Excellencies - Hand Surgery


Proprioception or kinesthesia is the ability to perceive and recognize the position of one’s body and each portion of it in space as well as the level of contraction of one’s muscle groups, regardless of visual support. It is equivalent to a “sixth sense” because it is activated by the stimulation of specific receptors, called proprioceptors or kinaesthetic receptors, widely located in the body, which send impulses in particular brain districts for the “inner” visualization of their body in space. Proprioception assumes a fundamental importance in the complex mechanism of movement control; from this we can guess its use in the field of physiotherapy for the recovery of certain motor schemes.
The proprioceptive receptors (neuromuscular spindles, Golgi’s tendon organs, Pacini and Ruffini’s corpuscles) are well represented along the whole upper limb and their activation allows to carry out physiologically the various manual and working activities of daily life.

It is clear how, following a severe hand trauma or repeated microtrauma related to work or sport, as well as after a wrist surgery, can be altered the geometry of the joints and consequently the anatomical relationships of different muscle groups, resulting in a dysfunction of this receptor complex. The alteration of proprioceptive mechanisms leads to a defect of “reading” of the space that surrounds us by the receptors, leading to the appearance of mechanisms of pathological compensation and a hijacking of the axis of movement of an articulation with overload of some of its portions, resulting in algic symptoms and long degenerative phenomena.

The restoration of neuromuscular control is an important element in the rehabilitation of pathologies affecting the wrist; the task of the wrist surgeon and the experienced physiotherapist is to identify and correct these dysfunctional compensation mechanisms, restoring a correct pattern of movement and thus solving the chronic painful problem that afflicts the patient.