Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.

  • Henry Gray
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    990/1036 (page 986)
    edge of tlie anterior annular ligament and the intercarpal joint. The lino of the radio-carpal joint, as already stated, is on a level with the apex of the styloid process of the ulna. In forcible [and resisted] flexion of the wrist, the tendon of the flexor carpi radialis and that of the palmaris longus come up in relief. On the outer side of the first-named tendon we feel the pulse, the radial artery here lying close to the radius. The tendon of the palmaris longus runs near the middle of the wrist, and close to its inner border runs the median nerve. In letting out deep-seated matter near the wrist, the incision should be made close to and parallel with the inner edge of the radial flexor tendon, so as to avoid injury to the median nerve. [The median nerve in the forearm lies under the flexor sublimis digi- torum, in a line drawn from the bend of the elbow just inside the artery to a point between the tendons of the palmaris longus and the flexor carpi radialis. It is here not only amenable to operations, but often is cut in accidents.] We can feel the tendon of the flexor carpi ulnaris for some distance above the wrist. It overlies the ulnar artery, and somewhat masks its pulsation. 142. Pulse.—The pulse at the wrist is felt just outside the tendon of the flexor carpi radialis. In feeling the pulse it should be remembered that, in some cases, the superficialis volse arises higher and is larger than usual. In such cases it runs by the side of the radial artery, and gives additional volume to the pulse. The old writers call it pulsus duplex, When in doubt, there- fore, it is well to feel the pulse in each, wrist. 14:3. Great Carpal Bursa.—The great synovial sheath under the annular ligament common to the flexor tendons of the fingers and the long flexor of the thumb, extends, upwards, about an incli and a half above the edge of the ligament, and, downwards, as low as the middle of the palm. This general synovial sheath communicates witb the special sheaths of the thumb and the little finger; not with that of the index, middle, and ring fingers. 111. *' Tabatiere Anatomique.—On the outer side of the wrist we can distinctly see and feel, when in action, the three extensor tendons of the thumb. Between the second and third there is deep depression, at the root of the thumb, whicli the French, humorously call the tabatiere anatomique. In this depres- sion we can make out—1, the relief of the superficial radial vein; 2, the radial artery, in its passage to the back of the hand; 3, the upper end of the metacar- pal bone of the thumb. 145. Tendons on Back of Wrist.—The relative positions of the several extensor tendons of the wrist and fingers, as they play in their grooves over the back of the radius and ulna, can all be distinctly traced when the several muscles are put in action. The length of their synovial sheaths should be remembered. They vary from one inch and a half to two inches and a half. The longest of all are those of the extensors of the thumb. When these sheaths are inflamed and swollen, the motion of the tendons becomes painful and gives rise to a feeling of crepitus, called tenalgia crepitans by some writers. It is said to be met with sometimes in pianists. [On the overstretch- ing of these muscles, see § 111.] 146. Lines of Arteries.—-The course of the radial artery corresponds with a line drawn from the outer border of the tendon of the biceps at the bend of the elbow down the front of the forearm to the front of the styloid process of the radius. In the upper third of its course the artery is overlapped by the supinator longus. To make allowance for this, the incision for the ligature of the artery in this situation should be made, not precisely in the line of its course, but rather nearer the middle of the forearm. The line of the ulnar artery runs from the middle of the bend of the elbow (slightly curving inwards) to the outer side of the pisiform bone. The radial and ulnar arteries can, in most cases, be effectually commanded by pressure well applied at the wrist, in wounds of the palmar arch.