Metode de recuperare medical BFT n mna i articulaia pumnului

posttraumatic
MNA I ARTICULAIA MNA I ARTICULAIA
PUMNULUI POSTTRAUMATIC PUMNULUI POSTTRAUMATIC
PLANUL LUCRRII
PARTEA I.
I.Generaliti deiniie! "la#ii"are! date e$ide%i&l&'i"e
II.Eti&$at&'enie "a()e! %e"ani#%e! anat&%ie $at&l&'i"
III.Criterii de #(#inere a dia'n&#ti"(l(i*
a+. e,a%en(l "lini" #e%ne #(-ie"ti.e /i &-ie"ti.e
-+. In.e#ti'aii $ara"lini"e e,. radi&l&'i" $r&-e de la-&rat&r
I0. E.&l(ie /i $r&'n&#ti"
0. Trata%ent*
1. trata%ent $r&ila"ti"
2. trata%ent i'ien&3dieteti"
4. trata%ent %edi"a%ent&#
5. trata%ent &rt&$edi"&3"6ir(r'i"al

PARTEA a II3a* trata%ent(l 78T.

1. $rin"i$iile /i &-ie"ti.e trata%ent(l(i 78T
2. trata%ent(l $rin 6idr&3ter%&tera$ie
4. trata%ent(l $rin ele"tr&tera$ie
5. trata%ent(l $rin %a#a9*
Ee"tele i)i&l&'i"e ale %a#a9(l(i
:e#"rierea anat&%i" a re'i(nii
Te6ni"a %a#a9(l(i
M&-ili)area arti"(laiil&r ;<inet&tera$ie+
Gi%na#ti" %edi"al
=. tera$ia &"($ai&nal
>. trata%ent(l -alne&l&'i" ;a$e %inerale! n%&l(ri+

7I7LIOGRA8IE

METO:E :E RECUPERAREA ME:ICAL METO:E :E RECUPERAREA ME:ICAL
7.8.T. ?N MNA I ARTICULAIA 7.8.T. ?N MNA I ARTICULAIA
PUMNULUI POSTTRAUMATIC PUMNULUI POSTTRAUMATIC
; ;ra"t(rii! l(,aii! ent&r#e ra"t(rii! l(,aii! ent&r#e+ +
PARTEA I. PARTEA I.
1
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
I.GENERALITII deiniie! "la#ii"are! date e$ide%i&l&'i"e. I.GENERALITII deiniie! "la#ii"are! date e$ide%i&l&'i"e.
M@na &%(l(i a "&n#tit(it &-ie"ti.(l a n(%er&a#e #t(dii de $ale&nt&l&'ie!
antr&$&l&'ie /i e%-ri&l&'ie. A"e#te l("rri #(-linia) An 'eneral (n $arad&,* da" din
$(n"t de .edere %&r&l&'i" %@na $#trea) .e#ti'ii anat&%i"e an"e#3trale ; iind deri.at
r tran#&r%ri $rea %ari dintr3(n ti%$ $ri%iti. An il&'e3nia #$e"iil&r + An #"6i%- din
$(n"t de .edere (n"i&nal %@na e#te a$&'e(l $r&3"e#el&r de e.&l(ie &rientat "tre
$re6en#i(ne deli"at /i de &r "@t /i "tre & $er"e$ie #en)&rial in.
I%$&rtana #en)&rial /i %&t&rie! a %@inil&r $entr( .iaa #&"ial /i $r&e#i&nal a
&%(l(i e#te "&n#idera-il.
Tande%(l B"reer3%@nC &r'an de e,e"(ie! $er%ite a"t(l "&%$le, al $re6en#i3(nii /i An
$l(#! "a &r'an de in&r%are! de'etele #(nt (n ade.rat re"e$t&r #en)&ri3al "are $er%it
&%(l(i # $al$e)e &r'anele din 9(r /i # inter$rete)e in&r%aiile .i)(ale.
Pr&'re#ele %e"ani)rii /i a(t&%ati)rii a( d(# la red("erea %e#eriil&r %an(a3le /i
arti)anale r a #"dea i%$&rtana (n"i&nal "&n#idera-il a %@inil&r.
M@na re$re)int "el %ai "&%$li"at #e'%ent de %e%-r( din &r'ani#%. At@t #r("t(tra!
"@t /i (n"ia #a #(nt ada$tate "&%$le,itii a"ti.itii (%ane. S($raaa! $r&$&ri&nal
en&r% din "&rte,(l "ere-ral "are "&ntr&lea) a"ea#t a"ti.itate! e#te & d&.ad a
"&%$le,itii a"e#t(i ade.rat DE&r'anEE.
M@na n( e#te d&ar &r'an(l $re6en#i(nii ; $entr( $ri)ele 'l&-ale #a( $entr( "ele de
%are inee + /i ale "elei %ai i%$&rtante #en#i-iliti di#"ri%inati.e! "i e#te! An a"ela/i
ti%$! &r'an(l #en#i-iliti (%ane! a e,$re#i.itii a $r&e#i&nali3tii "elei %ai ela-&rate.
?n &nd t&t re#t(l %e%-r(l(i #($eri&r! (%r! -ra! ante-ra! $(%n n( a( de"@t r&l(l
de a $(ne %@na An $&)iia "ea %ai a.&ra-il $entr( & a"i(ne deter%inant.
Ti$(rile le)i&nale ale %i"r&tra(%ati#%el&r %@inii #(nt "ele &-i/n(ite* $l'i! "&nt()ii!
l(,aii! ent&r#e /i ra"t(ri "are $&t intere#a t&ate #tr("t(rile anat&%i"e* $ielea!
li'a%entele! %(/"6ii! tend&anele! arti"(laiile! &a#ele! .a#ele /i ner.ii.
M@na %ai $re)int & #erie de #indr&a%e! -&li di#(n"i&nale! An a "r&r eti&3$at&'enie!
%i"r&tra(%ati#%(l 9&a" (n r&l deter%inant.
Tra(%ati#%(l $(%n(l(i /i a %@inii $r&$ri(3)i#e e#te (n an#a%-l( al t(l-(rril&r de
&rdin l&"al /i 'eneral $r&d(#e $rin a"i(nea (n(i a'ent .&l(ntar a "r(i &r de$/e/te
re)i#tena e#(t(ril&r a#($ra "r&ra a"i&nea)! $r&d("@nd $rintre altele* ent&r#e! ra"t(ri!
l(,aii.
8ra"t(ra $rin ra"t(r #e Anele'e & Antrer($ere t&tal #a( $arial a "&ntin(itii (n(i
&#! a$r(t An (r%a (ni tra(%ati#%.
8ra"t(ra n( e#te n(%ai (n #i%$l( a""ident tra(%ati" "( re$er"(r#i(ne l&"al! "i (n
$r&"e# $at&l&'i" "&%$le,! "are an'a9ea) intre' &r'ani#%(l. 8ra"t(ra e#te de /i & -&al
'eneral ;dere'lri $&#ttra(%ati"e 'enerale+! de"lan/at %ai ale# $rin inter%edi(l
#i#te%(l(i ner.&#.
2
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
?n %&d "la#i" ra"t(rile #e A%$art An*
8ra"t(ri An"6i#e ;#e'%entele #(nt a"&$erite inte'ral de $iele+
8ra"t(ri de#"6i#e ;te'(%ent(l /i #trat(rile de #(- el a( &#t le)ate ie de a'ent(l
.(lnerant!ie de ra'%entele &#&a#e din(ntr( in aar /i &#(l a9(n'e An "&nta"t "(
e,teri&r(l+.
8ra"t(rile dire"te #(nt "ele $r&d(#e "@nd a'ent(l tra(%ati" ra"t(rea) &#(l "6iar la
ni.el(l de a$li"are a /&"(l(i .i&lent. S(nt %ai re".ent Ant@lnite la &a#ele nea"&$erite de
%(/"6i* "la.i"(l! ti-ie.
8ra"t(rile indire"te #(nt "ele An "are traie"t(l de ra"t(r #e al la di#tan a de
$(n"t(l de a$li"are a tra(%ati#%(l(i /i #e $r&d(" $rin* le,ie! r#("iri! tra"i(ni! $re#i(ni
et".
Ent&r#a 3 &r%a %in&ra a tra(%ati#%el&r arti"(lare! An "are n( #e $ierde "&nta"t(l
$er%anent Antre #($raetele arti"(lare #i "&n#ta din Antinderea #a( r($t(ra (n(ia #a( %ai
%(lt&r li'a%ente ale (nei arti"(latii.
?n (n"ie de .i&lena %i/"rii! ent&r#ele $&t i*
U/&are de 'rad(l I F & Antindere -r(#" a e#(t(ril&rG
Gra.e de 'rad(l II /i III F r($t(ri ale (n&ra #a( %ai %(lt&r #tr("t(ri "&n9(n"ti.e /i
li'a%entare $eriarti"(lare.
L(,atia 3 e#te le)i(nea "are "&n#ta din $ierderea "&nta"t(l(i n&r%al dintre #($raeele
arti"(lare ale &a#el&r "are &r%ea) & arti"(laie ;de$la#area "a$etel&r &#&a#e ale (nei
arti"(laii+.
:($ %&d(l de $r&d("ere l(,aiile $&t i*
C&%$lete "@nd "ele d&( #($raee arti"(lare n( %ai a( ni"i (n "&nta"t Antre ele.
In"&%$lete "@nd %ai e,i#t (n &are"are "&nta"t.
II. ETIOPATOLOGIE "a()e! %e"ani#%e! anat&%ie $at&l&'i" II. ETIOPATOLOGIE "a()e! %e"ani#%e! anat&%ie $at&l&'i"
?n eti&l&'ia tra(%ati#%el&r #e Ant@lne#" a"t&ri %e"ani"i! i)i"i! "6i%i"i /i -i&l&'i"i.
8a"t&rii %e"ani"i $r&d(" tra(%ati#%e $rin &-ie"ti.e ti&a#e #a( a#"(ite! $rin
"deri #a( l&.iriG
8a"t&rii i)i"i $r&d(" le)i(ni tra(%ati"e di.er#e* ar#(ri! de'ert(ri! iradieri!
ele"tr&"(triG
8a"t&rii "6i%i"i $r&d(" tra(%ati#%e n(%ite "&r&)i(niG
8a"t&rii -i&l&'i"i $r&d(" le)i(ni tra(%ati"e $rin* Ane$t(ri! %(/"t(ri!
#@/ieri! et".
Anat&%ie $at&l&'i".
4
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
8ra"t(ra. ?n ra"t(ri -&lna.(l a"() d(reri .ii Antr3(n $(n"t i,! i%$&ten (n"i&nal!
$re)int de&r%area /i #"(rtarea #e'%ent(l(i re#$e"ti.! e"6i%&)e l&"ale! i%&-ilitate
an&r%al a (n(i #e'%ent iar la $al$ri /i i%&-ili)ri #e $er"e$ ere$itai &#&a#e /i
Antrer($erea relie(l(i &#&#.
Ent&r#a. La ent&r#ele $(%n(l(i 3 %i/"rile #(nt &rate de 6i$ere,ten#ie! %@na iind
%i/"at An a-d("ie $&ate a.ea l&" & dia#ta) arti"(laiei radi&3"(-itale! #in'(lar #a(
a#&"iat alt&r le)i(ni &#te&3arti"(lare.
?n ent&r#ele de'etel&r '#i% ent&r#ele %eta"ar$&3alan'iene! "are #e $r&d(" $rintr3&
%i/"are &rat de 6i$ere,ten#i(ne "@nd li'a%ent(l anteri&r #e #%(l'e de $e aa alan'ei
#a( de r#("ire "( An"linare lateral a de'et(l(i "@nd li'a%ent(l lateral %eta"ar$&3
#e#a%&idian e,tern ;"@nd e#te .&r-a de $&li"e+ #e r($e.
Ent&r#ele %eta"ar$&alan'iene n( #(nt %ai $(in re".ente de"@t "ele %eta3
"ar$&#e#a%&idiene. Prin a"ela/i %e"ani#% de e,ten#ie #a( t&r#i(ne /i An"linare lateral
li'a%entele laterale #e $&t r($e a#&"iind(3#e (ne&ri "( %i"i #%(l'eri &#&a#e.
Ade#ea ent&r#a e#te "&n#eina (nei l(,aii red(#e #$&ntan Andat d($ tra(%ati#%.
L(,aiile. L(,aiile Ant@lnite %ai rar! di#l&"area "a$tel&r &#&a#e ie intra"a$#(lar! "@nd
"a$#(la i-r&a# n( #e r($e! /i e#te d&ar Antin# /i de#$rin# A%$re(n "( $eri&#(l.
L(,aia #e $&ate An#&ii de de'radri ti#(lare #e.ere "( #e"6ele i%$&rtante! %ai $(in An
l(,aiile An"&%$lete! (nde "a$#(la #e r($e! li'a%entele #(nt r($te #a( #%(l#e! deter%in@nd
l(,aii nere'(late #a( ati$i"e.
M(/"6ii #(nt Antin/i dila"erai (ne&ri "( tend&n #%(l#! "artila9(l /i &#(l #(-"&ndral
#(er ade#ea i#(rri! ra"t(ri! #tri.iri $ar"elare.
T&ate a"e#te de'radri deter%in* 6e%at&a%e $eriarti"(lare "e #e $&t &r'ani)a /i
"al"ii"a! 6e%artr&)e "are alt(ri de "i"atri)area i-r&a# a "a$#(lei /i de retra"t(ra
li'a%entel&r i-r&)ate .&r li%ita %(lt %&-ilitatea arti"(lar! #"ler&)e /i atr&ii %(#"(lare
#a( "6iar r($t(ri de ner.G t&ate a"e#tea ridi" $r&-le%e de re"($erare de&#e-it.
L(,aia re"idi.ant tre-(ie "&n#iderat & #e"6el a (nei l(,aii %ai .e"6i a$r@nd %ai
ale# la arti"(laii la,e ;(%r! e%(r&3$atelar+! din "a()a (nei di#ten#i #a( r($t(ri .e"6i a
a$arat(l(i "a$#(l&3li'a%entar #a( a (nei ra"t(ri $ar"elare ale re-&rd(ril&r #a( %ar'inil&r
arti"(lare.
Cele %ai re".ente l(,aii #(nt* l(,aiile (%r(l(i! "&t(l(i! de'et(l(i %are! ale
arti"(laiil&r %ai %&-ili /i %ai a"ti.e.

a+ 8ra"t(rile %eta"ar$ienel&r diai)are #a( de "&l.
S(nt i%&-ili)ri "( atele $e aa d&r#al $e & d(rat de trei #$t%@ni! ti%$ An "are #e
%i/" %ere( de'etele. I%ediat d($ #(#$endarea i%&-ili)rii #e An"e$e %&-ili)rile a"ti.e.
8ra"t(rile "&l(l(i /i "a$(l(i de #tal %eta"ar$ian $&t da (ne&ri ;da" a$ar de$la#ri+! red&ri
An arti"(laiile %eta"ar$&alan'el&r.
5
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
-+ 8ra"t(rile alan'el&r
Cele %ai &-i/n(ite #(nt ale alan'ei $r&,i%ale de.iat d&r#al! iar al alan'ei %i9l&"ii
$&ate de.ia d&r#al #a( .&lar An (n"ie de #edi(l ra"t(rii An ra$&rt "( in#eria le,&r(l(i
#($eri"ial al de'etel&r. P&)iia de i%&-ili)are e#te "( $(%n(l An d&r#ile,ie! iar d(rata de
i%&-ili)are e#te de 234 #$t%@ni ;"( An"e$erea i%ediat a %&-ili)rii+. L(,aiile
arti"(laiil&r %@inii #e i%&-ili)ea) dea#e%enea 4 #$t%@ni. Ori"e a%@nare a An"e$erii
re"($errii .a deter%ina $ierderi ine.ita-ile de %&-ilitate /i .a ne"e#ita & a#i#ten
re"($erat&rie "&%$le, "a /i An "a)(l ra"t(ril&r "&%$li"ate. A"e#te "&%$li"aii $&t i
"&n#iderate de a$t #e"6ele /i #(nt*
C&n#&lidarea "( an'(laii .a deter%ina red&rea %ar"at arti"(lar! "e .a i
re"($erat $rin trata%ent inten#i.! dar ni"i&dat n( #e .a &-ine & re"($erare
"&%$letG
Aderena tend&n(l(i e,ten#&r(l(i la "al(#3 "@nd aderena n( e#te $rea #e.er
trata%ent(l "&n#er.at&r re)&l. (n"i&nal red&rea in#talat. :a" aderena
e#te i%$&rtant tre-(ie inter.enit "6ir(r'i"al $entr( eli-erarea tend&n(l(iG
Al'&ne(r&di#tr&ia %ai ale# An ra"t(rile de %eta"ar$ /i %ai rar An "ele de
alan'.
C&n#&lidarea Ant@r)iat An a"e#t "a) %&-ili)area #e $rel(n'e/te la > #$t%@ni!
"eea "e .a deter%ina & %@n ri'id.
?n 'eneral $&)ii&narea 're/it a ra"t(rii! $rel(n'irea d(ratei i%&-ili)rii! li$#a de
%i/"are ;a arti"(laiei li-ere+ An ti%$(l i%&-ili)rii /i i%&-ili)area %ai %(lt&r de'ete! #(nt
"ele %ai %(lte "a)(ri "are d(" An inal la %@na ri'id.
"+ 8ra"t(rile "are intere#ea) arti"(laiile interalan'iene.
Intere#area "a$etel&r arti"(lare ale interalan'ienel&r "( le)area "&n#e"(ti. a "a$#(lei
arti"(lare d("e An %area $arte a "a)(ril&r la red&rea arti"(lar "e n( .a $(tea i red(#
"&%$let. Ca #e"6el a a"e#t&r ra"t(ri a$are artrita tra(%ati". Red&area arti"(la3r
"&n#e"(ti. artritei tra(%ati"e #e red("e $rin e,er"iii a"ti.e /i iniltrri intraarti"(lare "(
"&rti"&id de 2 &ri $e #$t%@n.
d+ 8ra"t(ra3 l(,aie a $&li"el(i.
E#te & ra"t(r a %eta"ar$(l(i di#tal "( di#l&"are "ar$&%eta"ar$ian. :($ red("ere #e
i%&-ili)ea) $&li"ele An (/&ar a-d("ie! a$&i e#te le"tat (/&r.
e+ 8ra"t(ra #"a&id(l(i.
Re$re)int "ea %ai re".ent ra"t(r a &a#el&r "&r$(l(i. Ea $&ate intere#a %&-ilitatea
$(%n(l(i! n( at@t $rin ae"tarea &#(l(i! "@t $rin le)area "a$#(l(i /i li'a%ent(l(i. Une&ri
=
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
ra"t(ra #e "&%$li" "( ne"r&)a a#e$ti" a #"a&id(l(i. :(rerea /i #"derea &rei
%(#"(lare #(nt ele%ente $rin"i$ale "are deter%in i%$&rtana (n"i&nal.
+ 8ra"t(ra $(%n(l(i ;radi(#+.
E#te ra"t(ra "a$(l(i di#tal al radi(#(l(i "( de$la#area $&#ter&e,teri&ar a ra'%ent(3l(i
di#tal. A$arat(l 'i$#at #e $(ne "@t %ai #tr@n# ;dar "( e.itarea a$ariiei ede%(l(i de #ta)+!
$entr( a a#i'(ra "&ntra"ia. Re"($erarea tre-(ie "(t i%ediat! $entr( " e,i#t $eri"&l(l
al'&ner&di#tr&iei.
'+ Le)i(ni de tend&n.
P&t i r($t(ri $ariale #a( #e"i&nri "&%$lete! $&t intere#a d&ar tend&n(l #a( r($t(ra #e
a"e la )&na de in#erie $e &#! "( #%(l'eri de ra'%ent &#&#. E.ident " a"e#te le)i(ni
intere#ea)! An $ri%(l r@nd "6ir(r'(l! "are .a re)&l.a "6ir(r'i"al ;#(t(r! 're+ #a( &rteti"
An (n"ie de #it(aie! le)i(nea re#$e"ti..re"($erat&r(l tre-(ie # "(n&a#" An# "@nd /i
"(% tre-(ie An"e$(t /i e,e"(tat re"($erarea (n"i&nal! An (n"ie de tend&anele le)ate /i
de ti$(l inter.eniei.
6+ Tend&anele le,&ril&r.
Atit(dinea tera$e(ti" e#te dierit! An (n"ie de #edi(l le)i&nal.
1. Le)area tend&anel&r le,&ril&r An )&na $(%n(l(i.
Cderile An 'ea%! $e $ietre a#"(ite! $e -("i de ta-l #a( $rin tiet(ri de "(it! le)ea)
tend&anele le,&ril&r #($eri"iali /i! de %ai %(lte &ri! /i tend&anele le,&ril&r $r&(n)i. ?n
a"ea#t )&n #(nt le)ai re".ent ner.ii %edian /i "(-ital. N(%ai rare&ri #e &-#er. &
le)i(ne de ner.i An a"e#te "&ndiii r intere#are de tend&ane. In.er#(l #it(aiei n( %ai e#te
An# .ala-il.
2. Le)area tend&anel&r le,&ril&r An $al%.
A$are An a"elea/i "&ndiii "a /i le)i(nile din )&na $(%n(l(i. S(nt "e.a %ai re".ente la
%(n"it&rii "are l("rea) "( &-ie"te ti&a#e #a( An "a)(l (n&r e,$l&)ii. S(t(ra tend&anel&r
#e i%$(ne . An "a)(rile #i%$le! ne"&%$li"ate $ra"ti" n( e#te ne"e#ar re"($erarea An
#er.i"ii de #$e"ialitate. ?n "a)(rile "&%$li"ate! #e a$li" a"ela/i $r&'ra% "a la le)i(nile
tendin&a#e "&%$li"ate din )&na $(%n(l(i.
4. Le)i(nile tend&anel&r din )&nele $al%ar di#tal /i a de'etel&r $r&,i%al ;)&na
te"il&r+. ?n a"ea#t )&n "(n&#"(t! #(t(ra tend&anel&r are de "ele %ai %(lte &ri (n
$r&'n&#ti" nea.&ra-il $entr( (n"ia %@inii. S(t(ra tend&anel&r! An tea"a l&r #tr@%t!
deter%in i%ediat d($ inter.enia t(%eieri de tend&n "( ne"r&) i#"6e%i" "&n#e"(ti3..
N( #e indi" de"i #(t(ri $re"&"e! "i $la#tii ;'re&ane de tend&n ie ie $re"&"e! ie tardi.e!
d($ "@te.a #$t%@ni+. Re)(ltatele $la#tiil&r n( #(nt ni"i ele Ant&tdea(na e,"elente! $e#te
H=I din $a"ieni r%@n@nd "( (n dei"it &are"are de le,ie a de'etel&r ;$(l$a n( atin'e
/an(l di#tal $al%ar+.
5. Le)area tend&anel&r An )&na di#tal a de'etel&r.
Se"i&narea tend&anel&r le,&ril&r $r&(n)i la de'ete! di#tal! n( ridi" $r&-le%e
de&#e-ite. S(t(ra l&r e#te (ne&ri $&#i-il! alte&ri #e ren(n la ea /i #e rein$lantea) "a$(l
>
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
$r&,i%al al tend&n(l(i ;"el di#tal #e Ande$rtea)+. Se $r&d("e! -ine@nele#! & #"(rtare de
tend&n! dar tend&anele le,&ril&r $r&(n)i $er%it #"(rtri $@n la 1!4 "%! r a$ariia de
$ert(r-ri (n"i&nale.
i+ Tend&anele e,ten#&ril&r.
Le)area tend&anel&r e,ten#&ril&r e#te %ai rar de"@t a"eea a le,&ril&r /i! An 'eneral!
$(ne %ai $(ine $r&-le%e "6r(r'(l(i.
Tend&anele e,ten#&ril&r! #e"i&nate n( #e retra"t ;"( e,"e$ia e,ten#&r(l(i l(n' al
$&li"el(i+! de"i $&t i #(t(rate "( (/(rin! r dela-rri+.
1. R($t(ra tend&anel&r la ni.el(l alan'ei di#tale.
A$are de &-i"ei An #it(aia (nei le,i(ni -r(tale a (lti%ei alan'e. Une&ri! tend&n(l #e
#%(l'e de la l&"(l de in#erie antren@nd /i (n %i" ra'%ent &#&#.
2. R($t(ra tend&anel&r la ni.el(l alan'ei a 23a.
Le)area tend&anel&r la a"e#t ni.el #e $r&d("e An 'eneral $rin l&.irea dire"t #a( #tri.ire
"( #a( r #%(l'ere &#&a#.

9+ Le)area ner.il&r
:($ tra(%ati#%e $&t # ie le)ai ner.ii %@inii "are #(nt*
1. Ner.(l radial "are are "a (r%are "derea %@inii /i i%$&#i-ilitatea de a e,tinde
de'etele! i%$&#i-ilitatea de a a"e a-d("ia $&li"el(i! "( t(l-(rri #en)iti.e $e aa d&r#al
a %@ini.
2. Le)area tra(%ati" a ner.(l(i %edian "are are "a (r%are dei"it(l de le,ie /i e,ten#ie
a $(%n(l(i! i%$&#i-ilitatea de le"tare a $&li"el(i /i a de'et(l(i %edi(! 6i$&e#te)ie a
%@inii.
4. Le)area tra(%ati" a ner.(l(i "(-ital are "a (r%are i%$&#i-ilitatea de le"tare a
alan'el&r di#tale 5 /i =! dei"it de le,ie a $(%n(l(i.
I%$&#i-ilitatea de a ine & 6@rtie Antre $&li"e /i inde, /i 6i$&e#te)ie a %ar'ini "(-itale a
%@inii.
III. CRITERII :E SUSINERE A :IAGNOSTICULUI* III. CRITERII :E SUSINERE A :IAGNOSTICULUI*
a+. E,a%en(l "lini" #e%ne #(-ie"ti.e /i &-ie"ti.e. a+. E,a%en(l "lini" #e%ne #(-ie"ti.e /i &-ie"ti.e.
E,a%inarea %@inii -&lna.e #e -a)ea) $e "(le'erea de date An n(%r "@t %ai %are
ne"e#are $entr( #ta-ilirea dia'n&#ti"(l(i /i "&nd(ita trata%ent(l(i. E,a%en(l .a "($rinde
in.e#ti'aii ana%ne)i"e! "lini"e! ne(r&l&'i"e! .a#"(lare /i e,a%ene $ara"lini"e. Se .a
a"&rda atenie %i/"ril&r $&#i-ile $e "are le $&ate ee"t(a -&lna.(l /i el(l "(%
rea"i&nea) la "&%en)i.
H
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
La e,a%en(l "lini" al tra(%ati#%el&r tre-(ie a.(t An .edere (r%t&arele ele%ente*
l&"ali)ri! &r%a! di%en#i(ni! dire"ie! a#$e"t! $r&(n)i%e! $re)ena /i ti$(l 6e%&ra'iei!
alte $arti"(lariti. 0&r i n&tate %&dii"ri ti#(lare din i%ediata .e"intate a le)i(ni
tra(%ati"e* e"6i%&)e! ede%! 6e%artr&)a! 6idrartr&)a.
Si%$t&%ele #(-ie"ti.e /i &-ie"ti.e #(nt* d(rerea! t(%ea"ia arti"(lar! red&area ti"(lar
"are de %(lte &ri deter%in i%$&tena (n"i&nal a %@inii "( retra"t(ri %(#"(lare /i
"i"atri"i .i"i&a#e ale te'(%ent(l(i. Alt a#$e"t e#te atr&ia %(#"(lar #a(
al'&ne(r&di#tr&ia.
An"6il&)a arti"(lar "are $&ate i i-r&a# #a( &#&a# (nind $rin $(ni i-r&a#e #a(
&#&a#e e,tre%itile &#&a#e arti"(lare ;"al(# .i"i&#+.
La,itatea arti"(lar "eea "e d("e la l(,aii /i #(-l(,aii /i (ne&ri ent&r#e "( r($t(ri ale
"a$#(lei /i ale ele%entel&r arti"(lare. ?n (n"ie de 'ra.itatea a"e#tei l(,aii #e $&ate a9(n'e
la & in#ta-ilitate 'ra. arti"(lar An (n"ia ei! ne"e#it@nd inter.enia &$erat&rie.
Se%nele "lini"e ale (nei l(,aii #(nt d&%inate de i%$&#i-ilitatea de a a"e %i/"area
Antr3(n an(%it $lan.
Alt #e%n "lini" dat&rit i%&-ili)ri $rel(n'ite ale arti"(laiei a$ar #e"6elele %(#"(lare
"(% ar i* 6i$&tr&ii! atr&ii! retra"t(ri %(#"(lare! #e"6ele &#&a#e "( &#te&$&r&) de
i%&-ili)are! An inal "( $ierderea "a$a"itii de %(n".
A$ar aderene "a$#(l&3li'a%entare /i %(#"(l&3li'a%entare la %eta"ar$iene /i
interalan'iene.
-+. In.e#ti'aii $ara"lini"e 3 e,. radi&l&'i" $r&-e de la-&rat&r. -+. In.e#ti'aii $ara"lini"e 3 e,. radi&l&'i" $r&-e de la-&rat&r.
?n ra"t(ri e,a%en(l radi&l&'i" $re"i)ea) dia'n&#ti"(l! e.idenia) el(l ra"t(rii /i
"&n#tit(ie (n a9(t&r $rei&# An #ta-ilirea "&nd(itei de trata%ent.
?n "a)(l ent&r#el&r /i l(,aiil&r indi" $&)iia an&r%al a e,tre%itil&r &#&a#e! ti$(l /i
'rad(l l(,aiil&r $re"(% /i e.ent(alele ra"t(ri a#&"iate.
Se%nele radi&l&'i"e "&%$letea) e,a%en(l "lini" &rient@nd "&nd(ita /i trata%ent(l %ai
ale# An* ent&r#e! l(,aii! ra"t(ri. :ia'n&#ti"(l #e $(ne $e -a)a e,a%en(l(i radi&l&'i".
I0. E0OLUIE I PROGNOSTIC. I0. E0OLUIE I PROGNOSTIC.
E.&l(ia /i $r&'n&#ti"(l #(nt le'ate de 'rad(l ent&r#ei! l&"ali)area ei! trata%ent(l a$li"at
/i .@r#ta $a"ient(l(i.
?n ent&r#e #i%$le e.&l(ia e#te a.&ra-il /i .inde"area #e $r&d("e An H 15 )ile "(
re"($erare (n"i&nal l&"al.
?n ent&r#ele 'ra.e! ne'li9ate #a( in"&re"t tratate! arti"(laia de.ine in#ta-il /i d(rer&a#.
?n (n"ie de l&"ali)are! $r&'n&#ti"(l (r%ea) & #"ar de 'ra.itate "are %er'e de la &
#i%$l la,itate arti"(lar "&%$let re.er#i-il $@n la $eriartr&)a $&#ttra(%ati".
O ent&r# tratat "&re"t #e .inde" r #e"6ele An H321 de )ile! An ti%$ "e & ent&r#
ne'li9at are & e.&l(ie %(lt %ai l(n' "( (n $r&'n&#ti" nea.&ra-il.
E.&l(ia l(,aiil&r #i%$le e#te a.&ra-il /i .inde"area #e $r&d("e An 53= #$t%@ni
at(n"i "@nd trata%ent(l e#te "&re"t.
J
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
?n l(,aia "&%$li"at #a( in"&re"t tratat e.&l(ia e#te dii"il! (ne&ri dea.&ra-il /i
i%$(ne (n trata%ent Andel(n'at! $r&'n&#ti"(l iind re)er.at.
7enei"iind de trata%ent &rt&$edi"! "6ir(r'i"al /i %edi"a%ent&# de (r'en! ra"t(rile
"(n&#" An 'eneral & e.&l(ie a.&ra-il An "a)(l An "are ra'%entele &#&a#e A/i re#ta-ile#"
"&ntin(itatea! li'a%entele /i e#(t(rile "&n9(n"ti.e "(tanate A/i rea" inte'ritatea anat&%i"
/i A/i reia( (n"iile.
0. TRATAMENT. 0. TRATAMENT.
1. Trata%ent(l i'ien&3dieteti".
I'iena are (n r&l &arte i%$&rtant! /ti(t iind " & %@n %(rdar .enind An "&nta"t "(
ali%entele $e "are &%(l le "&n#(%! $&t d(na Antre'(l(i &r'ani#%.
:a" t&ate a"e#te n&r%e n( .&r i -ine a$li"ate at@t Anainte! $entr( %eninerea #ntii
"@t /i d($ an(%ite trata%ente! d($ "e a"e#tea a( &#t tratate $rin dierite %et&de!
trata%ent(l .a i t&tdea(na An )adar /i inei"ient! indierent "@t de -ine .a i a$li"at. :($
/&"(l tra(%ati"! An $ri%a )i ali%entaia -&lna.(l(i tre-(ie # ie li"6id. ?n $eri&ada de
.inde"are ali%entaia tre-(ie # ie -&'at An $r&teine /i "al&ri.
2. Trata%ent(l %edi"a%ent&#.
:($ tra(%ati#%e! %edi"aia #e a"e An 'eneral An dire"ia "&%-ateri d(reri /i red("erea
$r&"e#el&r inla%at&ri. Pentr( a"e#te &-ie"ti.e #e &l&#e/te*
Medi"aia antal'i" #e &l&#e/te de &-i"ei An d(rerile "( inten#iti %ai %ari. S(nt
&l&#ite*
Iniltraii "( ,ilin 1I "( #a( r 6idr&"&rti)&n An )&ne li%itateG
Cal%ante An "a)(l d(reril&r arti"(lareG
Ter%&le$ti"e ;Antide$rin! Te$rin+G
Ne(r&le$ti"e ;T&rida)in+.
Medi"aia antiinla%at&are #(nt (tili)ate %ai re".ent enil-(ta)&na! ind&%eta"in!
a#$irina! -r(en! $re"(% /i dierite (n'(ente "a* 6idr&"&rti)&n! enil-(ta)&na! #ali"ilat de
%etil! di"l&ena".
Trata%ent(l %edi"a%ent&#! antial'i" #a( antiinla%at&r tre-(ie An#&it de (n re'i%
ali%entar de&#e-it.
K
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
4. Trata%ent(l &rt&$edi"&3"6ir(r'i"al.
O-ie"ti.(l trata%entel&r An ent&r#ele #i%$le! e#te $(nerea An re$a(# a arti"(laiil&r
re#$e"ti.e "( a9(t&r(l (n(i a$arat 'i$#at ti%$ de 234 #$t%@ni.
?n ra"t(ri #e a"e i%&-ili)area $rin a$arat 'i$#at "are tre-(ie e,e"(tat "&re"t /i r #
#t@n9enea#" "ir"(laia.
:($ #"&aterea a$arat(l(i 'i$#at #e $r&"edea) la re"($erarea #e'%ent(l(i re#$e"ti.! ;"(
'ri9 $entr( arti"(laia re#$e"ti.+. Se re"&%and -i e%&liente ;-i "( tr@e+! %i/"ri
a"ti.e /i $a#i.e.
Trata%ent(l "6ir(r'i"al #e a"e An "a)(l l(,aiil&r ind("ti-ile .e"6i! de#"6i#e #a( "(
"&%$li"aii .a#"(l&3ner.&a#e. Trata%ent(l "6ir(r'i"al al ra"t(ril&r e#te indi"at "@nd n(
$(te% &-ine $rin tra"i(ne & -(n "&&$tare a ra'%entel&r &#&a#e.
Trata%ent(l "6ir(r'i"al al "&%$li"aiil&r tardi.e e#te "&%$le, /i #ele"ti. d($ "(%
a.e% de aa"e "( & $#e(d&3artr&)! "al(# e,(-erant! de)a,area #a( "&n#&lidarea .i"i&a#.
PARTEA a II a* TRATAMENTUL 78T. PARTEA a II a* TRATAMENTUL 78T.
1. PRINCIPIILE I O7IECTI0ELE TRATAMENTULUI 78T. 1. PRINCIPIILE I O7IECTI0ELE TRATAMENTULUI 78T.
1L
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
O dat "i"atri"ea .inde"at /i $eri"&l(l de n&i r($t(ri e#te %(lt di%in(at! re"($erarea
tre-(ie # An"ea$ r alt Ant@r)iere. Se .&r (r%rii*
C&re"tarea retra"t(ril&r e#(t(ril&r %&iG
A%eli&rarea "ir"(laieiG
Red("erea (n"iei tend&anel&rG
Rea"erea $re6en#i(niG
Rea"erea $e "@t $&#i-il a a-ilitii.
?n "adr(l antrena%ent(l(i 'eneral! #e (r%re/te*
A#($li)area arti"(larG
Cre/terea .ite)ii de e,e"(ie a %i/"ril&rG
Cre/terea Ande%@nriiG
:e).&ltarea r-driiG
Cre/terea &rei /i re)i#tenei %(#"(lare.
Tra(%ati#%(l deter%in An &nd a-aterea de la n&r%alitatea anat&%&(n"i&3nal a
%@inii. A"ea#t n&r%alitate! & $(te% deini $rin (r%t&arele "riterii $re)ente at@t An
$re6en#i(ne "@t /i An alte %i/"ri $e "are le a"e %@na*
A-#ena d(reriiG
E"6ili-r(l %(#"(larG
M&-ilitatea arti"(lar.
Trata%ent(l re"($erat&r al dei"it(l(i (n"i&nal al %@inii e#te dii"il! "ere
$r&%tit(dine! "(n&/tine e,a"te a#($ra anat&%iei (n"i&nale! e,$erien /i %(lt
$er#e.eren.
M@na #($&rt 're( i%&-ili)area! "6iar de #"(rt d(rat! red&rile /i retra"iile de.enind
(lteri&r &arte 're( red("ti-ile. E#te &arte dii"il de '#it Ant&dea(na e"6ili-r(l /i
ra$&rt(l 9(#t Antre i%&-ili)are /i re%&-ili)area %@inii tra(%ati)ate.
M@na tra(%ati" $re)int $atr( 'r($a9e %ari "lini"&3re"($erat&rii ; MNnn ParrN+*
1. Le)i(nile de tend&n
2. Parali)iile ner.il&r $erieri"i
3. M@na ri'id
4. A%$(taiile.
Ulti%(l 'r($ n( intr An $re&"($area a"e#tei %&n&'raiiG "el de al treilea e#te (n 'r($
$&li%&r! "are are tr#t(ri "&%(ne in"a$a"itatea de %&-ili)are a de'etel&r! "a
(r%are a (n&r ra"t(ri! le)i(ni de e#(t(ri %&i! t(l-(rri rele,e al'&di#tr&i"e #a( t&ate
la (n l&"! "a An #tri.iri! "e tran#&r% %@na Antr3(n #e'%ent ri'id EEAn'6eatEE . A"e#t
'r($ %ai are "&%(n tri$ti"(l &-ie"ti.el&r re"($erat&rii! %&-ili)area arti"(lar O t&niierea
%(#"(lar O "&&rd&narea #a( a-ilitatea 'e#ti".
11
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
?n ra"t(rile alan'el&r /i %eta"ar$ienel&r n( e#te & $r&-le% "&n#&lidarea dei"itar a
arti"(laiil&r adia"ente. C@te.a $rin"i$ii 'enerale tre-(ie rein(te*
M&-ili)area de'etel&r tre-(ie # #e a" An le,ieG
I%&-ili)area # ie "@t %ai #"(rt! # ie #(#$endat "6iar Anainte de
"&n#&lidarea "&%$let /i %&-ili)area # An"ea$ i%ediatG
I%&-ili)area deter%in &arte re$ede Bde)a#tr(lC (n"i&nal $entr( arti"(laiiG
:e'etele "are n( #(nt a-#&l(t ne"e#are a i i%&-ili)ate .&r i "&ntin((
%&-ili)ate a"ti.G
Ede%(l e#te "el %ai $eri"(l&# d(/%an al (n"iil&r %@inii /i el tre-(ie tratat
"a atare i%ediat.
?n %a9&ritatea "a)(ril&r l(,aiile #a( #(-l(,aiile "are #(nt An#&ite de r($t(ri "a$#(lare
#a( #%(l'eri &#&a#e. I%&-ili)area de #"(rt d(rat $rin $r&te)e e#te &-li'at&rie.
?n &rdinea re".enei ra"t(rile %@inii #(nt ale -a)ei %eta"ar$(l(i ;"a$t(l di#tal+! ale
diai)ei alan'el&r! ale "&l(l(i %eta"ar$ienel&r ;"a$t(l $r&,i%al+ /i ra"t(ra l(,aiei a
$&li"el(i.
2. TRATAMENTUL PRIN PI:RO3TERMOTERAPIE . TRATAMENTUL PRIN PI:RO3TERMOTERAPIE.
Pidr&tera$ia3e#te a$li"area An #"&$ $r&ila"ti" #i "(rati. al (n(i n(%r .ariat de
$r&"ed(ri "are a( la -a) a$ la dierite te%$erat(ri /i #(- di.er#e #tri de a're'are "a /i
(nele te6ni"i #tr@n# le'ate de a"e#tea.
?n %@na /i arti"(laia $(%n(l(i $&#ttra(%ati" #e $&t (tili)a (r%t&arele $r&"ed(ri*
7aia <inet&3tera$e(ti". E#te & -aie "ald la "are #e a#&"ia) %i/"ri An t&ate arti"(laiile
-&lna.(l(i.
Mi/"area An a$ re$re)int (n i%$&rtant %i9l&" de re"($erare "are #e -a)ea) $e
$rin"i$i(l le'i l(i Ar6i%ede Q A#($ra (n(i "&r$ #"((ndat intr3(n li"6id a"i&nea) & &r
de 9&# An #(# e'ale "( 're(tatea .&l(%(l(i de#l&"(it Q
Te6ni"a de a$li"are3-aia <inet& #e ee"t(ea) Antr3& "ad %ai %are "are #e (%$le 4R5 "(
a$ la te%$erat(ra de 4>34H34J
L
C. 7&lna.(l e#te in.itat # #e a#e)e An "ad /i ti%$ de =
%in. e#te l#at lini/tit # #e &-i/n(ia#" "( a%-iana.
:($ a"eea te6ni"ian(l e,e"(t #(- a$ la t&ate arti"(laiile $a"ient(l(i An %&d $a#i.
t&ate %i/"rile $&#i-ile An ti%$ de = %in. d($ a"eea $a"ient(l
e#te l#at $(in An re$a(# d($ "are e#te in.itat # re$ete #in'(r %i/"rile artate de
te6ni"ian. :(rata -i e#te de 2L34L %in. d($ "are -&lna.(l e#te /ter# /i l#at # #e
&di6nea#".
12
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
M&d(l de a"ti(ne3a"t&r(l ter%i" #i %e"ani". M&-ili)area n a$ e#te %ai $(in
d(rer&a# din "a()a rela,rii %(#"(lare "are #e $r&d("e #(- inl(ena a$ei "alde /i $ierderi
're(tii "&r$(l(i "&n&r% le'i l(i Ar6i%ede.
I%$&rtana %i/"rii $a#i.e e#te e#enial An re"($erarea %ai ale# An #tre# $#i6i" $entr(
" $a"ient(l Anele'e " arti"(laia e#te (n"i&nal /i re"($erarea e#te $&#i-il.
7ile "( $lante %edi"inale. S(nt &arte de# &l&#iteG #(-#tanele ar&%ate a( ee"t #edati.
a#($ra #i#te%(l(i ner.&#! a.&ri)ea) re)&r-ia! "al%ea) d(rerile! a%eli&rea) "ir"(laia!
a( ee"t rela,ant a#($ra e#(t(l(i "&n9(n"ti.. Se &l&#e#" #e%ine de in! %(/eel! l&ri de
tei! %ent! #al.ie #a( tr@e de 'r@(! n("! "&a9 de #te9ar! de "a#tan! %al! a%id&n! et".
:in a"e#te $lante #e a" in()ii #a( de"&"t(ri din =LL 1LLL' An 234 litri a$! "are #e
intr&d(" a$&i An a$a de -aie la ne(tralitatea ter%i" #a( "ld(! at(n"i "@nd #e (r%re/te /i
ee"t(l ter%i".
:(rata -i e#te de 2L 5L %in. Te%$erat(ra -il&r An 'eneral e#te de 4=34H
L
C. Se %ai
&l&#e#" /i "a -i de "(rire d($ a$arat 'i$#at.
7i l&"ale ier-ini alternante "( -i re"i. Intr&d("ei $artea "are tre-(ie tratat An a$
iart ;5L
L
C+ ti%$ de 435 %in.! a$&i intr&d("ei $artea a"eea An a$ "( '6ea #a( #(- a$
de r&-inet ;H321
L
C+ ti%$ de 132 %in.
?n ti%$ "e $a"inet(l #e al An a$ re"e! "re/tei te%terat(ra aei ier-ini $@n la
te%$erat(ra iniial #a( $(in $e#te 54
L
C.
8a"e &$erai(nea de >3H &ri /i #e #@r/e/te "( a$ re"e.
S"&$ /i ee"te* alternea) "&ntra"ia /i dilataia .a#el&r de #@n'eG deter%in & "re/tere
%ar"at! l&"al /i rele,! a l(,(l(i de #@n'eG inten#ii" %eta-&li#%(l /i $r&"e#(l de
&,idareG 'r-e/te .inde"areaG a"ti.itate #$&rit a 'l&-(lel&r al-e din #@n'e.
:(/(l "( a-(ri. E#te $r&ie"tarea .a$&ril&r #($ra@n"l)ii a#($ra (n&r re'i(ni li%itate.
:(rata e#te de 43> %in. P&ate i & $r&"ed(r de #ine #ttt&are! $&ate # $re"ead & -aie
'eneral #a( #e $&ate a#&"ia "( %a#a9.
La #@r/it #e a$li" & $r&"ed(r de r"ire! #$lare! #a( (n d(/ la te%$. de 1J32L
L
C.
M&d de a"i(ne* a"i(ne $(terni" a#($ra "ir"(latiei "( 6i$ere%ie /i re)&r-ie l&"al.

:(/ %a#a93 re$re)int a$li"area %ai %(lt&r d(/(ri r&)et "( a$ la te%$erat(ra de 4J3
5L
L
C a#&"iat "( %a#a9. Mai re".ent #e a$li" $arial %ai rar 'eneral. :(rata %a#a9(l(i
e#te de J31= %in.
:(/(l %a#a9 $r&d("e & 6i$ere%ie i%$&rtant "( (n An#e%nat ee"t re#&r-ti. /i de
t&niiere $rin a"i(nea "&%-inat a %a#a9(l(i /i a a"t&r(l(i ter%i".

?%$a"6etrile "( $arain. A"e#tea a" $arte din $r&"ed(rile ter%&3tera$i"e /i #e a$li"
$e re'i(ni li%itate de "&r$.
Te6ni"a de a$li"are* #e t&$e/te Antr3(n .a# & "antitate de $arain al- An a/a el in"@t #
%ai r%@n "@te.a -("i ne@n"l)ite! An #"&$(l e.itrii #($ra@n"l)irii. C( a9(t&r(l (nei
$en#(le late #e $en#(lea) re$ede re'i(nea intere#at de %ai %(lte &ri $@n "e #e reali)ea)
(n #trat de $arain de L!=31"% 'r&#i%e. Pe#te #trat(l de $arin #e $(ne & -("at de lanel
/i #e a"&$er re'i(nea "( $t(ra. :(rata e#te de 4L3>L %in.
14
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
La ni.el(l arti"(laiil&r $entr( a a.ea (n #trat %ai 'r&# #e $&t &l&#i %an/&ane le'ate
dea#($ra /i dede#($t(l arti"(laiil&r $re.a)(te "( (n &rii"i( $rin "are #e t&arn $araina
t&$ita. Pentr( %@ini /i $i"i&are #e $&t ee"t(a -i de $arain "( -(le re"i.
Pa"ient(l intr&d("e %@na /i & #"&ate /i a/tea$t $@n "e $araina #e Antre/te $e
te'(%ent. Se re$et %ane.ra de 234 &ri intr&d("@nd de ie"are dat #e'%ent(l la (n ni.el
ineri&r a de $re"edent(l.
C@nd te%$erat(ra de.ine #($&rta-il e,tre%itatea #e la# An $arain (n ti%$ %ai
Andel(n'at.
Pe arti"(laiile %i"i #e $&t a$li"a $l"i $arinate. :in "a()a ter%&3"&nd("ti-iliti
relati. %i"i $araina $&ate i &l&#it la te%$erat(ri ridi"ate r a $r&d("e ar#(ri.
A"i(ne3$araina $r&.&a"a & #($ra@n"l)ire $r&(nd /i (ni&r% a e#(t(ril&r. Pielea #e
An"l)e/te la 4J35L
L
C $r&.&"@nd & tran#$iraie l&"al a-(ndent. La de#a"erea $arainei #e
e.idenia) 6i$ere%ia $r&d(#a. :($ A%$a"6etare #e a$li" & $r&"ed(ra re"e.
4. TRATAMENTUL PRIN ELECTROTERAPIE 4. TRATAMENTUL PRIN ELECTROTERAPIE ;te6ni"! ee"te+ ;te6ni"! ee"te+
Ele"tr&tera$ia e#te a"eea $arte a i)i&tera$iei! "are #t(dia)a (tili)area a"ti(nii di.er#el&r
&r%e ale ener'iei ele"tri"e a#($ra &r'ani#%(l(i! "( #"&$ "(rati. #a( $r&ila"ti".
Pr&"ed(rile de ele"tr&tera$ie An "a)(rile tratate &rt&$edi" "are n( $re)int &#te&#in&.ite
%etali"e #a( arti"(laiile la di#tan $e %aterial(l de &#te&#inte) a"&l& (nde e,i#t. A"e#te
$r&"ed(ri #(nt -ine a""e$tate /i t&lerate de $a"ieni.
C(rent(l 'al.ani" $&ate i a$li"at #(- &r% de*
Gal.ani)area #i%$l
7ile 'al.ani"e
I&n&&re)a #a( i&n&'al.ani)area
Gal.ani)area #i%$l.
Ele"tr&)ii #(nt $l"i %etali"e din $l(%- la%inat de dierite di%en#i(ni An (n"ie de
re'i(nea de a$li"are #i ee"tele de $&laritate.
Se a$li" $e dierite re'i(ni* a$li"area tran#.er#al 3 ele"tr&)ii #(nt a#e)ai de & $arte /i
de alta a re'i(nii de tratatG a$li"are l&n'it(ninal 3 "@nd ele"tr&)ii #(nt $la#ai la di#tan
(n(l de "elalalt.
E#te &-li'at&ri( &l&#irea #trat(l(i 6idr&il Antre ele"tr&d #i te'(%ent $entr( $re.enirea
ar#(ril&r! "are tre-(ie #$alat d($ ie"are (tili)are.
Inten#itatea "(rent(l(i 3 "are e#te #tr@n# le'at de #en#i-ilitatea /i t&lerana te'(%ent(l(i!
de e.&l(ia ae"i(nii! de %ari%ea ele"tr&)il&r /i de d(rata a$li"aiei. Sen#i-ilitatea
te'(%ent(l(i e#te .aria-il An (n"ie de re'i(nea anat&%i".
15
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
:(rata 3 e#te de a$r&)i%ati. 4L de %in(te. N(%ar(l #i rit%(l #edinel&r3e#te .aria-il "(
dia'n&#ti"(l. ?n 'eneral #e &l&#e#" J31L #edine An ae"ti(ni a"(te /i 1232L #edine An
ae"i(ni "r&ni"e.
P&)iia -&lna.(l(i 3 An ti%$(l #edinei tre-(ie # ie An "ea antal'i" /i de$inde #i de
(n"ia re'i(ni tratate.
7ile 'al.ani"e.
S(nt indi"ate $entr( tratarea (n&r re'i(ni intin#e #a( "6iar a intre'(l(i "&r$. ?n a"ea#t
%&dalitate #e "&%-in at@t a"ti(nea "(rent(l(i "&ntin(( "@t /i ee"t(l ter%i" al a$ei! iind
%i9l&"it&are Antre ele"tr&d /i te'(%ent.
:en#itatea "(rent(l(i 3 e#te red(# %i"/&r@nd(3#e ri#"(l de ar#(r la inten#itatea
a$li"at. Se $&t a$li"a* -i $ariale #a( 53"el(lare! 'enerale #a( #ten'er.
7ile $ariale 3 #(nt al"at(ite din* 5 "adie de $&relan "&ne"tate la ele"tr&)i a(
re$re)entare $e (n ta-l&( de "&%and. A$a din "die .aria) Antre 4>34J
L
C
53"el(lare #(nt 2 $entr( %e%-rele #($eri&are /i 2 $entr( %e%-rele ineri&are.
:e $e ta-l&(l de "&%and $(te% reali)a "&%-&nai dierite ale ele"tr&)il&r An (n"ie de
ee"tele (r%rite.
:(rata (nei #edine 3 e#te Antre 1L34L %in. i rit%(l de a$li"are e#te )ilni" #a( la 2 )ile.
N(%ar(l de /edine 3 e#te de 1L31= #edine.
7ile 'enerale 3 #(nt &r%ate dintr3& "ad $re.a)(ta "( J ele"tr&)i i,ai An $erei ")i.
Sen#(l "(rent(l(i 3 e#te diri9at de la (n $an&( de "&%and An %(lti$le .ariante* de#"endent!
a#"endent! tran#.er#al #a( "6iar An dia'&nal.
Inten#itatea "(rent(l(i 3 e#te %ai %are de"@t "ea de la -ile $ariale .:(rata 31=34L %in.
Rit%(l (na la 234 )ile t&tali)@nd >312 #edine.
A"i(nea* #e -a)e) $e ee"t(l ter%&%e"ani" al a$ei! $e ee"t(l "(rnet(l(i "&ntin(( "@t
/i $e ee"t(l "6i%i" "@nd #e &l&#e#te i&ni)area.
Are ee"t e,"it&%&t&r! .a#&dilatat&r! tr&i"! de #ti%(lare a e,"ita-ilitii %(#"(lare.
I&n&'al.ani)area.
Re$re)int $r&"ed(ra $rin "are intr&d("e% An &r'ani#% "( a9(t&r(l "(rent(l(i "&ntin((
dierite #(-#tane %edi"a%ent&a#e "are a( & a"i(ne ar%a"&l&'i".
Prin"i$i(l 'eneral al i&ni)ari* #e -a)ea) $e di#&"ierea ele"tr&liti" a di.er#el&r #(-#tane
%edi"a%ent&a#e /i tran#$&rtarea ani&nil&r ;3+/i a "ati&nil&r ;O+ #$re ele"tr&)i de #e%n
"&ntrar An"r"rile l&r ele"tri"e.
C( #&l(ia "&nin@nd i&n(l %edi"a%ent&# #e A%-i-a #trat(l 6idr&il de #(- ele"tr&d(l
a"ti.. :e ai"i a"e#ta %i'rea) $rin te'(%ent(l inta"t $rin &rii"iile 'landel&r #(d&ri$are /i
#e-a"ee #$re $&l(l &$(# a9(n'@nd An interi&r(l &r'ani#%3
(l(i de (nde #(nt $rel(ai de reea(a li%ati" /i "ir"(laia #an".in #($eri"ial! a9('@nd An
"ir"(laia 'eneral. :&.ada $tr(nderi An &r'ani#% a i&nil&r tera$e(ti"i e#te re'#irea l&r An
(rin.
1=
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
:ierena dintre i&ni)are #i 'al.ani)area #i%$l "&n#t n(%ai An A%-i-area #trat(l(i
6idr&il An #&l(ie %edi"a%ent&a# An l&" de a$. Pentr( ei"ien %a,i% $&l(l a"ti.
tre-(ie # ie %ai %i" de"@t "el $a#i.
:(rata $r&"ed(ri 3 e#te de a$r&,i%ati. 4L %in. La ee"t(l ar%a"&3dina%i" al #&l(iei
%edi"a%ent&a#e #e ada(' /i ee"t(l anal'e)i" al "(rent(l(i "&ntin((.
Ee"t de de$&)it 3 reali)at de a"(%(larea #(-#tanel&r ar%a"&l&'i"e intr&d(#e la ni.el(l
ele"t&)il&r.
Ee"t(l de $tr(ndere $@na la #trat(l "(tanat $r&(nd are & a"i(ne rele, "(tii .i#"erale
la ni.el(l der%at&a%el&r. E#te $&#i-il d&)area $re"i# a #(-#tanel&r %edi"a%ent&a#e
a$li"ate.
Se $&t &-ine ee"te -(ne "( "antitai &arte %i"i de #(-#tane %edi"a%ent&a3#e
e.it@nd(3#e tra"t(l 'a#tr&3inte#tinal.

C(renii diadina%i"i.
Se a" a$li"aii $e $(n"tele d(rer&a#e -ine deter%inate! "( ele"tr&)i 'enerali de $l(%-
%i"i r&t(n)i #a( "6iar $(n"ti&r%i /i a$li"aii tran#.er#ale la ni.el(l arti"(laiil&r "(
ele"tr&)i $&lari de dierite %ri%i. Ele"tr&d(l ne'ati.3e#te a#e)at dire"t $e l&"(l d(rer&#.
Ele"tr&d(l $&)iti.3e#te a#e)at la 234 "%. di#tan.
Pa"ient(l tre-(ie # ie a/e)at "&%&d $e & "ana$ea de le%n i "( re'i(nea de tratat
de#"&$erit /i la Ande%@n.
Se An"e$e "( dia)at(l i, t&tdea(na inten#itatea # n( atin' $ra'(l d(rer&# ;.al&area
%ini% a inten#iti "are $r&d("e & "&ntra"ie %(#"(lar+ /i "re/te% tre$tat inten#itatea
dat&rit in#talri en&%en(l(i de a"&%&dare.
?n 'eneral d(rata $r&"ed(ri e#te de 53J %in. da" de$/i% a"ea#t d(rat#e di%in(
ei"a"itatea anal'eti".
:a" a.e% %ai %(lte re'i(ni d(rer&a#e "e i%$(n a$li"area $r&"ed(ri! d(rata a"e#teia
tre-(ie #")(t "( "@te 1%in. la ie"are n&( $r&"ed(r An "(r#(l a"elea/i #edine.
?n "a)(l a"i(nil&r .a#"(l&tr&$e /i ne(r&tr&e #e $&ate %enine & d(rat %ai indel(n'at
de 2L34L%in.
Rit%(l #edinel&r3e#te deter%inat de #tadi(l ae"i(ni da" inten#itatea d(reri e#te %are
a$li"% de 2 &ri $e )i! da" e#te %ai %i" 1 $r&"ed(r $e )i.
N(%r(l /edinel&r3$entr( a"i(ne anal'eti" #(nt (tile J31L #edine "&n#e"(ti.e
e.ent(al "( & $a() de H31L )ile d($ "are #e reia(. ?n #"&$ dina%&3'en $(te% &l&#i $e#te
1L #edine.
M&n&a)at(l i, 3 ee"t e,"itat&r! "re/te t&n(#(l %(#"(lar! a"i&nea) "a (n ade.rat
%a#a9 $r&(nd ele"tri"! e.idenia) )&nele d(rer&a#e din "adr(l ne(r&%ial'iil&r rele,e.
A"i&ne) .a)&"&n#tri"t&r /i t&nii" $erei arteriali la re".ena de =L P).
:ia)at(l i, 3 are a"i(nea "ea %ai antial'i"3ridi" $ra'(l #en#i-iliti d(rer&a#e.
?%-(ntairea "ir"(laiei arteriale $rin in6i-area #i%$ati"(l(i. Se (tili)ea) la re".ene de
1LL P).
Peri&ada #"(rt 3 are (n ee"t e,"itat&r t&ni"i)ant! a"i&nea) "a (n %a#a9 $r&(nd %ai
inten#! are & a"i(ne .a)&"&n#tri"t&are de (nde reie#e r&l(l re)&r-ti. "( a"i(ne ra$id
a#($ra 6e%at&a%el&r /i a ede%el&r $&#ttra(%ati"e #a( din #ta)a $erieri".
1>
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
Peri&ada l(n'3are (n ee"t $(terni" anal'e)i" /i %i&rela,ant! a"e#t ee"t e#te $er#i#tent
ti%$ %ai Andel(n'at! are dea#e%enea (n ee"t anti"&n'e#ti.. Se (tili)ea) la re".ene de
1LL P).
C(renii interereniali.
Se (tili)ea) ele"tr&)i $la" de di%en#i(ni .aria-ileG #e inter$(ne (n #trat 6idr&il Antre
Antre ele"tr&)i /i te'(%ent. Se (tili)ea) re".ene Antre L 1LL P) An (nie de ee"t(l
(r%ritG #e a" a$li"aii %an(ale #a( #$e"tr(%.
Ee"te* re'lea) t&n(#(l %(#"(lar! ee"te e,"itat&rii! ee"t anal'eti"! e,"itaie a#($ra
ner.il&r %&t&rii e#te & ade.rat 'i%na#ti" %(#"(lar! a"i(nea e,"it&%&t&rie! a"i(ne
de"&ntra"t(rant /i .a#"(l&tr&i" $re"(% /i a"i(ne de in6i-are a #i%$ati"(l(i /i #ti%(lare
a .a'(l(i.
Ultra#(net(l.
Ultra#(netele a( & re".en de JLL31LLL SP).
Undele (ltra#&ni"e #(nt $r&ie"tate din "a$(l e%it&r An linie drea$t #(- &r%a (n(i
a#"i"(l $er$endi"(lar $e #($raaa de e%i#ie a l&"ali)at&r(l(i.
E#te ne.&ie de (n "&nta"t $ere"t Antre #($raaa e%it&are /i te'(%ent "are #e
reali)ea) &l&#ind(3#e (n #trat de 'el! (lei #a( a$.
Ultra#(net(l e#te &l&#it An*
C@%$ "&ntin((3"@nd (nda (ltra#&ni" e#te l&n'it(dinal /i
ne@ntrer($t a.@nd & a"i(ne "&ntin(( a#($ra %edi(l(i re#$e"ti. "( $r&d("erea (n(i
%i"r&%a#a9 ti#(lar $r&(nd /i "( ee"t ter%i" i%$&rtant.
Ca$(l e%it&r #e $li%- $e te'(%ent $rin inter%edi(l 'el(l(i #a( al alt(i (n'(ent! r
a #e a$#a $rea tare! An #en# "ir"(lar #a( liniar An (n"ie de re'i(nea de tratat! /i "( & .ite)
&arte %i"
E#te &arte i%$&rtant "a e%it&r(l # $#tre)e (n "&nta"t $ere"t "( t&at #($raaa
te'(%ent(l(i /i # ie %enin(t An $&)iie .erti"al "( a"e#ta. Tre-(ie e.itate An "(r#a
e%it&r(l(i t&ate )&nele "( $r&e%inene &#&a#e $re"(% /i re'i(nile .a#"(lari)ate.
C@%$ di#"&ntin(3"@nd a.e% & Antrer($ere rit%i" "( & an(%it re".en a
(ltra#(net(l(i din "@%$ "&ntin(( /i "@nd tre-(ie # ine% #ea%a de &r%a /i d(rata
i%$(l#(l(i! d(rata $a()ei /i de re".ena inter"alri radiaiil&r re#$e"ti.e.
Prin inter%edi(l a$ei #e &l&#e/te at(n"i "@nd a.e% de tratat e,tre%iti anat&%i"e "(
%(lte #($raee nere'(late /i "( %(lte $r&e%inene &#&a#e.
?ntr3& -aie "ld( #e intr&d("e %@na #a( $i"i&r(l -&lna. An$re(n "( "a$(l e%it&r. Se
.&r e,e"(ta %i/"ri lente liniare #a( "ir"(lare la & di#tan de a$r&,i%ati. 4 "% a de
te'(%ent a.@nd 'ri9 "a #($raaa e%it&are # ie $aralel "( te'(%ent(l.
Se (tili)ea) #(-#tan de "&ntra#t "a # n( rele"te ra)a (ltra#&ni"! d(rata e#te de $@n
la 1L %in(te /i trata%ent(l #e a"e )ilni" #a( la 2 )ile.
?n a$li"aiile $eriarti"(lare "&nd("e la A%-(ntirea ela#ti"itii "a$#(l&li'a%entareG
a.&ri)ea) &r%area "al(#(l(i /i A%-(nte/te iri'aia %(#"(lar.
1H
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
5. TRATAMENTUL PRIN MASAT* 5. TRATAMENTUL PRIN MASAT*
Ma#a9(l e#te & $rel("rare %et&di" a $ril&r %&i ale "&r$(l(i! $rin a"i(ni %an(ale #a(
%e"ani"e An #"&$ i)i&l&'i" #a( "(rati.&3$r&ila"ti". S$(ne% " %a#a9(l e#te &
B$rel("rareC! de&are"e #e a"i&nea) din aar a#($ra "&r$(l(i! #(-ie"t(l %a#at n(
"6elt(ie/te ener'ie /i n( i #e "ere & $arti"i$are a"ti. la ee"t(area l(i.
E8ECTELE 8IUIOLOGICE ALE MASATULUI E8ECTELE 8IUIOLOGICE ALE MASATULUI
Ee"tele i)i&l&'i"e ale %a#a9(l(i #(nt de 2 el(ri*
1. L&"ale*
A"i(nea #edati.3a#($ra d(reril&r de ti$ ne.ral'i" %(#"(lar arti"(lar ;"al%area+.
A"i(nea 6i$ere%iant3 A%-(ntire a "ir"(laiei l&"ale "are #e %anie#t $rin
Anr&/irea /i An"l)irea te'(%ent(l(i! a#($ra "r(ia #e e,e"(t %a#a9(l.
A"i(nea Anlt(rri li"6idel&r inter#tiiale de #ta)3 "( a""elerarea
$r&"e#el&r de re)&r-ie An re'i(nea %a#at.
A"i(nile dire"te! %e"ani"e3inl(enea) e#(t(rile #(-"(tanate "&n9(n"ti.e /i
'r#&a#e! a.&ri)@nd #"6i%-(rile n(triti.e! $rin #$&rirea a$&rt(l(i de #@n'e.
?%-(nte/te /i $r&$rietile (n"i&nale ale %(/"6il&r ;e,"ita-ilitatea!
"&ntra"ti-ilitatea+ /i ale ner.il&r %&t&ri! "@nd # "rea#" i%$(l#(l %&t&r /i
"a$a"itatea de "&ntra"ie a %(/"6il&r.
2. Generale*
Sti%(larea (n"iil&r a$arat(l(i "ir"(lat&r3 A%-(nte/te "ir"(laia .en&a#! "re/te
"antitatea de 6e%&'l&-in din #@n'e! #$&rirea n(%r(l(i de le("&"ite /i 6e%atii.
Sti%(larea (n"iil&r a$arat(l(i re#$irat&r3(/(rea) #"6i%-(rile de 'a)e.
Cre/terea %eta-&li#%(l(i -a)al
Alte ee"te ale %a#a9(l(i #(nt*.
Ee"te a.&ra-ile a#($ra* #tri 'enerale a $a"ient(l(i! A%-(ntirea #&%n(l(i!
Ande$rtarea &-&#eli %(#"(lare.
Me"ani#%(l rele,3 An $iele e,i#t n(%er&a#e ter%inai ner.&a#e ;n(%ite
e,ter&"e$t&ri+ An %(/"6i! li'a%ente /i tend&ane! $r&$ri&"e$t&ri la ni.el(l "r&ra ia(
na/tere #ti%(li de dierite inten#iti "are $&rne#" #$re #i#3te%(l ner.&# "entral.
:ESCRIEREA ANATOMIC A REGIUNII :ESCRIEREA ANATOMIC A REGIUNII
1J
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
S"6elet(l %@inii e#te &r%at din 2H de &a#e A%$rite An 4 'r($e*
1. Car$(l "are e#te &r%at din J &a#e! "e #(nt di#$(#e $e 2 r@nd(ri*
R@nd(l #($eri&r e#te &r%at din*
O#(l #"a&id!
O#(l #e%il(nar!
O#(l $ira%idal!
O#(l $i#i&r%.
R@nd(l ineri&r e#te &r%at din*
O#(l tra$e)!
O#(l tra$e)&id!
O#(l %are!
O#(l "( "@rli'.
2. Meta"ar$(l3 e#te &r%at din = &a#e %eta"ar$iene! "are al"t(ie#" #e'%ent(l %i9l&"i( al
#"6elet(l(i %@inii. Ele #e n(%er&tea) dinaar An(ntr(! de la I la 0.
4. 8alan'ele #(nt An n(%r de 15! &r%ea) #"6elet(l #e'%ent(l(i di#tal al %@inii! adi"
al de'etel&r! "( e,"e$ia de'et(l(i %are den(%it /i $&li"e "are are n(%ai 2 alan'e! t&ate
"elelalte de'ete a( "@te 4 alan'e! n(%ite de #(# An 9&#* $r&,i%al! %edie /i di#tal.
M(/"6ii %@inii* #e $&t A%$rii An 2 'r($e*
1. M(/"6ii $r&$rii ai %@inii "are #e A%$art An 4 'r($e*
a+. M(/"6ii $&li"el(i ;#a( ai re'i(nii $al%are laterale+*
M(/"6i(l #"(rt a-d("t&r al $&li"el(i3e#te iner.at de ner.(l radial /i $arti"i$ la
%i/"area de a-d("ie a $&li"el(i.
M(/"6i(l #"(rt le,&r al $&li"el(i3"a$t(l #($eri"ial e#te iner.at de ner.(l
%edian! iar "el $r&(nd de ner.(l (lnar.
M(/"6i(l &$&)ant al $&li"el(i3e#te iner.at de ner.(l %edian. Prin "&ntra"ie a"e
le,ia /i r&taia %edial a $ri%(l(i %eta"ar$ian.
M(/"6i(l add("t&r al $&li"el(i3e#te iner.at de ra%(ra $r&(nd a ner.(l(i (lnar.
-+. M(/"6ii de'et(l(i %i" ;#a( e%inena 6i$&tenar+*
M(/"6i(l $al%ar #"(rt3e#te iner.at de ner.(l (lnar.
M(/"6i(l a-d("t&r al de'et(l(i %i"3e#te iner.at de ner.(l (lnar. E#te le,&r al
de'et(l(i %i".
M(/"6i(l &$&)ant al de'et(l(i %i"3 e#te iner.at de ner.(l (lnar. Prin "&ntra"ia
l(i! tra'e anteri&ar /i lateral %eta"ar$ian(l al I0 lea.

"+. M(/"6ii re'i(nii $al%are %i9l&"ii*
M(/"6ii l&%-ri"ali3#(nt 5 %(/"6ii din "are 2 laterali /i 2 %ediali. Cei 2
l&%-ri"ali laterali #(nt iner.aii de ner.(l %edian! iar "ei 2 %(/"6ii %ediali #(nt
iner.aii de ner.(l (lnar. Ei $r&d(" le,ia alan'ei $r&,i3%ale /i e,ten#ia
(lti%el&r 2 alan'e.
M(/"6ii inter&#&/i $al%ari #(nt An n(%r de 4! &"($ n(%ai 9(%tate din
#$aiile inter&#&a#e al II3lea! al III3lea! al I03lea. S(nt iner.ai de ra%(ra
$r&(nd a ner.(l(i (lnar. 8a"e le,ia $ri%ei alan'e /i e,ten#ia (lti%el&r d&(!
add("ia de'etel&r.
1K
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
M(/"6ii inter&#&/i d&r#ali #(nt An n(%r de 5 /i &"($ Antre'(l #$ai( &#&#.
S(nt iner.ai de ra%(ra $r&(nd a ner.(l(i (lnar. 8a"e le,ia $ri%ei alan'e /i
e,ten#ia (lti%el&r d&( alan'e! a-d("ia de'etel&r.
Arti"(laia radi&"ar$ian e#te & arti"(laie "&ndilian! "are (ne/te radi(#(l "( $ri%(l
r@nd al "ar$(l(i. Ca$#(la arti"(lar e#te (n %an/&n i-r&# "are #e in#er A%$re9(r(l
#($raeei arti"(lare a radi(#(l(i iar An 9&# A%$re9(r(l "&ndil(3l(i "ar$ian.
Partea anteri&ar a $(%n(l(i $re)int & #erie de relie(ri l&n'it(dinale &r%ate de
tend&anele #(-ia"ente. A"e#te relie(ri tendin&a#e deli%itea) d&( /an(ri l&n'it(dinale!
#(- "are #e '#e#" d&( "&nd("te &#te&i-r&a#e! &r%ate de li'a%ent(l inelar anteri&r al
"ar$(l(i! (n(l e,tern! $rin "are tre"e tend&n(l %arel(i $al%ar! alt(l intern %ai %are $rin
"are tre" ner.(l %edian /i t&ate tend&anele le,&ril&r "( te"ile l&r #in&.iale.
TEPNICA MASATULUI TEPNICA MASATULUI
MASATUL ANTE7RAULUI.
8&r%a ante-ra(l(i de$inde de .&l(%(l %a#ei %(#"(lare /i de de).&ltarea
#trat(l(i adi$&# #(-"(tanat. Pe e$itr&6lee #e in#er r&t(nd(l $r&nat&r! %arele $al%ar! %i"(l
$al%ar /i le,&r(l "&%(n #($eri"ial al de'etel&r. Pe e$i"&ndil #(nt in#erai an"&ne(l!
"(-ital(l $&#teri&r! e,ten#&r(l $r&$ri(3)i# al de'et(l(i %i" /i e,ten#&r(l "&%(n al
de'etel&r.
Pe re'i(nea anteri&ar a ante-ra(l(i $ielea e#te #(-ire! in! %&-il $e $rile
#(-adia"ente. Te'(%ent(l e#te -&'at iner.at. ?n $r&(n)i%ea %a#el&r %(#"(lare tre"e
ner.(l %edian /i "(-ital(l! "are! An "a) de le)i(ne $r&d("e $arali)ie %(#"(lar /i ane#te)ie
deiniti. a %@inii.
Pe re'i(nea ante-ra6ial $ielea e#te %ai 'r&a# /i %ai $(in %&-il! a"&$erit "( $r.
Ma#a9(l ante-ra(l(i An"e$e "( nete)irea $ril&r anteri&are! "are #e $&ate a"e "( &
#in'(r %@n! "( $&li"ele! "elelalte de'ete al(ne"@nd $e $artea $&#teri&ar! #a( "( a%-ele
%@ini. :($ nete)ire! #e tre"e la r%@ntat! la An"e$(t $e 'r($(l le,&ril&r $rin $re#i(ni
e,e"(tate "( & %@n #a( "( a%-ele! di#$(#e An inel! $rin %i/"ri a#"endente. Se a" /i
%i/"ri de Ant&ar"ere de 9&# An #(# $e $artea radial! al(ne"@nd #$re e$i"&ndil.
8r%@ntat(l re'i(nii $&#teri&are a ante-ra(l(i #e a"e $rin $re#i(ni a#"endente "( &
%@n $e ante-ra. At(n"i "@nd .&l(%(l %a#el&r %(#"(lare $er%ite #e $&ate a$li"a %a#a9(l
2L
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
"( d&( %@ini. ?n $l(#! la ante-r#a #e $&ate a$li"a -atere "( $artea "(-ital a de'etel&r /i
.i-raii.
MASATUL :EGETELOR I MINII.
Ma#a9(l de'etel&r #e a"e An"e$@nd "( nete)irea "( d&( de'ete Antre $&li"e /i inde,!
a$&i #e "&ntin( "( $re#i(ni! r%@ntri ;e.ent(al #(- &r% de %@n'@ieri+! ri"i(ni $e
arti"(laiile %eta"ar$&alan'iene /i interalan'iene. T&tdea(na %a#a9(l #e e,e"(t An #en#(l
"ir"(laiei .en&a#e.
Ma#a9(l re'i(nii d&r#ale An"e$e "( nete)irea de la arti"(laiile %eta"ar$&alan'iene /i
"&ntin(@nd An #(# $e $(%n /i "6iar ante-ra. C&%tn(% a$&i r%@nt@nd %(#"(lat(ra
tenar /i 6i$&tenar $rin #t&ar"ere Antre $&li"e /i inde,. Se tre"e a$&i la %a#area #$aiil&r
inter&#&#a#e "are #e $&ate a"e "( (n #in'(r de'et #a( -i%an(al! $rin $re#i(ni An a%-ele
dire"ii.
Pentr( %a#a9(l %@inii #e $reer & #(-#tan 'ra# ;(ntdele%n+! "are .a i An"l)it An
$reala-il An -aia %arin.
Inten#itatea /i &r%ele de %a#a9 #(nt deter%inate de #tarea l&"al a $ielii
MASATUL ARTICULAIEI RA:IOCARPIENE
Ma#a9(l re'i(nii anteri&are a $(%n(l(i #e a"e An 'eneral "( a9(t&r(l $&li"el(i! "are
(r%ea) relie(l tend&anel&r de 9&# An #(#! dinaar An(ntr(. Pe aa anteri&ar a $(%n(l(i!
%a#e(r(l Ant@lne/te (r%t&arele &r%ai(ni*
tend&n(l l(n' #($eri&r
artera /i .enele radiale
tend&anele %i"(l(i /i %arel(i $al%ar
ner.(l %edian
tend&anele le,&ril&r #($eri"iali
arterele /i .enele "(-itale! An#&ite de ner.(l "(-ital
tend&n(l "(-ital anteri&r.
Ma#a9(l re'i(nii $&#teri&are #e An"e$e "( nete)irea ;%a#a9(l de intr&d("ere "( $&li"ele+
(r%at de ri"i(nea arti"(laiei radi&"ar$iene.
MO7ILIUAREA ARTICULAIILOR ;SINETOTERAPIE+ MO7ILIUAREA ARTICULAIILOR ;SINETOTERAPIE+
Ori"e /edin de %a#a9 e (r%at An %&d &-li'at&ri( de %&-ili)area arti"(laiil&r /i
re'i(nil&r din .e"intatea )&nel&r %a#ate.
M&-ili)area #a( <inet&tera$ia n( tre-(ie # ie d(rer&a# ni"i "6iar An "a) de red&ri
arti"(lare! dea#e%enea ea n( tre-(ie &rat.
Mi/"rile reali)ate de ante-ra*
21
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
S($inaie3"@nd ante-ra(l #e r#("e/te Anaar!
Pr&naie3"@nd ante-ra(l #e r#("e/te An(ntr(.
Sinet&tera$ia An arti"(laia radi&"ar$ian3"( & %@n "&ntra$ri) dea#($ra arti"(laiei /i
"( "elalalt %@n #e e,e"(t %i/"rile de*
8le,ia3e#te %a,i% "@nd %@na e#te An"linat "(-ital iar de'etele e,tin#e.
E,ten#ia3e#te %a,i% "@nd %@na e#te An"linat radial iar de'etele #(nt le,tate.
Lateralitate!
R&tire!

Cir"(%d("ie3"&n#t An tre"erea #(""e#i. $rin* le,ie! a-d("ie! e,ten#ie! add("ie
#a( in.er#.
El&n'aie.
?n"linarea radial3"@nd &#(l %are #e An"lin Anaar! #e%il(nar(l a"e a"eia/i
%i/"are An(ntr(.
?n"linarea "(-ital3"@nd &#(l %are #e An"lin An(ntr(! #e%il(nar(l ee"t(ea)
a"eia/i %i/"are Anaar! iar #"a&id(l a9(n'e # ie de'a9at /i are $&#i-ilitatea dea
reali)a %i/"ri de &$&)iie.
Mi/"rile $a#i.e3#(nt Ant&tdea(na $re"edate de "ld(r /i %a#a9. A%$lit(di3nea
%i/"ril&r a"ti.e "re/te $r&'re#i. An ti%$(l (nei /edine atin'@nd %a,i%(l $&#i-il! %&%ent
"@nd $ra"ti" #e tran#&r% An Antinderii. Se %&-ili)ea) #e$arat ie"are arti"(laie! #e An"e$e
"( "ele di#tale! /i a$&i #e tre"e tre$tat #$re "ele $r&,i%ale. M&-ili)rile #e a" An t&ate
$lan(rile de %&-ilitate ale (nei arti"(lai.
Pri)ele a#i#tent(l(i .&r i "(te An a/a el An"@t # %&-ili)e)e n(%ai & arti"(laie.
Ni"i&dat n( #e .a tre"e $e & arti"(laie $rin inter%edi(l altei arti"(lai inter$(#e.

M&-ili)rile $a#i.&3a"ti.e3a" tre"erea #$re %&-ili)rile a"ti.e /i #(nt indi"ate An 2
"a)(ri $rin"i$ale*
C@nd &ra %(#"(lar e#te An" $rea #la- $entr( a a#i'(ra Antrea'a a%$lit(dine a
%i/"ri.
C@nd %i/"area a"ti. #in'(r n( #e a"e $e dire"iile de %&-ili)are i)i&l&'i"e #a(
d&rite.
M&-ili)rile a"ti.e3re$re)int in"&nte#ta-il -a)a re"($errii %@inii $&#t3tra(%ati"e.
M&dalitile te6ni"e de reali)are ale l&r #(nt .ariate ;An a$! $e (#"at! "( /i r a9(t&r(l
di.er#el&r in#talaii+! dar "ele %ai &l&#ite #(nt e,er"iii li-ere! e,er"iii "( An"r"are de
're(ti /i "&ntra"ii i)&%etri"e de&are"e %@na are & %(ltit(dine de %i/"ri #i%$le /i
a#&"iate. Sedinele .&r i #"(rte dar re$etate de %ai %(lte &ri An ti%$(l (nei )ile.
Mi/"area $a#i. /i $a#i.3a"ti. #&li"it #i#te%(l &#te&arti"(lar /i %(#"(lar! inl(en@nd(3
le %e"ani" /i #ti%(l@nd(3le (n"i&nal! intrein@nd(3le "alitati..
22
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
:e a#e%enea! a"ti.ea) "ir"(laia! de"i /i n(triia. :ar "ele %ai i%$&rtante ee"te ale
a"e#t&r %i/"ri #(nt a"elea de -tt&rire a "il&r ner.&a#e! "are in Btrea)C #"&ara
"ere-ral $entr( "&nd("erea /i "&&rd&narea t(t(r&r a"i(nil&r "&r$(l(i.
GIMNASTICA ME:ICAL GIMNASTICA ME:ICAL
Gi%na#ti"a %edi"al e#te (na dintre &r%ele de a$li"are ale <inet&tera$iei /i "&n#t din
e,er"iii! $r&"edee /i %et&de #$e"iale &r'ani)ate /i $(#e An #l(9-a $re.enirii /i "&re"trii
dei"itel&r i)i"e! &r'ani"e #a( $#i6i"e.
E,er"ii(l i)i" e#te %i9l&"(l de -a) al 'i%na#ti"ii tera$e(ti"e! a"ea#ta "&n#tit(ind(3#e!
"a (r%are a e,$erienei $ra"ti"e /i te&reti"e a"(%(late! An dierite $r&"edee "are #e a$li"
identi" An t&ate "a)(rile anal&a'e.
Ee"te %&r&'eneti"e /i %&r&$la#ti"e3 %i/"area deter%in & -(n iri'aie #an".in /i
n(triti. a &a#el&r #&li"itate An e&rt! a"e#tea d).&lt@nd(3#e n&r%al.
?n "a)(l arti"(laiil&r deter%in /i Antreine &r%a! "&ndii&nea) Antinderea #($raeei
arti"(lare! 'r&#i%ea "artila9(l(i arti"(lar! l(n'i%ea /i re)i#tena li'a%entel&r! a "a$#(lei
arti"(lare An (n"ie de ten#i(nea e,er"itat la ni.el(l a"e#t&ra.
Pentr( re"($erarea %ainii #e a" (r%at&arele e,er"itii*
1. C( $al%a #$ri9init de %a# /i "( de'etele An"6i#e #e a"e e,ten#ia a"ti. a ie"r(i de'et.
2. A"ela/i e,er"ii( "( a9(t&r(l "eleilalte %@ini #e a"e $e r@nd e,ten#ia de'etel&r.
4. C( ante-ra(l #$ri9init $e %a# #e e,e"(t le,ia "( & a$#are $e a treia alan'.
5. C( "&atele #$ri9inite $e %a#! $al%ele a3n a /i a$r&$iate #e e,e"(t "( "&ntra
re)i#ten le,ia /i e,ten#ia de'etel&r din arti"(laiile %eta"ar$iene.
=. :in a"eea/i $&)iie #e e,e"(t %i/"area de lateralitate #t@n' /i drea$t din arti"(laiia
%@inii.
>. C( "&atele #$ri9inite $e %a#! de'etele An"&rdate /i (/&r le"tate #e e,e"(t r&taii din
arti"(laia %@inii.
H. C( "&atele #$ri9inite $e %a# An #($inaie %@na An"6i#! #e e,e"(t le,ii /i e,ten#ii din
arti"(laia %@inii.
J. C( "&atele #$ri9inite $e %a# $al%ele An"6i#e An "&ntin(area ante-ra(l(i #e e,e"(t
#tr@n'erea An $(%n alan' d($ alan'.
K. C( $al%ele #$ri9inite $e "@te (n -(rete de -aie! ante-ra(l #$ri9init $e %a#! #e e,e"(t
a$("area #tr@n# a -(retel(i "( t&ate de'etele &dat "( e,ten#ia din arti"(laia %@inii.
1L. C( $al%a i,at $e (n #($&rt #$e"ial a%ena9at! al"t(it din "in"i -en)i de ela#ti" #e
e,e"(t le,ia #i e,ten#ia.
5. 5. TERAPIE OCUPAIONAL ;Er'&tera$ia+ TERAPIE OCUPAIONAL ;Er'&tera$ia+
E#te -ine "(n&#"(t air%aia l(i 8r. En'el# " B%@na e#te $r&d(#(l %(n"iiC /i de a"eea
n( tre-(ie # #(r$rind re"i$r&"a ei " Bd&ar %("a $&ate da (n"i&nalitate %@iniiC.
?n a"ti.itatea "&tidian $r&e#i&nal /i e,tra$r&e#i&nal! #e "ere %@inii (ne&ri &r /i
re)i#ten! alte&ri .ite) de e,e"(ie /i $re"i)ie #a( alte "&%-inaii ale a"e#t&r "aliti. Ele
n( $&t i An# &-in(te de"@t An "adr(l antrena%ent(l(i #$e"ii" al a"ti.itii (%ane a
24
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
%@inii. A"ea#ta e#te reali)at $rin tera$ia &"($ai&nal! "are in"l(de An "&n"e$ia an'l&3
#a,&n! at@t tera$ia $rin %(n" ;er'&tera$ia+! "@t /i 9&"(rile /i in#talaiile di#tra"ti.e
;tera$ia &"($ai&nal $r&$ri(3)i#+.
Tera$ia &"($ai&nal $entr( di#(n"ia %@ini are $atr( %ari #"&$(ri*
1. A re"@/ti'a /i de).&lta a-ilitile .ieii )ilni"e An #"&$(l de a a"e $a"ienii "@t %ai
inde$endeni $&#i-il. Pentr( a"ea#ta #e (tili)ea) t&t el(l de ada$tri ;%@nere #$e"iale
$entr( lin'(r! (r"(li ! "(it! %anete An l&" de r&-inete #a( -(t&ane et".+. a"ea#ta An
"a)(rile "( in.aliditi #e.ere #a( deiniti.e.
2. A $er%ite %(n"a An #"&$(l a%eli&rrii %&-ilitii arti"(lare! "re/teri &rei %(#"(lare
/i re"@/ti'rii "&&rd&nrii %i/"ril&r. Ti$(rile de %(n" (tili)ate e#te -ine # "&re#$(nd
%(n"ii $r&e#i&nale a $a"ient(l(i #a( $a#i(nil&r l(i.
4. A $er%ite e.al(area ne"e#itil&r (n&r a"iliti de %(n" $rin ada$trile #"(lel&r! a
%a/inil&r! (nelte An (n"ie de %e#eria tre"(t ;#a( .iit&area+ a $a"ient(l(i.
5. Ade#"&$eri /i de).&lta n&i .&"aii $r&e#i&nale $entr( $a"ienii "are! dat&rit
di#(n"iei %@inii! n( #e %ai $&t Ant&ar"e la a"ti.itatea anteri&ar.
?n %a9&ritatea "entrel&r de tera$ie &"($ai&nal $entr( $a"ienii "( di#(n"ii ale %@ini!
#e (tili)ea) (r%t&arele a"ti.iti*
I%$ri%eria ;ti$&'raierea+! in"l()@nd t&ate &$erai(nile* "(le'erea literel&r!
aran9area l&r! $re#area $e 6@rtie! et".
e#(t(l de r)-&i! &arte %(lt (tili)at! ""i #&li"it & %are .arietate de %i/"ri /i
$ri)e ;"&ne"i&narea (n(i % de $@n) "ere 14LL %i/"ri+. ?n $l(# An a/e)are
.erti"al! &-li' la a"ti.itatea "( %@inile ridi"ate! A%$iedi"@nd &r%area
ede%(l(i.
0arieti* '6er'6e(l! r)-&il( &ri)&ntal $entr( "&.&are /i (nele a"ti.iti "&ne,e* t&r#!
r#("it! dr"it! $eriat et"G
:a"til&'raiat! #"ri#! de#en te6ni"G
?%$a"6eta93a%-ala9 $entr( & di.er#itate de &-ie"te /i de %&deleG
L("r( de %@n ;tri"&tat! -r&dat! "(#(t! et"+G
Tra&ra9! t@%$lrie /i d(l'6erie (/&arG
Str(n'rie An le%n #a( ier! er&nerieG
L("r( An $ielrieG
Cr&it&rie! len9erieG
Ele"tr&ni" ! "ea#&rni"rieG
Grdinrit! &lrit et".
R(larea "le(l(iG
A -ate (n &(! la$te $rin#! et"G
?n/irarea %r'elel&r $e & #&arG
C@ntat(l la $ian! a"&rde&n #a( la in#tr(%ente de #(latG
M&delri "( $la#telinG
8&l&#irea &are"el&r la de"($at 6@rtie! "art&nG
A$("area (n&r &-ie"te %ari $entr( a le #i%i "( %@naG
A$("area &-ie"tel&r din "e An "e %ai %i"i* %&nede! #"&-it&ri et"G
25
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
R#&irea (nei "riG
T&ate a"e#te a"ti.iti a( &#t #ele"i&nate $e "riteriile B'e#ti"ii $r&e#i&naleC.
:elaet /i L&-et! #t(diind 14LL %e#erii! a( artat " e,i#t d&ar 54 de 'e#t(ri de -a)!
"are #e $&t "&%-ina Antre ele. :in a"e#te 54 de 'e#t(ri! 25 a$arin %@inii. A"e#te 'e#t(ri
$r&e#i&nale #e A%$art An*
a+. Ge#t(ri &-li'at&rii ne"e#itate de %edi(l $r&e#i&nal /i n( de %(n"a $r&$ri(3)i# ;de
e,. (r"at(l3"&-&r@t(l #"ril&r $entr( (n )idar+G
-+. Ge#t(ri #&li"itate de %(n"! dar "&%andate de %a/inile (nelete ;An.@rtirea (nei
%ani.ele! tierea "( &are"a et".+G
"+. Ge#t(ri $r&$rii %(n"ii! dar al "r&r '6ida9 n( e#te "&%andat ;$i"t(r! #(d(r!
%&delat&ri! et"+.
?n aar de a"ti.itile l("rati.e! tera$ia &"($ai&nal "($rinde 9&"(rile di#tra"ti.e! 9&"(ri
"( "ara"ter "&%$etiti. #a( de a(t&de$/ire.
Unele dintre a"e#tea #(nt 9&"(ri di#trati.e #a( #$&rti.e -ine "(n&#"(te! "( #a( r
ada$tri #$e"ii"e! altele #(nt "reate #$e"ial $entr( re"($erarea di#(n"iei %@inii. Iat
"@te.a dintre a"e#te 9&"(ri*
T&"(l Bda%eC An "are $ie#ele #(nt .aria-ile "a .&l(% #a( 're(tate. Une&ri $la"a
e#te %etali"! iar $ie#ele #(nt %a'neti)ateG
T&"(l B&t-al "( $&%$ie #(lt&areC. O %in'e de $in'3$&n' e#te diri9at de
#(l(l (n&r $&%$ie &r%ate dintr3& $ar de "a("i(" "( & ti9G
T&"(ri %e"ani"e "are #e %ani$(lea) $rin ti9 "( %@nere ;&t-al! -a#"6et et"+G
7iliard! teni# de %a#G
Teni#! "ri<et! '&l! -ad%int&nG
Ar(n"area "( #'ei la intG
Mar&""&! /a6! et".
>. TRATAMENTUL 7ALNEOLOGIC ;a$e %inerale! n%&l(ri+ >. TRATAMENTUL 7ALNEOLOGIC ;a$e %inerale! n%&l(ri+
P&ate i &arte (til da"*
?n ale'erea #tai(nil&r ne .&% &rienta d($ rea"ti.itatea -&lna.(l(i /i -&lile a#&"iate.
?n #en#(l a"e#ta .&% indi"a -ile #rate! i&d(rate de ti$ 7a)na /i G&.&ra! -ile #(l(r&a#e
de ti$ Per"(lane. Trata%ent(l -alnear #e a"e t&ata .iata.
?n (n"ie de #(-#tanele "6i%i"e $e "are le "&nin a$ele %inerale a%inti% (r%at&arele
#tai(ni*
7ile 8eli,3#(nt -i &li'&3%etali"e #la- %inerali)ate /i radi&3i&ni"eG
7ile Per"(lane! P("i&a#a! 0(l"ana3#(nt -i ter%ale #i #(l(r&a#eG
G&.&ra3#(nt -i #(l(r&a#e! i&date /i #rateG ;n%&l #ili"&# /i i&dat+G
7a)na3#(nt -i i&date /i #rateG
S&.ata! A%ara! #(nt -i #rate /i "( n%&l(ri de la"(ri #rate.
Lit&ral(l ;E&rie #iTe"6ir'6i&l+ 3 -i #rate /i "( n%&l #a$r&$eli"
2=
Metode de recuperare medical BFT n mna i articulaia pumnului
posttraumatic
?n #tai(nile de trata%ent #e a$li" & 'a% lar' de $r&"ed(ri -alne&i)i&tera$i"e. Pe
l@n' a"e#te $r&"ed(ri "el %ai i%$&rtant a"t&r Al "&n#tit(ie "li%at&tera$ia "e are (n
de&#e-it r&l a#($ra $#i6i"(l(i -&lna.(l(i.
7I7LIOGRA8IE* 7I7LIOGRA8IE*
L("reia Titir" Ur'enele Medi"&3C6ir(r'i"ale ;#inte)e $entr( "adre %edii+! Ed.
Medi"al! 7("(re/ti! 1KJK.
Pr&e#&r :r. :&". 0i"t&r Ci&-an( Re"($erare (n"i&nal An $ra"ti"a re(%at&l&'i"! Ed.
Medi"al! 7("(re/ti! 1KHK!
:(%itr( :(%itr( Gid de reed("are (n"i&nal! Ed. S$&rt3T(ri#%! 7("(re/ti 1KJ1.
T(d&r S-en'6e Sinet&l&'ie $r&ila"ti"! tera$e(ti" /i de re"($erare! Ed. Medi"al!
7("(re/ti! 1KJH.
Si## Iar&#la. 8i)i&<inet&tera$ie /i re"($erare %edi"al! Ed. Medi"al! 2LL2
S-en'6e T(d&r Re"($erarea %edi"al a #e"6elel&r $&#ttra(%ati"e ale
%e%-rel&r! Ed. Medi"al! 1KJ1
C&n. :r. 0. Ran'a! Pr&. :r. I. Te&d&re#"( E,ar"( Anat&%ia /i 8i)i&l&'ia O%(l(i! Ed.
Medi"al! 7("(re/ti! 1K>K.
:r. Claren"e :ail /i C6arle# T6&%a# Pidr&ter%&tera$ie ;trata%ente #i%$le $entr(
ae"i(ni &-i/n(ite+! Ca#a de Edit(r30ia /i Sntate! 7("(re/ti! 1KKK.
0a#ile Mar"( Ma#a9 /i Sinet&tera$ie! Ed. S$&rt3T(ri#%! 7("(re/ti 1KJ4.
2>