Hand spike

“ The consequences are paralysis of the elbow extensors, the supinator longus, the supinator brevis, and the whole of the extensors of the wrist, thumb, and fingers; and loss of sensation over the cutaneous areas supplied by the nerve in the arm, forearm, and hand. For the patient the most striking symptoms are the flexion of the wrist and fingers, the loss of power to abduct the thumb, and especially the [75] enfeeblement of grasp due to the inability to fix the wrist during the action of the finger flexors. ”

“ There is considerable effusion of blood, the skin is tense, and the muscles, vessels, and nerves are compressed; this is further increased if the elbow is flexed and splints and tight bandages are applied. The muscles acquire a board-like hardness and no longer contract under the will, and passive motion is painful and restricted. Slight contracture of the fingers is usually the first sign of the malady; in time the muscles undergo further contraction, and this brings about a claw-like deformity of the hand. The affected muscles usually show the reaction of degeneration. ”

“ Pain in right wrist, striking to each finger. Beating in the arm and right wrist. Nervous pain from the right elbow to the ring- and little fingers. Cracking in right forearm. 315. Numbness of the right arm, all the muscles hurt him. Trembling of the right arm. Weight at the arms. Lancinating pain in the muscles of the upper arm, and in the trapezoid muscle. Sense of weariness in the arm, though lying down. 320. Pain in whole right hand. Burning at the whole hand. Contusive pain at the back of the right hand. The ball of the thumb of each hand is painful. ”

“ A nineteen-year-old girl and a man in the forties, who had each but one normal hand, the other, instead of fingers, having only little prominences of skin without bones or muscles, thought they bent their absent fingers when they bent the deformed stump. Tickling these eminences, or binding a string about the fore-arm, caused the same sensations as in amputated persons, and a pressure on the ulnar nerve made the outer fingers tingle. ”

“ The articular structures [7] show no trace of disease, the tendons are normal, the finger retains all its strength within the progressively narrowing range of motion left to it by the disease, and the utility of the hand may for a long while be little impaired. Sooner or later other fingers may become involved, and the affection may appear in the opposite hand, to follow a like course. The process of contraction is slow in progress, perhaps extending over ten or twenty years; it is painless, and is uncomplicated by any signs of active inflammation. ”

“ The condition in the hand suggests a radial paralysis. The patient is unable to flex his fingers, though he probably is able to make some movements with his thumb. Sometimes, on request to move the hand, a series of coarse oscillations follows, somewhat like a tremor. ”

“ Thus when inflammation occurs in the finger, as in a whitlow, the pain is not only constantly severe, but it is increased by every pulsation of the heart, and thus has a throbbing character. By raising the hand nearly to a level with the head both the constant pain and the severity of the throbs may be relieved, as the blood is not sent with such great force into the arteries and returns more readily through the veins. ”

“ When a very nervous child, or one convalescent from chorea, holds out its hands in front on a level with the shoulder, and with its fingers spread out, we commonly see the nervous hand. As the palms are turned down, the wrist droops slightly. The metacarpo-phalangeal joints are moderately extended, the first and second internodes being either flexed or kept straight. The thumb is simply extended backward, and somewhat abducted from the fingers; and a twitching of the fingers is frequently observed. ”

“ When, now, we pass from this light to very heavy work, it will be obvious that to hold a stone in the hollow of the hand, and to strike an object with it so that the reaction of the blow shall be mainly met by the muscular action of the back of the hand, and the thinnest section of the wrist, would be not only fatiguing, but might be injurious to the delicate network of muscles there found, and so damage this part of the hand. ”

“ The pulse, under the forefinger, of the right hand, is gentle and lacks vitality. The right hand pulse, under my second finger, is superficial, and has lost all energy. The deep and agitated beating of the forepulse of the left hand arises from the febrile state, due to the weak action of the heart. ”

“ Clinical Features.—The attitude of the patient is characteristic: the elbow is flexed and is supported by the opposite hand, while the head is inclined towards the affected shoulder to relax the muscles of the neck. Crepitus is elicited on bracing back the shoulders, or on attempting to raise the arm beyond the horizontal, and these movements cause pain. Tenderness is elicited on making pressure over the seat of fracture, and also on distal pressure. ”

“ The attitude is one of slight flexion with drooping of the hand and fingers. The fingers become stiff as a result of adhesions in the tendon sheaths, and the power of opposing the thumb and fingers may be lost. Pain is usually absent until the articular surfaces become carious. Softening of the ligaments may permit of lateral mobility, and sometimes partial dislocation occurs. Abscess may be followed by sinuses and infection of the tendon sheaths, especially those in the palm. ”

“ Stimulating an incident or excitor nerve of the extremities, by tickling or pricking the sole of the foot or the palm of the hand after sensation is apparently destroyed, causes a special muscular contraction or motion in the limb, if the excito-motor system be uninjured. Irritating the eyelashes induces contraction of the eyelids; and the irritation of one will sometimes cause contraction of both. ”

“ Beating in the nape of neck, like the ticking of a clock. Throbbing of the external carotid. When raising the hand to the right side of the neck, a penetrating pain in feet, spreading to the ear. The neck remains twisted when turned.
Upper Extremities: Painful drawing at the inner side of the arm. 215. Itching under the axilla, with tetter. The arm and hand are swollen, blueish, covered with red spots, also the right leg and foot. Bruising pain in the deltoid muscle. Painful drawing from axilla to wrist, at inner side. Crampy constriction at the bend of the elbow. ”

“ The _lower-arm type_ of paralysis, associated with the name of Klumpke, is usually due to over-stretching of the plexus, and especially affects the anterior branch of the first dorsal nerve. In typical cases all the intrinsic muscles of the hand are affected, and the hand assumes the claw shape. ”

“ The right hand was found markedly congested and 1.5 cm. larger in circumference. The fingers and hand were especially weak. There was a marked tremor of the arm. Electric excitability normal. The sensory disorder was in glove form. Hypesthesia to touch reached the elbow, analgesia to a point three fingers’ breadth below the elbow, and anesthesia to cold to a point two fingers’ breadth still lower, a sort of stepwise dissociation of sensibility resembling what is found in spinal lesions. The case was presented as one of local traumatic hysteria. ”

“ The numbness then spread to the legs, especially to the left leg. There was continual tingling in terminal joints of fingers of left hand; hypalgesia over both forearms and hands, especially on left side; total analgesia over left dorsum.
Two days later, the patient could feel articles and reported that the numbness occurred only in the early morning and was followed by a tingling as the numbness passed off. On the same day, the hands and forearms showed a total loss of sensibility to pain, except for a small area on the flexor surface below the elbow joint. ”

“ When the hands are unconfined we notice nothing, but if we squeeze them into gloves, or our feet into tight shoes, we feel something beating in fingers and toes. This is the blood gushing in, and as the skin cannot yield as in ordinary conditions, the extremely delicate nerve-filaments which branch into it are pressed at every pulsation. If our finger swells from a whitlow, an inflammation, a knock or a burn, immediately the [65] physiological pulsations, unnoticed before, become continuous, causing an acute, stinging pain. ”

“ Other diseases of the wrist are comparatively rare. They include pyogenic affections, such as those resulting from infective conditions in the palm of the hand, different types of gonorrhœal, rheumatic, and gouty affections, and arthritis deformans. An interesting feature, sometimes met with in arthritis deformans, consists in eburnation of the articular surfaces of the carpal bones, although the range of movement is almost nil. ”

“ This agitation, which it is often difficult to perceive, sometimes becomes very evident upon mere inspection. When the elbow is rested upon the table, and a body of considerable length held in the hand, its extremity is seen to vaccillate, to rise and fall a little at each pulsation. ”

“ The back of the hand is the usual spot to be first affected, then the arms, and in a bad case the legs also, which become puffy at the joints, and before long the wretched victim will be covered with sores and abrasions. ”

“ The heart being grasped in the hand, is felt to become harder during its action. Now this hardness proceeds from tension, precisely as when the forearm is grasped, its tendons are perceived to become tense and resilient when the fingers are moved. ”

“ The arm and hand felt now more than ordinarily heavy, and were evidently much weakened: aching, and feeling extremely wearied after the least exertion. The strength of the arm was not completely recovered at the end of more than twelvemonths; and, after more than twice that time, exertion would excite the feeling of painful weariness, but no palpitation [50] or other unpleasant symptom has occurred during the five or six years which have since passed. ”

“ When such sensations affect a limb, the employment of firm compression by the hand or by a ligature occasionally succeeds in warding off an attack. The aura may be so distinct and of such duration as to enable the patient to lie down, or seek a place of safety before the fit comes on. ”

“ The majority of patients say that, while they are unable to detect these sensations—only extra-susceptible individuals have this faculty,—their pain is disappearing, or has already disappeared. Patients who are most susceptible to pressure or contact will trace heat or cold from an individual hair of the head, or an eyelash, to the margin of the finger-nail or toe-nail, and if a hair or eyelash be quickly pulled out, the sensation of numbness is often quickly registered beneath the finger-nail or toe-nail of the invaded zone. ”

“ Thus, if the nerve at the elbow, over the “crazy bone,” is touched, a tingling is felt in the fingers rather than at the point of pressure. A person who has had an arm or leg amputated will frequently speak of his fingers or toes on that side being cold, or complain of pain in them, because the scar below the point of amputation tightens around the nerves and pinches them.
It is through the nerves that people get in touch with the outer world and that they judge of size, weight, etc. All careful adjustment of the muscles is under the control of the nervous system. ”

“ Lancinations or shootings through the whole body, as if needles were stuck in; followed by itching from the elbow to the hands, with small violet-colored spots on the arm, back and feet, second day. Pain at the outer part of the left arm, with a large, red, inflamed spot like erysipelas. Heat on the surface of the body as from exposure to the sun, the feet being cold. Pain at the vertex, as from a blow, dull pain on the top of the head, left side, worse when turning the head or walking, second day, 11 o’clock in the morning. ”

“ The action of the forefinger pulse, of the right wrist, is faint and lacks strength, as the breathing of the lungs is too weak. The second finger pulse of the right wrist is superficial and devoid of vigour, as the spleen must be affected injuriously by the liver. ”

“ Irregularities of development are most likely to occur in those joints which, for one or other reason, have the least functional activity. In the hand the little finger is much less powerful than its fellows; and in association with this it may often be noticed that the fourth tendon of the flexor sublimis is reduced to a mere thread; in the foot the same thing is observed in the corresponding digit, but in a more marked degree, and it is the degenerate little toe which is most liable to the “hammer deformity.” ”

“ For the skin of the finger is connected by a bundle of fine nervous fibres, which run up the whole length of the arm, with the spinal marrow and brain, and we know that the feeling of pain caused by the prick of a pin is dependent on the integrity of those fibres. After they have been cut through close to the spinal cord, no pain will be felt, whatever injury is done to the finger ”

“ The pain is usually sharp, severe, and located in the limbs, and is worse from moving and pressure. There are tingling feelings in the hands, feet and body, and a feeling as if ants or insects were crawling over them, and there is also increased sensitiveness of the nerve trunks or entire limb. There is loss of muscular power, first marked, perhaps, in the legs, and it extends upwards and reaches the arms. Sometimes it first begins in the arms. In typical cases the extending muscles of the wrist and ankles drop. ”