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Examination of Pediatric Hand and Wrist
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Mohsina Subair, Satyaswarup Tripathy, Ranjit Kumar Sahu
Dorsal interossei: Keep the hand palm up on the table and try to push the index and ring finger toward the middle finger and instruct the patient to resist the action. For the middle finger, test against resistance when the patient tries to move it to either side.
Industrial and environmental agents
Published in James W. Albers, Stanley Berent, Neurobehavioral Toxicology: Neurological and Neuropsychological Perspectives, 2005
James W. Albers, Stanley Berent
Case presentation (Kajiyama et al., 1993)1A 25-year-old man worked for 2 years at a vinyl chloride resin factory where he was exposed to lead stearate, a stabilizer of resin. Neurological examination revealed atrophy of small hand muscles, especially in the left dorsal interossei (his dominant hand). Sensation was intact, and there was no evidence of a generalized neuropathy.Electrodiagnosis. Nerve conduction studies showed evidence of partial conduction block at the elbow, indicating possible compressive mono-neuropathy related to cubital tunnel syndrome. Within months following chelation therapy, there was progressive recovery of ulnar motor evoked amplitude, conduction velocity, and diminution of the conduction block at elbow.
A Natural History of Silent Brain Syndrome over 36 Years: A case report
Published in Orbit, 2021
Nathan Pirakitikulr, David T. Tse
Given the prior medical history and unusual constellation of clinical findings, the patient was referred to neurosurgery and endocrinology for evaluation. The consulting neurosurgeon found no indication of shunt failure or over-drainage based on clinical exam and therefore did not recommend shunt revision or removal. A review of the patient’s neurosurgical records revealed that 1 year after shunt placement the patient had undergone a pneumoencephalogram to determine shunt patency and identify any obstructions in the ventricular system. No abnormalities were noted in this report. An endocrinological evaluation, which included an assessment of adrenocortical, thyroid and insulin function, was normal except for a low leptin hormone level (0.6 ng/mL, reference: 1.2–9.5 ng/mL BMI-adjusted). On physical exam, he was noted to have significant loss of subcutaneous adipose tissue on the face and neck, temporalis fossa, and moderately diminished fat on the chest, abdomen and extremities. Atrophy of the dorsal interossei of the hand was a prominent feature (Figure 2a). The consulting endocrinologist described the patient’s appearance as “gaunt” owing to the sunken cheeks and hollowed temples, in addition to the enophthalmos. The patient was started on pioglitazone, a diabetes drug aimed to promote subcutaneous fat deposition by restoring the body’s proper response to insulin. The treatment had no beneficial effect and was discontinued. No further systemic workups or treatments were recommended.
A case of unilateral shoulder joint hydrarthrosis with wild-type amyloidogenic transthyretin amyloidosis
Published in Modern Rheumatology Case Reports, 2020
Toshiaki Tsukada, Masamitsu Tanaka, Yoichi Miyazaki, Yoshihiro Nishiura, Taro Yamashita, Masao Kishikawa
This is the case of an 82-year-old Japanese female with hydrarthrosis and arthritis of the right shoulder joint. Seven years ago, she was admitted to the neurological department at Isahaya General Hospital complaining of gait disturbance and numbness of the extremities. She has no family members with a history of neurological disease. She had normal serum creatine kinase, haemoglobin A1c, anti-nucleolar antibody, myeloperoxidase anti-neutrophil cytoplasmic antibody and proteinase-3 anti-neutrophil cytoplasmic antibody. In screening for malignancy with computed tomographic scanning (CT) and tumour markers, no malignancy was observed. Neurological examination showed distal dominant weakness and sensory disturbance in the extremities. All deep tendon reflexes were absent. She had no foot deformity. Nerve conduction study (NCS) showed absent sensory nerve action potentials, low compound muscle action potentials (CMAPs), prolongation of distal latency, and reduction of motor conduction velocity (Table 1). Needle electromyography of the left first dorsal interossei of the hand demonstrated acute denervation and reinnervation. With these results, she was diagnosed with demyelinating polyneuropathy with axonal damage. She did not want further examination, therefore, the aetiology of the polyneuropathy remained unknown. After discontinuing follow-ups at the Department of Neurology at Isahaya General Hospital, she lived alone and stayed indoors, moving around by crawling on the floor using mainly her right upper extremity, as she is right handed.