig. 106). This finger shape is usually hereditary. People with these fingers can be very patient, but sometimes they explode over trifles. There is no doubt that it was thanks to this feature that the “killer finger” got its name.

FINGER MOBILITY

The thumbs are divided into inflexible and mobile. If the finger bends freely back at the joint, it is considered mobile (Fig. 107). A person with mobile thumbs is open, positive, and optimistic. He does not tolerate pressure and in conflict situations prefers to retreat without entering into an argument or causing a scandal.

If the thumb is inactive and does not bend back at the joint, it is called inflexible. A person with this type of thumb is reliable, constant, stubborn, persistent and purposeful. He never backs down, even if he finds himself under very strong pressure.

There was a period in my life when I worked as a salesman, and knowledge of palmistry helped me a lot then. If a customer stood in front of me with flexible thumbs, I could press lightly on him, and, yielding to the pressure, he would make a purchase.

If I had to deal with a person whose thumbs were stiff, I didn't even try to put pressure on him. If I tried to click on such a client, all my attempts would end in failure. Moreover, I would erect obstacles to future success with my own hands.

Phalanges are the small bones that form the fingers. Each finger has three phalanges: the base, middle and nail parts. Depending on the length and shape, they can tell about a person's talents. Opening your palm, you will see them: all twelve. Take a ruler, measure the length of each of them, starting from the top and moving towards the junction of the fingers with the palm, and write down the data in a notebook. See which of the three types of phalanges are the longest and the shortest.

Upper phalanges

If the upper phalanges are longer than the middle and base ones, then you are a thinker. Long upper phalanges belong to people who enjoy learning, are interested in science and love to analyze facts. However, they are not always able to put their knowledge into practice.

For example, a person who is well versed in art and knows everything about artists cannot draw anything himself.

A person whose upper phalanges are no longer than the rest also loves to study and analyze facts, but his talents are hidden not in scientific, but in some other areas - the other two sections of the phalanges will tell about this.

Middle phalanges

If your middle phalanges are longer than the rest, you are a great organizer and love to divide people into groups, delineate and analyze problems. With your ability to find a practical solution to any problem, you are likely to achieve your goals. Company executives, financiers and businessmen, advanced workers who complete tasks accurately and on time, usually have elongated middle phalanges of the fingers. If your middle phalanges turn out to be the shortest, try to be more careful and disciplined in your work.

Basic phalanges

If the base phalanges are the longest, you are probably physically a very strong person. People with such hands are not afraid of difficult and dirty work; many achieve success in sports. But most of all, these people love everything to be beautiful - “beautifully done.” They are often excellent cooks; many become brilliant chefs or restaurant owners. Such people like to admire paintings, jewelry or antiques. Among them there are often famous collectors.