SYNOVIAL VAGINAS OF SINEWS [ vaginae synoviales tendinum (PNA)] — receptacles of sinews of the extended meshkoobrazny form, a wall to-rykh are formed by the synovial membrane surrounding sinews and facilitating their sliding in places of a prileganiye to bone ledges and sheaves. About the most mobile joints (e.g., radiocarpal, talocrural) long sinews of muscles together with synovial vaginas lie in the special osteofibrous and fibrous channels formed by bone ledges and the condensed sites of own fascia. These channels hold sinews (see) in a certain situation, interfering with their laterposition and removal from bones that provides the exact direction of muscular draft. The page of century of page and walls of the osteofibrous channel surrounding it form a vagina of a sinew (vagina tendinis).
The page of century of page consists of two parts passing one into another: outside (parietal), growing together with an inner surface of the osteofibrous channel, and internal (visceral), growing together with an outside cover of a sinew — peritendiniy (fig. 1).
Synovial membrane (see) S. century of page allocates synovial fluid (see), edges are facilitated by sliding of a sinew at reduction and relaxation of a muscle. On length of a sinew one part of a synovial vagina passes into another, forming the dublikatura called by a mesentery of a sinew (mesotendineum), in a cut there pass vessels and nerves to a sinew. The mesentery of a sinew sometimes becomes stronger thin ligaments of sinews (vincula tendinum). Length of a mesentery in various S. century of page is not identical and depends on the volume of shift of a sinew at the movement, S.'s length of century of page also varies in considerable limits. On the proximal and distal ends of S. of century of page outside and internal its parts also pass each other therefore the crack (synovial cavity) which is available between them is closed; sometimes the next S. can be reported to century of page with each other. Century of page passes one or several sinews in one S.
The greatest number C. of century of page is around radiocarpal and talocrural joints, on a brush and foot; their relationship has important practical value.
On brushes (see) allocate two groups C. of century of page: one on palmar, another on a dorsum. On a palmar surface from the beam party there is short S. century of page of a beam sgibatel of a wrist (vagina synovia-lis tendinis m. flexoris carpi radia-lis). In the channel of a wrist is available two vaginas (fig. 2) isolated synovial: lateral — a vagina of a sinew of a long sgibatel of a thumb of a brush (vagina tendinis m. flexoris pollicis longi) and medial — the general synovial vagina of sgibatel (vagina sy-novialis communis mm. flexorum). In 40% of cases the separate synovial vagina for sinews of the deep and superficial sgibatel going to the II finger, the page which is located between lateral and medial S. century and several kzada from them meets. In the proximal direction C. of century of page, the wrists lying in the canal, approximately on 1 — 2 cm act over edge of a retinaculum of sgibatel (retinaculum flexorum). In the distal direction the synovial vagina of a sinew of a long sgibatel of a thumb stretches to the place of an attachment of this muscle to the basis of the II phalanx of a thumb, its length of 9 — 12 cm. The general synovial vagina of sgibatel at the level of average thirds of the II—V metacarpal bones comes to an end with cul-de-sacs, surrounding the corresponding sinews of superficial and deep sgibatel of fingers; its length on average 15 cm
of S. of century of page of fingers of a brush (vaginae synoviales tendinum digitorum manus) are located on the palmar surface of the II—V fingers. For index, average and anonymous fingers they are same (originate at the level of metacarpophalangeal joints and reach the basis of distal phalanxes), a synovial vagina of a little finger in most cases (to 94%) is reported with the general synovial vagina of sgibatel. At newborn S. century of page of all five fingers are put separately from S. for century of the page located in the channel of a wrist. Only later, within the first year of life, synovial vaginas of sinews of I and V fingers connect to the corresponding S. century of page in a wrist. In S. century of page of fingers of a brush is available on two mesenteries: one four a coal form, ties a sinew with a proximal phalanx, another, triangular, fixes a sinew to an average phalanx. At children these mesenteries are expressed better, than at adults.
On a dorsum of a brush under a retinaculum of razgibatel (retinaculum extensorum) six rather short synovial vaginas (fig. 3) are located. The first (beginning from the beam party) — a vagina of sinews of a long abductor and short razgibatel of a thumb of a brush (vagina tendinum mm. abductoris longi pollicis et extensoris brevis pollicis); the second — a vagina of sinews of beam razgibatel of a wrist (vagina tendinum mm. extensorum carpi radialium); the third — a vagina of a sinew of a long razgibatel of a thumb of a brush (vagina tendinis m. extensoris pollicis longi); the fourth — a vagina of sinews of razgibatel of fingers and an index finger (vagina tendinum mm. extensoris digitorum et extensoris indicis); the fifth — a vagina of an extensor tendon of a little finger (vagina tendinis m. extensoris digiti minimi): the sixth — a vagina of a sinew of an elbow razgibatel of a wrist (vagina tendinis m. extensoris carpi ulnaris). The proximal border of synovial vaginas is located 2 — 3 cm above an awl-shaped shoot of a beam bone, distal — within metacarpal bones. The vagina of an extensor tendon of a little finger has the greatest length (6 — 8 cm). At adults the first and second vaginas of sinews have the constant message among themselves in the form of an oval window.
In rare instances on a dorsum of a brush meets seven the century of page isolated by S. when separately from each other there pass sinews of a long abductor and a short razgibatel of a thumb of a brush, it is extremely rare — eight the century of page isolated by S. when all sinews, except for extensor tendons of fingers and a razgibatel of an index finger, are located in own synovial vaginas. There are also four S. century of page when sinews of beam razgibatel of a wrist, a long razgibatel of a thumb of a brush, a razgibatel of fingers, a razgibatel of an index finger pass in the general synovial vagina.
On to foot (see) S. century of page are located on a back, medial, lateral and bottom surface. On a dorsum of foot under an upper retinaculum of razgibatel (retinaculum mm. extensorum inferius) are three the isolated synovial sinews of a vagina (fig. 4). The vagina of a sinew of a front tibial muscle is medially located (vagina tendinis m. tibialis anterioris) length apprx. 8 cm, proximal edge to-rogo is 5 cm above a medial anklebone. Lateralny the vagina of a sinew of a long razgibatel of a thumb of foot lies (vagina tendinis m. extensoris hallucis longi), the proximal end to-rogo is located 1,5 — 2 cm above a lateral anklebone, and distal — at the line to a tarsus-plusnevykh of joints. At outer lateral edge of foot there passes the vagina of sinews of a long razgibatel of fingers of foot (vagina tendinum m. extensoris digitorum pedis longi); ero proximal border is at the level of the line of an ankle joint, and distal — at the level of a wedge-shaped and carinate joint.
On a medial surface of foot under a retinaculum of sinews-sgibateley (retinaculum mm. flexorum) are three separate synovial vaginas (fig. 5): synovial vagina of a sinew of a back tibial muscle (vagina synovialis tendinis m. tibialis posterioris) lies directly behind a medial anklebone, several kzada lies a vagina of sinews of a long sgibatel of fingers of foot (vagina tendinum m. flexoris digitorum pedis longi), still kzad — a synovial vagina of a sinew of a long sgibatel of a thumb of foot (vagina synovialis tendinis m. flexoris hallucis longi). Approximately in 20% of cases of S. of century of page of a long sgibatel of a thumb of foot it is reported with a vagina of sinews of a long sgibatel of fingers. S.'s length of century of page of medial group fluctuates within 7 — 9 cm. The proximal ends of vaginas are located about 3 — 5 cm above a medial anklebone, distally S. come to an end with century of page of a back tibial muscle at the place of an attachment of this muscle to a navicular, and two other vaginas — at the level of a medial wedge-shaped bone.
On a lateral surface of foot under an upper retinaculum of sinews of fibular muscles [retinaculum mm. peroneorum (fibularium) superius] passes the general S. century of page e fibular muscles [vagina synovialis mm. peroneorum (fibularium) communis], in Krom a sinew of a short fibular muscle is located knutr from a sinew of a long fibular muscle. In the distal direction the general synovial vagina forks, and under the lower retinaculum of a sinew of fibular muscles take place in separate synovial vaginas (fig. 6). General S.'s length of century of page about 8 cm; its proximal border is 2,5 — 4,5 cm above a lateral anklebone, distal — is slightly higher than a calcaneocuboid joint. The site of a sinew of a long fibular muscle on the bottom party of foot is put into an independent vagina — a bottom vagina of a sinew of a long fibular muscle [vagina tendinis m. peronei (fibularis) longi plantaris], length to-rogo fluctuates within 3,5 cm (fig. 7). It begins in a furrow of a fibular muscle of a cubical bone and comes to an end at the place of an attachment of a long fibular muscle to a medial wedge-shaped bone.
On a bottom surface of foot, in addition to a bottom vagina of a sinew of a long fibular muscle and other vaginas of sinews passing here, five independent S. are located with century of page of sgibatel of fingers of foot (vaginae synoviales tendinum digitorum pedis). They are located throughout phalanxes of fingers (fig. 7). The longest of them — S. century of page of a long sgibatel of a thumb. Mesenteries in S. for century of page of fingers differ in complex structure and connect sinews of sgibatel of fingers to proximal phalanxes.
At S.'s injury of century of page can occur the isolated hemorrhage in S.'s cavity of century the page which is shown the swelling on its course arising directly after damage. Results of a puncture confirm the diagnosis. Treatment includes absolute rest of the injured extremity, hard bandaging with the subsequent massage, further thermal procedures. As a result of anguishes or stretchings (is more often than repeated) the opening in fibrous part C. of century of page and gryzhevidny protrusion of its synovial part can be formed (see. Ganglion ).
Inflammatory diseases of S. of century of page happen infectious and aseptic, nonspecific and specific, acute and chronic (see. Tendovaginitis ).
From tumors of synovial vaginas of sinews meet high-quality and malignant synoviomas (see).
Bibliography: V. P's sparrows. Anthropotomy, t. 1, M., 1932; r and about-ryan A. V., of an awn shche in V. K. and Kostikov B. A. Purulent diseases of a brush, M., 1978; Kazantsev A. I. Synovial vaginas and ways of spread of an infection on foot, Anniversary Saturday., it is devoted. V. M. Mysh, page 353, Novosibirsk, 1947; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 2, book 1, page 364, M., 1960; Pavlova V. N. Synovial environment of joints, M., 1980; Sinelnikov R. D. Atlas of anthropotomy, t. 1, M., 1978.
V. I. Kozlov; N. I. Minin (patol.).