Proximal phalanx of the 5th toe. Features of the anatomy and structure of the phalanges of the human fingers. Anatomical features of the PFJ

The human hand consists of many small joints. Thanks to this, the fingers can perform quite complex movements: write, draw, play musical instruments. The brush is involved in any everyday human activity. Therefore, various joint pathologies in this area greatly reduce the quality of life. Indeed, due to limited mobility, it becomes difficult to perform the simplest actions.

And the joints are most often affected, since this is the most vulnerable place and subject to heavy loads. Due to the structural features, inflammation, metabolic disorders or injuries may occur here. One of the most important and mobile joints of the hand is the metacarpophalangeal joint. It connects the metacarpal bones to the main phalanges of the fingers and provides mobility to the hand. Due to their location and functions, these joints are most often subject to various pathologies.

general characteristics

The metacarpophalangeal joints of the hand are spherical joints with a complex structure. They are formed by the surfaces of the heads of the metacarpal bones and the bases of the first phalanges. After the wrist joint, these are the largest and most mobile in the hand. They bear the main load during any hand work. The metacarpophalangeal joint of the thumb is slightly different due to its special structure, location and function. Here it has a saddle shape, so it is not so mobile. But it is he who is responsible for the grasping movements of the hand.

This joint can be easily seen if you clench your hand into a fist. In this case, the metacarpophalangeal joints of the four fingers form semicircular bulges, spaced approximately 1 cm from each other. The most noticeable bump is in the area of the middle finger. Due to this location, these joints are very vulnerable and are quite often subject to trauma or various pathological processes. In this case, not only the work of the hand is disrupted, but also the overall performance of a person.

The metacarpophalangeal joints are the most mobile in the hand; they can bend, extend, move in the lateral plane and even rotate

Movements in the joint

This joint is the most mobile among all the joints of the hand. He has quite complex biomechanics. Fingers in this place can perform the following movements:

flexion-extension;
abduction-adduction;
rotation.

Moreover, the last movements are available only for 4 fingers. The large one has a special structure - only two phalanges. Therefore, his metacarpophalangeal joint is block-shaped - it can perform a limited number of movements. It only bends; all other movements are blocked and impossible even in a passive form. This articulation of the thumb follows the form and function of all other interphalangeal joints.

The metacarpophalangeal joints of the remaining fingers are more mobile. This is explained by their special structure. The base of the phalanx is slightly smaller than the head of the metacarpal bone. Their strong connection is ensured by a fibrocartilaginous plate. On the one hand, it serves for tight contact between the bones and stabilization of the joint, which is especially noticeable when extending the finger. But when he starts to move, this plate slides, providing a greater range of motion.

A feature of this joint, due to which the finger can move in different directions, is the elasticity of its capsule and synovial membrane. In addition, the joint capsule has deep pockets in front and back. They ensure the sliding of the fibrocartilaginous plate, and it is in these places that the tendons of the muscles that control the operation of the fingers are attached.

Greater mobility of these joints is possible due to the presence of two types of ligaments. One is attached to the fibrocartilaginous plate and the head of the metacarpal bone. It ensures normal sliding of this plate. Other ligaments are collateral, located on the sides of the fingers. They ensure their flexion and extension, and also slightly limit the mobility of the joint. For example, with a bent finger, its movement in the lateral plane, that is, its abduction and adduction, is impossible. The operation of this joint is also controlled by the palmar ligament and the transverse interdigital ligament.

Unlike the thumb, which bends less than 90 degrees at the metacarpophalangeal joint, the other fingers have a greater range of motion. The index finger has the least mobility; it can bend 90-100 degrees, no more. Further to the little finger, the amplitude of movements, especially passive ones, increases. And the middle one cannot bend more than 90 degrees even passively due to the tension of the interdigital ligament, which prevents it from approaching the palm.

The metacarpophalangeal joints are the only ones in the hand that can be extended, although with a small amplitude - no more than 30 degrees. Although in some people the mobility of the fingers can reach such an extent that they extend at a right angle. In addition, in this place it is possible to perform rotational movements, both passive and active. But their mobility is different for each person.

It is in these places that pain most often occurs due to age-related changes in tissues, after increased stress or other pathologies

Features of pathologies

Due to such a complex structure of the metacarpophalangeal joints and a large range of movements, they are most often subject to injuries and various pathologies. Pain in this area may be associated with damage to the joint capsule, the surface of the bone heads, the cartilaginous plate or ligaments. They make it difficult to move the hand and lead to serious problems when performing normal activities. Therefore, you should not ignore the first symptoms of pathologies; the sooner treatment is started, the faster hand function will be restored.

Such diseases most often occur in people after 40 years of age, which is associated with age-related changes in tissues and the consequences of increased stress. Moreover, women are most susceptible to damage to the joints of the hand. After all, during menopause, hormonal changes occur in their bodies, which negatively affects the functioning of the entire body. In addition, pathologies of the metacarpophalangeal joints can occur due to injuries, increased stress, hypothermia or infectious diseases.

If you experience pain in your hand, you should definitely consult a doctor for examination and an accurate diagnosis. After all, the treatment of different diseases is different, but their symptoms can often be the same. It is worth visiting a doctor if there is pain when moving your finger or at rest, swelling, redness of the skin, or limited movement of the hand.

After diagnostic procedures, one of the following pathologies is usually detected:

rheumatoid arthritis;
psoriatic arthritis;
infectious arthritis;
osteoarthritis;
gout;
stenosing ligamentitis;
inflammation of soft tissues;
injury.

These joints are often affected by arthritis, causing pain and inflammation

Arthritis

Most often, the fingers are affected by arthritis. This is an inflammatory disease that affects the joint cavity. Arthritis can occur as a complication after a general infectious disease, injury, or as a result of pathologies of the immune system. The joints of the fingers can be affected by rheumatoid arthritis, psoriatic or infectious. Common symptoms of these diseases are pain, swelling, flushing and limited mobility.

But there are differences between different types of arthritis. The rheumatoid form of the disease is characterized by a chronic course and symmetrical lesions of the fingers on both hands. With psoriatic arthritis, inflammation of just one finger may develop. But all his joints are affected. At the same time, it swells and becomes like a sausage.

In infectious arthritis, inflammation is associated with the entry of pathogenic microorganisms into the joint cavity. Mainly one joint is affected. There is a tugging pain, often very severe, swelling, and a rise in temperature. Sometimes pus accumulates in the joint cavity.

Arthrosis

Chronic degenerative joint disease is arthrosis. It usually develops in several places at once, but often affects the base of the fingers. This pathology is characterized by aching pain that occurs after exercise, joint stiffness, and deformation. All this leads over time to the inability to perform basic movements with the fingers: fasten buttons, hold a spoon, write something.

Arthrosis affects cartilage tissue, leading to its destruction. Therefore, the metacarpophalangeal joint with this pathology can quickly lose mobility. After all, its peculiarity is that a large range of movements is ensured by the sliding of the fibrocartilaginous plate. And when it is destroyed, the joint is blocked.

Sometimes rhizarthrosis occurs, in which the first finger is isolated. The reasons for the destruction of cartilage tissue in this place are regular increased loads on it. Rhysarthrosis must be differentiated from gout or psoriatic arthritis, the symptoms of which are similar, but their treatment is very different.

Destruction of cartilage tissue during arthrosis leads to severe deformation of the joints

Gout

This is a pathology of metabolic processes, as a result of which the accumulation of uric acid in the blood and the deposition of salts in the joints begins. Gout usually affects the metatarsophalangeal joints on the foot, but in women it can also occur on the big toes.

The disease develops in attacks. During an exacerbation, sharp, severe pain occurs in the joint, it swells and turns red. It becomes impossible to touch it or move your finger. Usually the attack lasts from several days to a week. Gradually, gout can lead to joint deformation and complete immobility.

Ligament inflammation

If the annular ligament of the fingers is affected, they speak of the development of stenotic ligamentitis. The main symptoms of the pathology resemble arthrosis - pain also occurs when moving. A characteristic feature of the disease is clearly audible clicks when moving, and sometimes jamming of the finger in a bent position.

Similar to this pathology is tendinitis - inflammation of the collateral or palmar ligaments. But its peculiarity is that the finger gets jammed in an extended position; often the patient cannot bend it on his own.

The metacarpophalangeal joint is very vulnerable, especially on the big toe

Injuries

Injuries to the metacarpophalangeal joints are common. Athletes are especially susceptible to them, but you can injure your hand even when doing homework with careless movement. The most common injury in this area is a bruise, which is accompanied by severe pain and the development of a hematoma. It hurts to move your finger, but all symptoms most often go away quickly even without treatment.

A more serious injury is a dislocation. The metacarpophalangeal joint can be injured when it is hyperextended, for example during sports or a fall. In this case, severe pain occurs, the joint becomes deformed and swells. Quite often, dislocation of the thumb occurs, since it is subjected to the greatest loads. And pitting it against the rest of the brush makes it vulnerable.

Treatment

When treating pathologies in this place, it should be remembered that immobilization of the metacarpophalangeal joints can only be carried out in a flexion position. Indeed, due to the peculiarities of the collateral ligaments, their long-term fixation can lead to finger stiffness in the future. Therefore, if immobilization is necessary, for example, after an injury, you need to do it correctly. It is best to use a ready-made orthosis or a bandage applied by a doctor. But otherwise, diseases of these joints are treated in the same way as similar pathologies in other places.

Most often, patients go to the doctor because of painful sensations. To get rid of them, NSAIDs or analgesics are prescribed. These can be “Baralgin”, “Trigan”, “Ketanov”, “Diclofenac”. Moreover, they can be used both internally and externally in the form of ointments. For severe pain, injections are sometimes made directly into the joint cavity. And in advanced cases, corticosteroids can be used.

When cartilage tissue is destroyed, the use of chondroprotectors is effective. At the initial stage, they are able to completely stop tissue degeneration. Sometimes joint damage and metabolic disorders in them are associated with circulatory pathologies. In this case, Actovegin, Vinpocetine or Cavinton may be prescribed. These drugs improve blood circulation and nerve conduction, and also accelerate tissue regeneration processes. If the inflammation is caused by an infection, antibiotics must be used: Ofloxacin, Doxycycline, Cefazolin and others.

When treating these pathologies, it is especially important to relieve pain, which greatly reduces the performance of the hand.

After pain and inflammation disappear, auxiliary treatment methods are prescribed to restore finger mobility. These can be physical procedures, for example, magnetic therapy, mud applications, paraffin, acupuncture, electrophoresis. Therapeutic exercises for the fingers are also useful, since prolonged immobilization can lead to muscle atrophy. Special exercises prevent the development of stiffness, improve blood circulation and tissue nutrition.

The metacarpophalangeal joints are the most important for the normal functioning of the hand. But injuries and various pathologies affecting this joint can lead to a complete loss of its functionality.

Since a person moves in an upright position, the lion's share of the load falls on the lower extremities. Therefore, it is important to monitor your body weight, making it easier for the bones of the foot to work.

The structure of the ankle joint in humans is represented by the articulation of the bones of the foot with the shin bones, ensuring the performance of complex functions.

Human ankle joint
Circulatory and nervous systems of the foot
Diagnostic measures
Pathologies of the ankle and feet

Human ankle joint

The bones are clearly shown in the diagram and classified into groups.

These include:

Articulation of the bones of the lower leg with the bones of the foot.
Internal articulation of the tarsal bones.
Articulations between the bones of the metatarsus and tarsus.
Articulations of the proximal phalanges with the metatarsal bones.
Articulation of the phalanges of the fingers with each other.

The anatomical abilities of the foot require a high level of motor activity. For this reason, a person can perform heavy physical activity.

Both the foot and the entire leg are designed to help a person move freely in the environment.

The structure of the foot is divided into 3 working parts:

Bones.
Ligaments.
Muscles.

The skeletal base of the foot includes 3 sections: toes, metatarsus and tarsus.

The design of the toes includes phalanges. Just like the hand, the big toe consists of 2 phalanges, and the remaining 4 fingers - of 3.

There are often cases when the 2 components of the 5th fingers grow together, forming a finger structure of 2 phalanges.

The structure has proximal, distal and middle phalanges. They differ from the phalanges of the hand in that their length is shorter. A clear expression of this is seen in the distal phalanges.

The tarsal bones of the posterior section have talus and calcaneal components, and the posterior section is divided into the cuboid, scaphoid and sphenoid bones.

The talus lies at a distance from the distal end of the tibia, becoming the bony meniscus between the bones of the foot and knee.

It consists of a head, neck and body, and is designed to connect with the shin bones, ankle bones and calcaneus.

The calcaneus is part of the posterior lower lobe of the tarsus. It is the largest part of the foot and has a laterally flattened, elongated appearance. At the same time, the calcaneus is the connecting link between the cuboid and talus bones.

The navicular bone is located on the inside of the foot. It has a convex forward appearance with articular components connecting to nearby bones.

The cuboid part is located on the outer side of the foot, articulating with the calcaneus, navicular, cuneiform and metatarsal bones. At the bottom of the cuboid bone there is a groove in which the tendon of the elongated peroneus muscle is laid.

The composition of the sphenoid bones includes:

Medial.
Intermediate.
Lateral.

They lie in front of the scaphoid, inboard of the cuboid, behind the first 3 metatarsal fragments and represent the anterior inner part of the tarsus.

The skeleton of the metatarsus appears in tubular segments, consisting of a head, body and base, where the body is similar to a triangular prism. In this case, the longest bone is the second, and the thickest and shortest is the first.

The bases of the metatarsal bones are equipped with articular surfaces that serve as a connection to the bony components of the tarsus. In addition, it articulates with the adjacent bones of the metatarsus. At the same time, the heads equipped with articular surfaces are connected to the proximal phalanges.

The metatarsal bones are easily palpated due to the fairly thin covering of soft tissue. They are placed in multi-angle planes, creating a vault in a transverse line.

Circulatory and nervous systems of the foot

Nerve endings and blood arteries are considered an important component of the foot.

There are 2 main arteries of the foot:

Rear.
Posterior tibial.

Also, the circulatory system includes small arteries that distribute to all tissue areas.

Due to the distance of the arteries of the feet from the heart, circulatory disorders are often recorded due to oxygen deficiency. The results of this manifest themselves in the form of atherosclerosis.

The longest vein that carries blood to the heart area is located at the point of the big toe, extending inside the leg. It is commonly called the great saphenous vein. In this case, the small saphenous vein runs along the outside of the leg.

The tibial anterior and posterior veins are located deep in the leg, and the small ones drive blood into the large veins. Moreover, small arteries supply tissues with blood, and tiny capillaries connect veins and arteries.

A person suffering from circulatory disorders notes the presence of edema in the afternoon. In addition, varicose veins may appear.

As in other parts of the body, nerve roots in the foot read all sensations and transmit them to the brain, controlling movement.

The nervous system of the foot includes:

Superficial fibular.
Deep fibula.
Posterior tibial.
Calf.

Tight shoes can compress any nerve, causing swelling, which will lead to discomfort, numbness and pain.

Diagnostic measures

At the moment when alarming symptoms arise in the foot area, a person comes to an orthopedist and traumatologist, who, knowing the complete structure of the ankle joint, can determine a lot by external signs. But at the same time, specialists prescribe the examination necessary for a 100% correct diagnosis.

Examination methods include:

X-ray examination.
Ultrasonography.
Computed and magnetic resonance imaging.
Athroscopy.

Detecting pathologies using x-rays is the most cost-effective option. Pictures are taken from several sides, recording possible dislocations, tumors, fractures and other processes.

Ultrasound helps to detect concentrations of blood, find foreign bodies, a possible swelling process in the joint capsule, and also check the condition of the ligaments.

Computed tomography provides a complete examination of bone tissue for neoplasms, fractures and arthrosis. Magnetic resonance imaging is an expensive research technique that provides maximum reliable information about the Achilles tendon, ligaments and articular cartilage.

Atroscopy is a minimally invasive intervention that involves inserting a special camera into the joint capsule, through which the doctor can see all the pathologies of the ankle joint.

After collecting all the information using instrumental and hardware means, examining doctors and obtaining laboratory test results, an accurate diagnosis is made with the determination of treatment methods.

Pathologies of the ankle and feet

Frequent pain, external changes, swelling and impaired motor functions can be signs of foot ailments.

Typically, a person may experience the following diseases:

Arthrosis in the ankle joint.
Arthrosis of the toes.
Valgus change of the thumb.

Arthrosis of the ankle joint is characterized by crunching, pain, swelling, and fatigue during running and walking. This is due to the course of the inflammatory process, which damages the cartilage tissue, leading to typical deformation of joint tissue.

The causes of the disease can be constant increased loads and injuries, provoking the development of dysplasia, osteodystrophy and negative changes in statics.

Treatment is carried out based on the degree of arthrosis with means that reduce pain, restore blood circulation and block the spread of the disease. In difficult cases, surgical intervention is performed to relieve the patient of damaged joint segments, restoring mobility and eliminating pain.

Arthrosis of the toes is noted as a result of disruption of metabolic processes and typical blood circulation in the metatarsophalangeal joints. This is facilitated by a lack of moderation in exercise, uncomfortable narrow shoes, injuries, excess weight and frequent hypothermia.

Symptoms of the disease include swelling, deformation of the structure of the fingers, pain during movement and crunching.

At the initial stage of finger arthrosis, measures are taken to avoid deformation and relieve pain. If an advanced stage is detected, in most cases the doctor prescribes arthrodesis, endoprosthesis replacement or surgical arthroplasty, which should completely solve the problem of the disease.

Hallux valgus, better known as a “bump” at the base of the big toe. This disease is characterized by displacement of the head of one phalangeal bone, inclination of the big toe to the other four, weakening of the muscles and resulting deformation of the foot.

Treatment that inhibits the development of the disease is determined by prescribing baths, physiotherapy, and physical therapy. When the form of changes becomes obvious, an operation is performed, the method of which is determined by the attending orthopedist, taking into account the stage of the disease and the general well-being of the patient.

Why do my fingers hurt: causes of pain in the joints of the fingers of the right and left hand

To learn more…

Pain in the small joints of the fingers and toes is a fairly common phenomenon and at first glance seems harmless.

Most often, this condition is observed in people after forty years of age, however, there are many diseases in which pain in the fingers of the right or left hand occurs in the younger generation.

The human musculoskeletal system includes more than 300 small and large joints. The most mobile ones are in the fingers and toes. These joints have a thin connective membrane and a small articular surface.

This is why they are so often susceptible to damage and disease.

A joint is a connection of end bones covered with hyaline cartilage. The articulation site is covered with a synovial membrane, which contains joint exudate.

Each finger of the hand (middle, little, index, ring, except the thumb) consists of three phalanges:

Proximal.
Average.
Distal.

In addition, they have three joints:

Proximal - connects the bones that form the palm with the proximal phalanx of the finger.
Middle phalangeal – connects the proximal and middle phalanx.
Distal - with its help the middle phalanx articulates with the distal one.

Why does pain appear in the fingers? The reason for this condition is inflammatory diseases of the joints and traumatic injuries.

Diseases that damage the joint

Pain in the fingers and toes can occur due to the following diseases:

Arthritis (psoriatic, stenotic, infectious, reactive, rheumatoid).
Arthrosis.
Gout.
Bursitis.
Osteoarthritis.
Osteomyelitis.
Tenosynovitis.
De Quervain's disease.
Raynaud's syndrome.
Angiospastic peripheral crisis

This is why pain may appear in the fingers, both in the right and left limbs. And now more about each disease.

Arthritis

Arthritis is a whole group of pathologies characterized by acute inflammation of the elements of the joint and adjacent tissues.

With any type of arthritis, pain in the fingers and toes appears not only when the limb performs any actions, but also in a state of complete rest.

Moreover, the pain is intense, and in the morning there is stiffness in the joints. During loads, crepitus (crunching), increased local temperature and deformation of the joint are possible.

Rheumatoid arthritis is a combined type of connective tissue pathology. Rheumatoid arthritis typically affects small joints (little fingers and other fingers of the left or right hand).

Symptoms of rheumatoid arthritis:

inflammation of the metacarpophalangeal joints of the fingers;
symmetry - if inflammation develops on the right arm, it will certainly affect the other limb.

This disease is insidious in that when it appears, there is a high risk of involvement of large joints in the inflammatory process: knee, elbow, ankle, hip.

Pain from rheumatoid arthritis usually occurs at night and in the morning.

Gout

Gout or gouty arthritis is another type of arthritis. The cause of the disease is an excessive accumulation of uric acid in the body, the crystals of which settle on soft and hard tissues and destroy the joint.

Previously, only rich people who could afford excesses in food suffered from gout: fatty meat and fish, alcoholic drinks.

Meat is the main source of purines, which lead to the development of gouty arthritis. Gout usually affects the big toes.

Symptoms:

pain in big toes;
if the disease affects the joints of the right or left hand, we can talk about the development of polyarthritis;
the joint becomes red and swollen.

For a gout attack:

the joints of the toes are very swollen;
the pain is burning, it mainly occurs at night;
There is a local increase in temperature.

On average, a gout attack lasts from three days to several weeks. A characteristic feature of gouty arthritis is the formation of tophi - pathological compacted nodules that do not cause pain to the patient and are only a cosmetic defect.

Psoriatic arthritis is a form of psoriasis. In addition to the fact that the skin is affected, inflammation occurs in the joints of the legs and arms (right or left). This type of arthritis affects all joints of one finger at once. The inflamed finger becomes red and swollen. Joints are affected asymmetrically.

Septic infectious arthritis occurs due to infection entering the joint tissue through damaged areas of the skin or through the blood. Only one joint or several joints may hurt. The intensity of the symptoms of the disease depends on the stage of its development.

The following symptoms are characteristic of purulent or advanced inflammation:

fever;
severe intoxication;
body temperature rises to a critical level.

In childhood, the symptoms of the disease are more pronounced, which cannot be said about the pathology that develops in an adult.

Other joint diseases

Stenosing ligamentitis is characterized by inflammation of the annular ligament of the fingers of the right or left hand.

Symptoms of the disease

numbness;
severe burning sensation;
cyanosis and swelling of the finger;
the pain affects all fingers, but does not affect the little finger.
the joint cannot be straightened without external forces.

Discomfort and pain intensify at night and in the morning. During the day, the pain disappears completely.

With osteoarthritis, cartilage tissue in the joint is destroyed. Women during menopause are more susceptible to this disease.

Causes of osteoarthritis:

hereditary factors;
hormonal disorders;
metabolic disease;
loads associated with the profession.

Symptoms of osteoarthritis:

stiffness of the right or left hand in the morning;
limited mobility in joints;
crepitus when working with hands;
when the joint is loaded, pain appears that subsides at night;
dull pain at night is possible with venous stagnation.

At first, the disease affects only one joint, after which the remaining joints are also involved in the inflammatory process. Those diarthrosis that during the first inflammation took on all the work are subject to secondary damage.

If only the thumb joint on your right hand hurts, your doctor may suspect rhizarthrosis, a type of osteoarthritis. This disease typically involves damage to the base of the joint, which connects the metacarpal and wrist bones.

Rhizarthrosis can be triggered by constant stress on the muscles and joints of the thumb. Signs of pathology include pain and deformation of the bones of the thumb.

Osteomyelitis is a purulent-necrotic process that can occur in the bones of the arms and legs, bone marrow, soft tissues and joints. The causes of osteomyelitis are pus-producing bacteria.

The main symptoms of the onset of the disease:

severe intoxication;
significant increase in temperature;
nausea and vomiting;
joint pain;
chills;
deterioration of general condition;
headache.

If osteomyelitis has been going on for several days, additional symptoms appear:

restriction of active and passive movement of the hands;
swelling of the hand muscles;
a venous pattern may appear on the skin;
increased pain.

Even if joint pain, intoxication and fever have eased somewhat, this is not at all evidence that the disease is receding. On the contrary, these signs may indicate the transition of the disease to the chronic stage.

Fistulas often appear on the affected areas, from which pus is released in small quantities. The fusion of fistulas forms subcutaneous channels, leading to curvature of the fingers and their immobility.

Bursitis is a disease in which the joint capsules become inflamed and fluid accumulates in the joint cavity.

Symptoms of bursitis:

sharp pain on palpation;
dark red skin tone;
increase in local temperature;
the formation of a mobile and soft swelling.

If the cause of bursitis is an injury to the hand or finger, there is a possibility of developing a purulent form of bursitis, which is accompanied by:

weakness throughout the body;
pain in the limb;
constant nausea;
headache.

Angiospastic peripheral crisis is another cause of pain in the fingers. The disease is accompanied by coldness of the fingers, their cyanosis, and then severe redness of the skin. The cause of the pathology is hypothermia.

When the wrist joint is injured or compressed, ulnar nerve neuropathy can occur, causing pain in the fingers. The more advanced the disease, the more limited the functionality of the fingers at the time of abduction and adduction of the hand.

If the pain in the fingers is paroxysmal and accompanied by pallor of the tips, this pathology is called “Raynaud’s syndrome.” The disease can occur independently or be a symptom of another disease.

The main signs of Raynaud's syndrome:

white fingertips;
severe burning pain that occurs after stress or hypothermia.

The disease is dangerous because its presence in the body disrupts the delivery of oxygen to cells and tissues, as a result of which the fingertips can become dead. All symptoms of the disease are directly related to impaired peripheral blood circulation in the vessels.

De Quervain's disease is an inflammation of the thumb ligament. The pathology is characterized by the appearance of pain in the wrist joint, which intensifies with movements of the hand. The pain may radiate to the forearm, shoulder and neck. On palpation, swelling and severe pain are noted in the affected area.

Tenosynovitis is a pathology characterized by an acute or chronic inflammatory process in the connective tissue membranes of the tendons.

Symptoms:

pain when bending and straightening a finger;
crepitus with any movements;
swelling in the tendon sheath area.

Relieves pain and swelling in joints due to arthritis and arthrosis
Restores joints and tissues, effective for osteochondrosis

To learn more…

Proximal phalanx (phalanx proximalis)

Foot bones(ossa pcdis).

View from above.

1-distal (nail) phalanges;
2-proximal phalanges;
3-middle phalanges;
4-metatarsal bones;
5-tuberosity of the fifth metatarsal bone;
6-cuboid bone;
7-talar bone;
8-lateral malleolar surface;
9-calcaneus;
10-lateral process of the buffalo calcaneus;
11-tubercle of the calcaneus;
12th posterior process of the talus;
13-block of the talus;
14-support of the talus,
15-neck of the talus;
16-scaphoid bone;
17-latsral sphenoid bone;
18-intermediate sphenoid bone;
19-medial sphenoid bone;
20-sesamoid bone.

Foot bones(ossa pedis).

Plantar side (bottom view).

A-tarsal bones, G-tarsal bones, B-bones of the fingers
feet (phalanxes).

1-phalanx;
2-sesamoid bones;
3rd metatarsal bones;
4-tuberosity of the first metatarsal bone;
5-lateral sphenoid bone;
6-intermediate sphenoid bone;
7-medial sphenoid bone;
8-tuberosity of the fifth metatarsal bone;
9-groove of the peroneus longus tendon;
10-scaphoid bone;
11-cuboid bone;
12-head of the talus;
13-support of the talus;
14-calcaneus;
15-tubercle of the calcaneus.

- tightly closed linear formation of heavy infantry in Ancient Greece, Macedonia and Ancient Rome. Had 8-16 ranks. She had great striking power, but was inactive...
Historical Dictionary
- the battle formation of the Greek army in the form of a tightly closed formation of hoplites of 8-16, sometimes even 25 rows...
Ancient world. Dictionary-reference book
- tightly closed linear military formation, consisting of several. ranks of heavy infantry in Dr. Greece...
Dictionary of Antiquity
- order of battle in ancient Greek. troops in the form of a tightly closed linear formation of hoplites with a formation depth of 8-16 rows. Along the front, F. occupied up to 500 m...
Soviet historical encyclopedia
- Phalanx, . The battle in the heroic era was, apparently, a battle of leaders alone...
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- see Kugelberg-Welander disease...
Large medical dictionary
- V. s., in which the branches of the vagus nerve are crossed only to the upper parts of the stomach...
Large medical dictionary
- , tightly closed linear construction in Greek. infantry) for battle. The f. had 8–16 rows, along the front it occupied up to 500 m...
Great Soviet Encyclopedia
- a multitude - a hint of the phalanx among the ancients - an army, a detachment. Wed. It’s not he alone here, but a whole phalanx of them... Pisemsky. People of the forties. 5, 12. Wed. servants, powdered, in livery caftans... gives her a place.....
Michelson Explanatory and Phraseological Dictionary (orig. orf.)
- ; pl. fala/ngi, R....
Spelling dictionary of the Russian language
- Greek row, formation; | poisonous insect, centipede...
Dahl's Explanatory Dictionary
- PHALANX, -i, female. 1. The ancient Greeks had a close formation of infantry. 2. In utopian socialism, C. Fourier: large community, commune. 3. In Spain: the name of the fascist party...
Ozhegov's Explanatory Dictionary
- PHALANX, phalanges, women. . 1. Tightly packed infantry formation among the ancient Greeks. || trans. Generally a slender, serried row of someone or something. A phalanx of white pawns moved to attack the black king. 2...
Ushakov's Explanatory Dictionary
Explanatory Dictionary by Efremova
- phalanx I 1. Each of the three short tubular bones that form the skeleton of the fingers of the limbs in humans and vertebrates. 2. see also. phalanx II 1...
Explanatory Dictionary by Efremova
- phalanx I 1. Each of the three short tubular bones that form the skeleton of the fingers of the limbs in humans and vertebrates. 2. see also. phalanx II 1...
Explanatory Dictionary by Efremova

"Proximal phalanx" in books

PHALANX

From Fourier's book author Vasilkova Yulia Valerievna

PHALANX Unlike the “Theory of Four Movements”, the “Treatise” is full of practical advice: how to create an association... how to better organize the life of the Harmonians... Fourier groups humanity into phalanxes, borrowing this name from the ancient Greeks, from whom it meant

§ 5. Greek phalanx

From the book Ancient City author Elizarov Evgeny Dmitrievich

§ 5. Greek phalanx Of course, one cannot see in all this the formation of a truly special breed of heroes who became related to the immortal inhabitants of Olympus, victorious supermen, “blond beasts”, for whom there are no longer any barriers or

Macedonian phalanx

From the book Daily Life of the Army of Alexander the Great by Faure Paul

Macedonian phalanx From the infantry formations of the Greeks, whether allies in the pan-Greek federation or mercenaries, the Macedonian phalanx (literally meaning “log”, “grinding roller”) differed not only and, perhaps, not so much in weapons or equipment, but before

Phalanx

From the book Greece and Rome [The evolution of the art of war over 12 centuries] author Connolly Peter

Phalanx During the 8th century. BC. Revolutionary changes occurred in the military affairs of the ancient Greeks. Instead of the previous principle of battle, when each fought the enemy “on his own,” a system was now introduced that required much greater discipline. Such a system was

"African Phalanx"

From the book Foreign Volunteers in the Wehrmacht. 1941-1945 author Yurado Carlos Caballero

“African Phalanx” After the Allied landing in Northern France (Operation Torch), of all the North African territories of France, only Tunisia remained under the sovereignty of Vichy and the occupation of Axis troops. After the landings, the Vichy regime attempted to create volunteer forces

Phalanx

From the book Greece and Rome, encyclopedia of military history author Connolly Peter

Chapter 2 Phalanx

From the book The Art of War: The Ancient World and the Middle Ages [SI] author

Chapter 2 Phalanx But the role of the infantry phalanx in Alexander’s victories should not be underestimated either. Let's look at all the advantages and disadvantages of the Macedonian phalanx. I already said above in the section on the Greco-Persian Wars that the main advantage of the phalanx is

Chapter 2 Phalanx

From the book The Art of War: The Ancient World and the Middle Ages author Andrienko Vladimir Alexandrovich

Spanish phalanx

From the book Great Soviet Encyclopedia (IS) by the author TSB

Phalanx

From the book Great Soviet Encyclopedia (FA) by the author TSB

Solpuga or phalanx

From the book I Explore the World. Insects author Lyakhov Peter

Solpuga or phalanx Solpugas, or as they are also called phalanges, form a separate order among arachnids. The appearance of the phalanx is frightening and clearly does not invite close acquaintance. Its body, 5–7 centimeters long, is usually brownish-yellow in color and completely covered

Zhdanov phalanx

From the book Air Battle for the City on the Neva [Defenders of Leningrad against Luftwaffe aces, 1941–1944] author Degtev Dmitry Mikhailovich

Zhdanov's phalanx In Leningrad, meanwhile, they were preparing for defense. The situation prevailing in the city now made everyone understand that the enemy was already at the gates. It was no longer regular units that were sent to the front, but improvised units collected from around the world. July 10

"Phalanx of Heroes"

From the book Literary Newspaper 6305 (No. 4 2011) author Literary Newspaper

“Phalanx of Heroes” Heritage “Phalanx of Heroes” On the moral and aesthetic experience of Decembrism Nikolay SKATOV, Corresponding Member of the Russian Academy of Sciences Decembrism is not only a social and political movement, not only a phenomenon of national culture. Even besides

Christ's phalanx

From the book Volume V. Book 1. Moral and ascetic creations author Studit Theodore

Christ's phalanx My brothers, fathers and children. Do not be offended by the words with which I, humble, address you, for I do this constantly out of love for you and out of diligent care for you. Since I am your unworthy shepherd, I must fulfill my ministry and, as far as

"Phalanx"

From the book Domestic anti-tank systems author Angelsky Rostislav Dmitrievich

“Phalanx” The 1957 Decree, along with work on the future “Bumblebee” complex, prescribed the implementation of theme No. 8, which also provided for the development of an infantry rocket-propelled anti-tank projectile with a light launcher with similar moderate characteristics in terms of

Lower limb

The bones of the lower limb are divided into four main groups: (1) foot, (2) lower leg, (3) thigh (femur), (4) hip joint. This chapter provides a detailed overview of the radioanatomy and setup for three of them: feet, lower legs, middle And distal femur, including ankle And knee joints.

FOOT

The bones of the foot are generally similar to the bones of the hand and wrist studied in Chapter 4. The 26 bones of one foot are divided into four groups

Phalanges (toes) 14

Metatarsal bones (instep) 5

Tarsal bones 7

Phalanges of the toes

The distal part of the foot is represented by phalanges, forming fingers. The five toes of each foot are numbered first through fifth, respectively, if counted from the medial edge or from the big toe. Note that the first, or thumb, finger has only two phalanges, proximal and distal, as well as the thumb. The second to fifth toes of each foot also have medial phalanx. Thus, two phalanges of the thumb and three in each finger from the second to the fifth make up a total 14 phalangeal bones.

The similarity with the hand in this case is obvious, since each hand also has 14 phalanges. However, the phalanges of the foot are shorter than the phalanges of the hand, and their range of motion is significantly less.

When describing any bone or joint, it is necessary to indicate which toe and which foot it belongs to. For example, the description - the distal phalanx of the first toe of the right foot - gives the exact location of the bone.

The distal phalanges of fingers 2-5 are so small that it is quite difficult to see them as separate bones on an x-ray.

Metatarsus bones

Five metatarsal bones form the instep of the foot. They are numbered in the same way as the fingers, from one to five, counting from the medial edge to the lateral.

Each metatarsal bone has three parts. The small rounded distal part is called head. The elongated thin middle part is called body. The slightly expanded proximal end of each metatarsal bone is called basis.

Lateral division base of the fifth metatarsal has a protruding uneven tuberosity, which is the site of attachment of the tendon. The proximal fifth metatarsal and its tuberosity are usually clearly visible on radiographs, which is important because this area of the foot is often injured.

(5-6-7) 1, 2, 3 Cuneiformia

The resemblance of the tarsus to that of the upper limb is not so obvious because the tarsus has seven bones, as opposed to the eight bones of the carpus. In this case, the tarsal bones are larger than the carpal bones and less mobile, since they form the basis for supporting the body in an upright position.

The seven bones of the tarsus are sometimes classified as bones of the ankle joint, although only one bone, the talus, directly belongs to this joint. Each of the tarsal bones will be further considered separately, along with all the bones with which it has articulations.

Heel bone (Calcaneus)

The heel bone is the largest and strongest bone in the foot. Its posteroinferior section is formed by a well-defined process - tubercle of the calcaneus. Its uneven, rough surface is the site of attachment of muscle tendons. The lower expanded section of the tubercle passes into two small rounded processes: the larger one lateral and the smaller, less frequently mentioned, medial process.

On the lateral surface of the calcaneus there is fibular block, which can have different sizes and shapes and is visualized laterally in the axial projection image. On the medial surface, in its anterior section, there is a large protruding process - support of the talus.

Articulations. The calcaneus articulates with two bones: in the anterior part with the cuboid and in the upper part with the talus. The connection with the talus forms an important subtalar joint. This articulation involves three articular surfaces that provide redistribution of body weight to maintain it in an upright position: this is an extensive posterior articular surface and two smaller ones - anterior and middle articular surfaces.

Note that the medial articular surface is the superior part of the protruding buttress of the talus, which provides medial support for this important supporting joint.

The depression between the posterior and middle articular surfaces is called groove of the calcaneus(Fig. 6-6). In combination With similar to the groove of the talus, it forms an opening for the passage of the corresponding ligaments. This hole, located in the middle of the subtalar joint, is called sinus tarsus(rice. 6-7).

Talus

The talus is the second large bone of the tarsus, it is located between the lower part of the tibia and the heel bone. Together with the ankle and talocalcaneal joints, it participates in the redistribution of body weight.

Articulations. The talus articulates with four bones: top with tibia and tibia, from below with calcaneal and in front with scaphoid.

Arches of the feet

Longitudinal arch of the foot. The bones of the foot form longitudinal and transverse arches, providing powerful spring-type support for the weight of the entire body. The springy longitudinal arch is formed by medial and lateral components and is located mostly at the medial edge and center of the foot.

The transverse arch runs along the plantar surface of the distal tarsus and tarsometatarsal joints. The transverse arch is formed mainly by the sphenoid bones, especially the short second, in combination with the largest sphenoid and cuboid bones (Fig. 6-9).

ANKLE JOINT

Front view

Ankle joint formed by three bones: two long bones of the lower leg, tibial and fibular and one tarsal bone - the talus. The expanded distal part of the thin fibula extending onto the talus is called the external (lateral) ankle.

The distal portion of the larger and more powerful tibia has a widened articular surface for articulation with an equally wide superior articular surface of the talus. The medial elongated process of the tibia, extended along the medial edge of the talus, is called the internal (medial) ankle.

The inner parts of the tibia and fibula form a deep U-shaped cavity, or joint space, covering the block of the talus on three sides. However, it is impossible to examine all three parts of the gap in a direct (posterior) projection, since the distal parts of the tibia and fibula are covered by the talus. This is because the distal fibula is located somewhat posteriorly, as shown in the pictures. Posterior projection with an inward rotation of the foot by 15°, called projection of the joint space 1 and shown in Fig. 6-15, allows a full view of the open articular space above the talus.

Anterior tubercle- a small expanded process located laterally and anteriorly in the lower part of the tibia, articulates with the upper lateral part of the talus, while partially overlapping the fibula in front (Fig. 6-10 and 6-11).

Distal articular surface of the tibia forms the roof of the fork and is called the ceiling of the tibia. In some types of fractures, especially in children and adolescents, damage to the distal epiphysis and ceiling of the tibia occurs.

Side view

In Fig. Figures 6-11 show the ankle joint in a true lateral view, which shows that the distal fibula is located approximately 1 cm posterior to the tibia. This relative position becomes important in determining the true lateral position of the lower leg, ankle joint and foot. The main mistake when placing the ankle joint laterally is slight rotation of the joint, as a result of which the medial and lateral malleoli practically overlap each other. However, this will result in the ankle joint being depicted in an oblique projection, as shown in the figures. Thus, with true lateral projection lateral malleolus located approximately at 1 cm posterior from the medial malleolus. In addition, the lateral malleolus is also longer adjacent - medial approximately on 1 cm (this is better seen in the frontal projection, Fig. 6-10).

Axial (axial) view

An axial view of the inner edge of the distal fibula and tibia is shown in Fig. 6-12. The roof of the lower surface of the tibia (the roof of the tibia) is shown in this figure from the inside, in the end view of the ankle joint. The relationship is also visible lateral and medial malleolus fibula and tibia, respectively. Smaller, fibula located more posteriorly A line drawn through the center of both ankles is at an angle of approximately 15-20° to the frontal plane (parallel to the front surface of the body). Consequently, in order for the intermalleolar line to become parallel to the frontal plane, the shin and ankle

This joint should be rotated 15-20°. This relationship of the distal tibia and fibula is important when positioning the ankle joint or ankle slot in various projections, as described in the positioning sections of this chapter.

Ankle joint

The ankle joint belongs to the group block-type synovial joints, in which only flexion and extension movements are possible (dorsial flexion and plantar flexion). This is facilitated by strong collateral ligaments that pass from the medial and lateral malleolus to the calcaneus and talus. Significant lateral pressure can cause sprain of the ankle joint, accompanied by stretching or rupture of the lateral ligaments and rupture of the muscle tendons, which leads to expansion of the intra-articular space on the side of the injury.

1 Frank ED et al: Radiography of the ankle mortise, Radiol Technol 62-65: 354-359, 1991.

EXERCISES ON RADIOGRAMS

The following radiographs of the foot and ankle in the three most common projections provide an anatomical overview of the bones and joints. To conduct a review test, you are asked to name (or write down) all the parts marked in the pictures, having previously closed the answers given below.

Left foot, lateral view (Fig. 6-13)

A. Tibia.
B. Heel bone.

B. Tubercle of the calcaneus.
D. Cuboid bone.

D. Tuberosity of the fifth metatarsal bone.

E. Superimposed sphenoid bones. G. Scaphoid bone.

3. Subtalar joint. I. Talus.

Oblique projection of the right foot(rice. 6-14)

A. Interphalangeal joint of the first toe of the right foot.
B. Proximal phalanx of the first toe of the right foot.

B. Metatarsophalangeal joint of the first toe of the right foot.
D. Head of the first metatarsal bone.

D. Body of the first metatarsal bone. E. Base of the first metatarsal bone.

G. Second, or intermediate, sphenoid bone (partially overlapped by the first, or medial, sphenoid bone). 3. Scaphoid bone. I. Talus. K. Tubercle of the calcaneus. L. Third, or lateral, sphenoid bone. M. Cuboid bone.

N. Tuberosity of the base of the fifth metatarsal bone. O. The fifth metatarsophalangeal joint of the right foot. P. Proximal phalanx of the fifth toe of the right foot.

Projection of the joint space of the right ankle joint(Fig. 6-15)

A. Fibula.
B. Lateral malleolus.

B. Open joint space of the ankle joint.
G. Talus.

D. Medial malleolus.

E. The lower articular surface of the tibia (the articulating surface of the epiphysis).

Lateral projection of the ankle joint(rice. 6-16)

A. Fibula.
B. Heel bone.

B. Cuboid bone.

D. Tuberosity of the base of the fifth metatarsal bone. D. Scaphoid bone.

E. Talus. G. Sinus of the tarsus.

3. Anterior tubercle. I. Tibia.

TIBIAL AND FIBAL BONES

The next group of bones of the lower limb, which will be discussed in this chapter, includes two bones of the lower leg: tibia And fibular

Tibia

The tibia is one of the largest bones in the human skeleton and serves as the supporting bone of the lower leg. It can be easily felt through the skin in the anteromedial part of the leg. It has three parts: central body And two ends.

Proximal section. The expanded lateral sections of the upper, or proximal, end of the tibia form two powerful processes - medial And lateral condyle.

On the upper surface of the head of the tibia, between the two condyles, is located intercondylar eminence, in which two small tubercles are distinguished, medial And lateral intercondylar tubercles.

The upper articular surface of the condyles has two concave articular surfaces, often called tibial plateau, which form an articulation with the femur. On the lateral projection of the lower leg it can be seen that The tibial plateau has an inclination of 10° to 20° in relation to a line perpendicular to the long axis of the bone (Fig. 6-18) 1. This important anatomical feature must be taken into account when positioning to obtain a straight posterior projection of the knee joint, the central ray should run parallel to the plateau and perpendicular to the cassette. In this case, the joint space will appear open in the image.

In the proximal part of the bone, on its anterior surface, immediately behind the condyles, there is a rough protrusion - tibial tuberosity. This tuberosity is the attachment site of the patellar ligament, which contains the tendons of the large muscle of the anterior surface of the thigh. Sometimes adolescents experience separation of the tibial tuberosity from the shaft of the bone, a condition known as Osgood-Schlatter disease(see clinical indications, p. 211).

The body of the tibia is the long middle part of the bone located between its two ends. Along the anterior surface of the body, between the tibial tuberosity and the medial malleolus, there is a pointed crest, or leading edge tibia, which can be easily felt under the skin.

Diet department. The distal part of the tibia is smaller than the proximal one, it ends in a short process of a pyramidal shape, medial malleolus, which can be easily palpated in the medial area of the ankle joint.

On the lateral surface of the lower end of the tibia there is a flat, triangular shape fibular notch, to which the lower end of the fibula is adjacent.

Fibula

The fibula is smaller and located laterally to the back in relation to the larger tibia. The upper, or proximal, part of the bone forms an expanded head, which articulates with the outer surface of the posteroinferior part of the lateral condyle of the tibia. The upper end of the head is pointed, it is called top head of the fibula.

Body The fibula is the long thin part between its two ends. Expanded distal fibula

1 Manager Bj: Handbooks in radiology, ed. 2, Chicago, 1997, Year Book Medical Publishers, Inc.

FEMUR

The femur, or femur, is the longest and most powerful of all the tubular bones of the human skeleton. It is the only long bone between the hip and knee joints. The proximal femur will be described in Chapter 7, along with the hip joint and pelvic bones.

Middle and distal femur, anterior view(rice. 6-19)

As with all tubular bones, the body of the femur is an elongated and thinner part. On the front surface of the lower thigh bone lies the patella, or kneecap. The patella, the largest sesamoid bone in the skeleton, is located anterior to the distal femur. Note that in the frontal view, with the leg fully extended, the lower edge of the patella is approximately 1.25 cm above, or proximal to, the knee joint itself. It is important to remember this when positioning the knee joint.

The small, smooth, triangular-shaped depression on the front surface of the lower part of the femur is called the patellar surface (Figure 6-19). This depression is also sometimes called the intercondylar groove. In the literature, the definition of trochlear groove is also found (meaning a block-shaped formation, reminiscent of a spool of thread, which consists of the medial and lateral condyles with a depression between them). It is necessary to know all three terms as they relate to this recess.

With the leg straightened, the patella is located slightly above the patella surface. Lying deep within the muscle tendon, the patella, when the knee is bent, moves downward, or distally, along the patellar surface. This is clearly visible in Fig. 6-21, p. 204, which shows the knee joint in a lateral view.

Middle and distal femur, posterior view (Fig. 6-20)

On the posterior surface of the distal femur are two rounded condyles, separated in the distal posterior portion by a deep intercondylar fossa, or notch, above which the popliteal surface is located (see p. 204).

The distal portions of the medial and lateral condyles contain smooth articular surfaces for articulation with the tibia. When the femur is in a vertical position, the medial condyle is located slightly lower, or distal, to the lateral one (Fig. 6-20). This explains why the CL must be angled 5-7° cranially when performing a lateral view of the knee, which projects the condyles onto each other and the femur parallel to the cassette. An explanation for this is given additionally in Fig. 6-19, which shows that in a vertical anatomical position, when the condyles of the distal femur are parallel to the lower plane of the knee joint, the body of the femur in an adult is deviated from the vertical by approximately 10°. The value of this angle ranges from 5° to 15°". In short people with a wide pelvis, this angle will be larger, and in tall patients with a narrow pelvis, it will be correspondingly smaller. Thus, the value of this angle in women, as a rule, is more than men.

The characteristic difference between the medial and lateral condyles is the presence of the adductor tubercle, a slightly protruding area to which the adductor tendon attaches. This tubercle is located in the posterior

Keats TE et al: Radiology, 87:904, 1966.

Patella

Patella(patella) - a flat, triangular-shaped bone, approximately 5 cm in diameter. The patella appears upside down because its pointed apex forms an inferior edge, and rounded base- upper. Outer side anterior surface convex and rough, and the inner one is oval in shape back surface, articulating with the femur, smooth. The patella protects the front of the knee joint from injury, in addition, it acts as a lever that increases the lifting force of the quadriceps femoris muscle, the tendon of which is attached to the tibial tuberosity of the leg. The patella in its upper position with a fully straightened limb and a relaxed quadriceps muscle is a mobile and easily displaced formation. If the leg is bent at the knee joint and the quadriceps muscle is tense, the patella moves down and is fixed in this position. Thus, it can be seen that any displacement of the patella is associated only with the femur and not with the tibia.

KNEE-JOINT

The knee joint is a complex joint that includes, first of all, femorotibial the joint between the two condyles of the femur and their corresponding condyles of the tibia. Also involved in the formation of the knee joint femoral-patellofemoral nickname joint, because the patella articulates with the anterior surface of the distal femur.

Menisci (articular discs)

The medial and lateral menisci are flat intra-articular cartilage discs between the superior articular surface of the tibia and the femoral condyles (Fig. 6-27). The menisci are crescent-shaped, their thickened peripheral edge gently declines towards the thinned central part. The menisci are a kind of shock absorbers that protect the knee joint from shock and pressure. It is believed that the menisci, together with the synovial membrane, are involved in the production of synovial fluid, which plays the role of lubricating the articular surfaces of the femur and tibia, covered with elastic and smooth hyaline cartilage.

I L A V A O

LOWER LIMB

Straight posterior projection of the lower leg (Fig. 6-29)

A. Medial condyle of the tibia.
B. Body of the tibia.

B. Medial malleolus.
D. Lateral malleolus.

D. Body of the fibula. E. Neck of the fibula. G. Head of the fibula. 3. Apex (styloid process) of the fibular head

I. Lateral condyle of the tibia. K. Intercondylar eminence (tibial crest

Lateral projection of the lower leg (Fig. 6-30)

A. Intercondylar eminence (tibial crest
bones).

B. Tibial tuberosity.

B. Body of the tibia.
D. Body of the fibula.

D. Medial malleolus. E. Lateral malleolus.

Straight posterior view of the knee joint (Fig. 6-31)

A. Medial and lateral intercondylar tubercles; you
stupas of the intercondylar eminence (crest of the tibia
cervical bone).

B. Lateral epicondyle of the femur.

B. Lateral femoral condyle.

D. Lateral condyle of the tibia. D. Upper articular surface of the tibia.

E. Medial condyle of the tibia. G. Medial condyle of the femur.

3. Medial epicondyle of the femur.

I. Patella (visible through the femur).

Lateral view of the knee joint (Fig. 6-32)

A. Base of the patella.
B. Apex of the patella.

B. Tibial tuberosity.
D. Neck of the fibula.

D. Head of the fibula. E. Apex of the head (styloid process) of the fibula

bones. G. Medial and lateral condyles superimposed on each other

3. Patellar surface (intercondylar, or trochlear groove).

Lateral projection of the knee joint (with slight rotation) (Fig. 6-33)

I. Tubercle of the adductor muscle. K. Lateral condyle. L. Medial condyle.

Tangential view (patellofemoral joint) (Fig. 6-34)

A. Patella.

B. Patellofemoral joint.

B. Lateral condyle.

D. Patellar surface (intercondylar, or trochlear, groove). D. Medial condyle.

The only exception to the group of synovial joints is distal tibiofibular joint, related to fibrous compounds, in which the articulation between the articular surfaces of the tibia and fibula occurs with the help of connective tissue. It refers to syndesmoses and is continuous motionless, or inactive joint (amphiarthrosis). The most distal part of this joint is smoothed and covered by the common synovial membrane of the ankle joint.

SURFACES AND PROJECTIONS OF THE FOOT Surfaces. Determining the surface of the foot can sometimes cause some difficulties, since the foot rear called top part. Dorsum usually refers to the back parts of the body. In this case we mean dorsum of the foot, which is the upper, or opposite to the sole, surface. The sole of the foot is rear, or plantar, surface.

Projections. Posterior projection of the foot is plantar projection. Less commonly used anterior projection may also be called rear projection. Radiologists should be familiar with each of these terms and have a good understanding of the specific projection they are performing.

LAYINGS

General issues

X-rays of the lower extremity are usually performed on an imaging table, as shown in Fig. 6-38. Patients with severe trauma are often examined directly on a stretcher or gurney.

DISTANCE

The X-ray source/receiver distance (XRD) for radiography of the lower extremity is usually 100 cm. If the image is taken on a cassette located on the table deck, it should be taken into account that the distance from the table deck to the cassette holder is usually 8-10 cm, and therefore the emitter should raise further. When taking x-rays on a gurney or stretcher, use the depth gauge, usually located on the depth diaphragm of the machine, to set the RIP = 100 cm.

Radiation protection

When radiography of the lower extremity, gonadal protection is desirable, since the gonads are in close proximity to the irradiation zone. The gonad area can be protected with any leaded vinyl cover 1 . And although the requirements for radiation protection of gonads apply only to patients of reproductive age and only when the gonads are directly located in the area of the direct beam, it is recommended to apply it in all cases.

DIAPHRAGM

The rules for diaphragming are always the same - the boundaries of the diaphragm area should be visible on all four sides of the image, but the images of the organs being examined should not be cut off. The minimum size cassette should be used to obtain an image of the area of interest. Note that when radiography of the lower limb, small cassettes are most often used.

Several projections can be performed on one cassette for radiography of the lower extremity, so careful attention should be paid to diaphragm setting.

When using digital X-ray imaging receivers (particularly computed radiography systems with memory phosphor plates), cover the unused area of the cassette with a sheet of leaded vinyl. The phosphor is very sensitive to scattered radiation, which can cause severe fog on subsequent radiographs.

If the aperture boundaries are visible from all four sides, then this makes it easier to find the center of the image - at the intersection of the diagonals.

GENERAL PRINCIPLES OF LAYING

For the upper and lower limbs when laying, the same rule applies - the long axis of the limb being examined should

Rice. 6-38. Exemplary placement for the mediolateral projection of the lower limb:

Correct direction of the CL;

Correct aperture;

Correct use of radiation protection;

Diagonal placement of the lower limb allows you to get
X-ray image of both joints

not located along the long axis of the cassette. If you need to perform several projections, then When taking multiple images on one cassette, the orientation of the limb must be maintained.

The exception is the adult shin. It is usually laid diagonally across the cassette so that the knee and ankle joints enter, as shown in Fig. 6-38.

CORRECT CENTERING

Accurate centering and positioning of the body part being examined, as well as the correct direction of the CL, are very important when radiography of the upper and lower extremities. The photographs should show open joint spaces and there should be no geometric distortions of the shape of the bones, that is, the part of the body being removed should be parallel to the plane of the cassette, and the CL should be directed perpendicular to the limb being removed. Follow the directions on the styling pages.

EXPOSURE SETTINGS

Exposure parameters for radiography of the lower limb:

1. Low or medium kV (50-70).

2. Short exposure time.

3. Small focus.

Correctly exposed radiographs of the lower extremity should show both soft tissue contours and clear trabecular bone structure.

RADIOGRAPHY IN PEDIATRICS

Firstly, you should speak to the child in a language he understands. Parents often assist in restraining the child, especially if it is not a case of trauma. At the same time, care should be taken to ensure their radiation protection. Braces are useful in many cases because they help the child keep the limb still and in the desired position. Soft pillows for ease of laying and straps for fixation are common tools. Sand cushions should be used carefully as they are heavy. Measuring body thickness is an important factor in determining optimal exposure parameters.

In general, reduced exposure parameters are used in pediatrics due to the small size and low density of the limbs being examined. Use short exposure times, increasing the current (mA), - this reduces the dynamic blur of the image.

RADIOGRAPHY IN GERIATRICS

Elderly patients should be positioned for imaging with caution, and radiography of the lower extremity is no exception. Pay attention to signs of a hip fracture (leg excessively twisted). Routine positioning should be adjusted to suit the patient’s ability to bend limbs and personal pathology. When positioning the limb, pillows and supports should be used to ensure patient comfort.

Exposure parameters should be selected taking into account possible osteoporosis or osteoarthritis. Using short exposure times, increasing the current (mA), this reduces the dynamic blur of the image due to voluntary and involuntary movements.

ARTHROGRAPHY

Arthrography is commonly used to visualize large synovial joints such as the knee. It is performed by introducing contrast agents into the joint cavity under sterile conditions. Arthrography reveals diseases and injuries of the menisci, ligaments and tendons (see Chapter 21).

RADIONUCLIDE DIAGNOSTICS

Radionuclide scanning is intended for the diagnosis of osteomyelitis, metastatic processes in the bones, impacted fractures, as well as inflammatory diseases of the subcutaneous tissue. The organ being examined is assessed within 24 hours from the start of the study. Radionuclide testing is more informative than radiography, since it allows you to assess not only the anatomical, but also the functional state of the organ.

Clinical indications

Radiologists should be familiar with the most common clinical indications for lower extremity radiography, which are (the attached list is not complete):

Bone cysts- benign tumor-like formations, which are a cavity filled with serous fluid. They most often develop in children and are located mainly in the knee joint.

Chondromalacia patella- often called runner's knee. The pathology is based on dystrophic changes (softening) of the cartilage, leading to its wear; accompanied by pain and constant irritation of the affected area. Runners and cyclists are often affected.

Chondrosarcoma- malignant bone tumor. The predominant localization is the pelvis and long tubular bones. It is more common in men over 45 years of age.

Ewing's sarcoma- primary malignant bone tumor is usually observed in childhood, from 5 to 15 years. The tumor is usually localized in the diaphysis of long tubular bones. The clinical picture includes pain, increased body temperature at the onset of the disease, and leukocytosis.

Exostosis, or osteochondroma- a benign tumor-like bone lesion, the essence of which is the overproduction of bone substance (the knee joint area is often affected). The tumor grows in parallel with the growth of the bone, moving away from the adjacent joint.

Among all bone fractures, the data is 5%.

Fractures of the second finger are more common, with the fifth finger in second place.

In almost 20% of cases, multiple fractures of the phalanges of various fingers are observed.

Damage to the main phalanges most often occurs, then to the nail and rarely to the middle phalanges.

Four of the five fingers of the hand consist of three phalanges - the proximal (upper) phalanx, the middle and the distal (lower).

The thumb is formed by a proximal and distal phalanx.

The distal phalanges are the shortest, the proximal ones are the longest.

Each phalanx has a body, as well as a proximal and distal end. For articulation with neighboring bones, the phalanges have articular surfaces (cartilage).

Causes

Fractures occur at the level of the diaphysis, metaphysis and epiphysis.

They are available without offset or with offset, open and closed.

Observations show that almost half of phalangeal fractures are intra-articular.

They cause functional disorders of the hand. Therefore, phalangeal fractures should be considered as a severe injury in a functional sense, the treatment of which must be approached with the utmost seriousness.

The mechanism of fractures is predominantly direct. They occur more often in adults. The blows fall on the back surface of the fingers.

Symptoms

Throbbing pain, deformation of the phalanges, and in case of non-displaced fractures - deformation due to swelling, which spreads to the entire finger and even the back of the hand.

Displacements of fragments are often angular, with lateral deviation from the axis of the finger.

Typical for a phalangeal fracture is the inability to fully extend the finger.

If you place both hands with your palms on the table, then only the broken finger does not adhere to the plane of the table. With displacements along the length, shortening of the finger and phalanx is noted.

For fractures of the nail phalanges

Subungual hematomas occur. Active and passive movements of the fingers are significantly limited due to exacerbation of pain, which radiates to the tip of the finger and is often pulsating.

The severity of the pain corresponds to the site of the phalanx fracture.

Not only the function of the fingers is impaired, but also the grasping function of the hand.

When the dorsal edge of the nail phalanx is torn off

When the dorsal edge of the nail phalanx is torn off (Bush fracture) with the extensor tendon, the nail phalanx is bent and the victim cannot actively straighten it.

Intra-articular fractures cause deformation of the interphalangeal joints with axial deviations of the phalanges.

Axial pressure on the finger aggravates the pain at the site of the phalanx fracture. In fractures with displaced fragments, pathological mobility is always a positive symptom.

Diagnostics

X-ray examination clarifies the level and nature of the fracture.

First aid

Any fracture requires temporary fixation before medical intervention, so as not to aggravate the injury.

If the phalanges of the hand are fractured, two or three ordinary sticks can be used for fixation.

They need to be placed around the finger and wrapped with a bandage or any other cloth.

As a last resort, you can bandage the damaged finger to a healthy one. If a painkiller tablet is available, give it to the victim to reduce pain.

A ring on an injured finger provokes an increase in swelling and tissue necrosis, so it must be removed in the first seconds after the injury.

In the case of an open fracture, it is prohibited to set the bones yourself. If disinfectants are available, you need to treat the wound and carefully apply a splint.

Treatment

No offset

Fractures without displacement are subject to conservative treatment with plaster immobilization.

Displaced fractures with a transverse or close to it plane are subject to closed one-step comparison of fragments (after anesthesia) with plaster immobilization for a period of 2-3 weeks.

Working capacity is restored after 1.5-2 months.

With an oblique fracture plane

Treatment with skeletal traction or special compression-distraction devices for the fingers is indicated.

For intra-articular fractures

Intra-articular fractures, in which it is not only possible to eliminate the displacement, but also to restore the congruence of the articular surfaces, are subject to surgical treatment, which is carried out with open reduction with osteosynthesis of fragments, and early rehabilitation.

Must be remembered that treatment of all phalangeal fractures should be carried out in the physiological position of the fingers (half-bent at the joints).

Rehabilitation

Rehabilitation for finger fractures is one of the components of complex treatment, and it plays an important role in restoring finger function.

On the second day after the injury, the patient begins to move the healthy fingers of the injured hand. The exercise can be performed synchronously with a healthy hand.

The damaged finger, which is accustomed to being in a motionless state, will not be able to freely bend and straighten immediately after the immobilization is removed. To develop it, the doctor prescribes physiotherapeutic treatment, electrophoresis, UHF, magnetic therapy, and physical therapy.