Wiisl and Hand. 101 



proceed, viz., the lower end of the humerus, and thereby 

 increases the scope and strength of their application. With- 

 out these accessory actions of the humerus, the hand could 

 be supinated and pronated only through an angle of about 

 80 ; with them, the range may reach in the neighborhood 

 of 340. 



Diseases. Inflammation of the Structures of the 

 Hand. When the superficial tissues of the palm are in- 

 flamed, pain is severe, although there is very little swell- 

 ing present, since the integument is bound down to the 

 palmar fascia by means of strong dense fibres, whereas, 

 when the similar structures of the dorsum are affected, 

 pain is less, while the swelling is greater, because of the 

 relative laxity of the superficial tissues on the dorsum as 

 compared with those on the palm. 



Dupuytreris contraction is due to a shortening of the 

 superficial fibres, which, derived from the processes of the 

 palmar fascia, run to the integument of the palm and the 

 bases of the fingers. Not only are these fibres affected, 

 but the processes, themselves, are contracted, with the re- 

 sult that, the fingers are flexed, especially the little finger, 

 and the skin is thrown into pits or folds. When the sy- 

 novial sac, surrounding the superficial and the deep flexor 

 tendons in the palm, is distended, the condition is termed 

 ''compound palmar ganglion," and, since the sac extends 

 above the wrist, beneath the annular ligament, the swell- 

 ing presents an hour-glass appearance, being bound down, 

 at its middle, by this ligament. Fluctuation may be eli- 

 cited by placing one finger on the front of the wrist above, 

 and another on the palm below the annular ligament. 



When septic inflammation, i.e.; whitlow or felon affects 

 the last phalanges, the inflammatory action is generally 

 confined to these phalanges, instead of spreading up the 

 fingers, especially if the deeper structures, i.e., the perios- 



