By asking patients to lift the head back (extension), touch chin to chest (flexion), chin to each shoulder
(rotation), and finally touch each ear to the corresponding shoulder, but without raising the shoulder (lateral bending).
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How do you evaluate its ROM?
By asking patients to lift the head back (extension), touch chin to chest (flexion), chin to each shoulder (rotation), and finally touch each ear to the corresponding shoulder, but without raising the shoulder (lateral bending).
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How do you assess the cervical spine?
By inspecting for deformities and abnormal posture. Also by palpating for tenderness over the spinous processes, trapezius, scaleni, and sternomastoids.
Can the fingers provide a clue to a patient’s sexual orientation?
Maybe. In a recent Nature study, researchers from Berkeley suggested that the length of the index and ring fingers might indeed statistically predict sexual orientation. According to their theory, womb exposure to high levels of androgens would shorten the index fingers of males, causing them to become a little smaller than the ring fingers. Women would have instead indices that are either longer or, at least, equal to their ring fingers. Researchers carried out their study by going to street fairs in San Francisco and persuading more than 700 fairgoers to have copies of their hands made on portable photocopying machines. They also inquired about family histories and sexual orientations. By doing so, they discovered that gay men have indices even shorter than those of straight men. And, more interestingly, that gay men also have a much greater number of older brothers. And so their theory speculates that womb exposure to even higher levels of androgens (as in cases of many preceding male siblings) would paradoxically induce a gay sexual orientation. This hypermasculinization would be the reason why, according to the same researchers, gay men often have longer genitalia and subtle differences in brain structure. It would also explain the finger pattern of gay women, which is very similar to that of straight men (i.e., indices shorter than ring fingers), similarly related to high womb exposure to androgens. What is really interesting, though, is that the role of the middle finger hasn’t yet been clarified. Maybe in a future study. On a partially related note, Romans-of-old also believed in connections between fertility and fingers—especially the fourth finger of the left hand, which they thought linked to the heart through a unique nerve. That is why they used to “chain” it at time of marriage by putting a ring around it, as a sign of enslavement of both heart and passions. And inside that ring they engraved the words: “Ubi Tu Gaia, Ego Gaius; Ubi Ego Gaius, Tu Gaia” (When you are happy, I am happy; and when I am happy, you are happy”). In other words, reciprocal tolerance is key to a successful marriage—good advice for all times. What is a paronychia? A felon?
A paronychia is an infection at the nail margin, accompanied by swelling, erythema, and tenderness of the skin surrounding the nail. As it progresses, the infection points to the finger edge. A felon is instead a close-space infection of the fingertip pulp, usually due to staphylococci and gram-negative organisms. This may start as cellulitis, but eventually evolves into an abscess, with throbbing pain, swelling, and erythema of the finger pad. Although often triggered by wooden splinters or minor cuts (such as lancing for diabetic monitoring), felons have no history of injury in more than one half of the cases. They may represent a paronychial spread. What is a stiff hand syndrome?
It is thickening of the hands’ skin, which becomes waxy and tightened. Also called diabetic hand syndrome (or diabetic cheiroarthropathy, from the Greek kheir, hand), this eventually causes limitation of finger movement, with varying degrees of fixed flexion of the PIP joints. As a result, patients become unable to fully extend fingers or press their palms flat together (prayer sign). It is exclusively seen in protracted type 1 or type 2 diabetes, often paralleling microvascular injury. Describe the Bunnell-Littler test
It is a test for patients with difficulty flexing the PIP joint, since it can differentiate interosseous tightness from capsular contraction. To carry it out, ask patients to hold the MCP joint in a few degrees of extension, and then flex their PIP joint. If unable to do so, have them place the MCP in flexion, and then reattempt PIP flexion. Those with capsular contraction will not flex the PIP at all, whereas those with interosseous tightness will flex it by using the second maneuver What is a telescoped digit?
A finger that on exam can be moved in and out like a telescope. A telescoped digit (usually the PIP) reflects extreme joint destruction. What is a sausage digit?
It is the inflammation of a whole digit, giving it a diffusely swollen appearance. A sausage-shaped swelling of a toe or finger (i.e., dactylitis, from the Greek daktulos, finger) can be quite painful. When unassociated with trauma, it is usually caused by tenosynovitis, and often periostitis as well as arthritis. It is frequently seen in seronegative arthritis, typically psoriatic, but also sarcoid–related. In psoriasis, it is often associated with pitting of the fingernails What is the presentation of CMC squaring?
The hallmark is pain, first on activity and then even at rest. It is localized at the base of the thumb and usually moderate in intensity, even though at times it may be incapacitating. Tenderness on palpation, crepitus on rotation, and joint limitations in fine motor skills also are typical. Grasp and proximal thumb-index pinching may be limited, and so are activities of daily living that rely on these movements, like using scissors, opening jars, or operating a can opener. |