scholarly journals A 38-year-old man presenting with a >1-month history of increased sensitivity to touch in the right index finger, thumb and middle finger with a positive Tinel’s sign over the median nerve

2021 ◽  
Author(s):  
Georgiana Zamfir ◽  
Halimah Chattun ◽  
Zaina Alam ◽  
Jan Coebergh ◽  
Asif Saifuddin
Keyword(s):  
Median Nerve ◽  
Index Finger ◽  
Middle Finger ◽  
History Of ◽  
Increased Sensitivity ◽  
The Right

scholarly journals P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Natalia Cernovschi - Feasey ◽  
Julekha Wajed
Keyword(s):  
Pleural Effusion ◽  
Soft Tissue ◽  
Middle Finger ◽  
Joint Involvement ◽  
Long Bones ◽  
History Of ◽  
Systemic Symptoms ◽  
The Right ◽  
Hands And Feet ◽  
Radiographic Changes

Abstract Background/Aims  Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods  A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results  Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion  Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure  N. Cernovschi - Feasey: None. J. Wajed: None.

Functional magnetic resonance imaging of somatosensory cortex activity produced by electrical stimulation of the median nerve or tactile stimulation of the index finger

2000 ◽  
Vol 93 (5) ◽  
pp. 774-783 ◽  
Author(s):  
Maxwell Boakye ◽  
Sean C. Huckins ◽  
Nikolaus M. Szeverenyi ◽  
Bobby I. Taskey ◽  
Charles J. Hodge
Keyword(s):  
Electrical Stimulation ◽  
Median Nerve ◽  
Somatosensory Cortex ◽  
Tactile Stimulation ◽  
Index Finger ◽  
Functional Magnetic Resonance ◽  
Content Type ◽  
The Right ◽  
Fine Print ◽  
Stimulation Of

Object. Functional magnetic resonance (fMR) imaging was used to determine patterns of cerebral blood flow changes in the somatosensory cortex that result from median nerve stimulation (MNS).Methods. Ten healthy volunteers underwent stimulation of the right median nerve at frequencies of 5.1 Hz (five volunteers) and 50 Hz (five volunteers). The left median nerve was stimulated at frequencies of 5.1 Hz (two volunteers) and 50 Hz (five volunteers). Tactile stimulation (with a soft brush) of the right index finger was also applied (three volunteers). Functional MR imaging data were transformed into Talairach space coordinates and averaged by group. Results showed significant activation (p < 0.001) in the following regions: primary sensorimotor cortex (SMI), secondary somatosensory cortex (SII), parietal operculum, insula, frontal cortex, supplementary motor area, and posterior parietal cortices (Brodmann's Areas 7 and 40). Further analysis revealed no statistically significant difference (p > 0.05) between volumes of cortical activation in the SMI or SII resulting from electrical stimuli at 5.1 Hz and 50 Hz. There existed no significant differences (p > 0.05) in cortical activity in either the SMI or SII resulting from either left- or right-sided MNS. With the exception of the frontal cortex, areas of cortical activity in response to tactile stimulation were anatomically identical to those regions activated by electrical stimulation. In the SMI and SII, activation resulting from tactile stimulation was not significantly different (p > 0.05) from that resulting from electrical stimulation.Conclusions. Electrical stimulation of the median nerve is a reproducible and effective means of activating multiple somatosensory cortical areas, and fMR imaging can be used to investigate the complex network that exists between these areas.

scholarly journals Event-related synchronization/desynchronization in terms of manual motor program switching in men

Biologija ◽  
2018 ◽  
Vol 63 (4) ◽  
Author(s):  
Olha Korzhyk ◽  
Olha Pavlovych ◽  
Lyudmyla Shvarts ◽  
Tetyana Shevchuk ◽  
Olena Dmytrotsa ◽  
...  
Keyword(s):  
Index Finger ◽  
Spectral Power ◽  
International System ◽  
Motor Program ◽  
Middle Finger ◽  
Parietal Lobes ◽  
Low Tone ◽  
The Right ◽  
Change Response ◽  
Manual Movement

The scientific community is paying increasing attention to the characteristics of brain processes providing switch of manual motor programs. Thirty-two right-handed men aged 18–23 years participated in the experiment. The EEG registration was performed according to the international system 10/20, with closed eyes during manual reactions in the Go-Stop-Change paradigm. In the case of a low tone (70%), men had to press the left button of the console (go-response) with the right index finger. A high tone (30%) required rapid pressing of the right button (stop-change-response) with the middle finger. Event-related desynchronization and synchronization of the spectral power of the EEG frequency (6 Hz to 23 Hz) were estimated in the Matlab environment. Significant ERS response is established at the frequency of 6 Hz in symmetrical frontal, central and parietal parts, at 9 Hz – in the left parietal area, at 14–15 Hz – in frontal, central, and parietal areas of the right cortex, and at the frequency of 22 Hz – in the right frontal lobe. However, EEG desynchronization is recorded at the frequency of 7–8 Hz in the frontal and central areas of both hemispheres. The most sensitive to the manual movement stop followed by switching to an alternative event is associated with synchronization of electrical cortical activity, which showed higher values of the spectral power at the frequency of 6 Hz and 14–15 Hz in frontal and central allocations, and was lower at the frequency of 16–17 Hz in both parietal lobes than that during the Go-response.

scholarly journals Acute blue finger syndrome: a rare benign cause of acute digit discolouration

2019 ◽  
Vol 12 (1) ◽  
pp. e223365
Author(s):  
Kiran Dhaliwal ◽  
Colin Thomas Brewster ◽  
Sivarajasingham Pakeerathan
Keyword(s):  
Rapid Assessment ◽  
Middle Finger ◽  
X Rays ◽  
Benign Condition ◽  
Volar Aspect ◽  
History Of ◽  
The Right ◽  
Digital Ischaemia ◽  
First Time

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.

Intraneural Synovial Sarcoma of the Median Nerve in a 15-Year-Old Male: A Case Report and Review of Literature

Hand ◽  
2021 ◽  
pp. 155894472097513
Author(s):  
Arthur Samia ◽  
Joshua Scarcella ◽  
Richard Zeri ◽  
Yifan Guo
Keyword(s):  
Median Nerve ◽  
Synovial Sarcoma ◽  
Thenar Eminence ◽  
Right Hand ◽  
History Of ◽  
Synovial Sarcomas ◽  
Poorly Differentiated ◽  
Web Space ◽  
The Right

There have been 8 synovial sarcomas of the median nerve reported. We report a case of a 15-year-old male with synovial sarcoma of the right-hand median nerve. Patient presented with a 2-month history of enlarging mass at the base of the right thenar eminence associated with numbness in the median nerve distribution. Physical examination revealed a soft mass over the thenar eminence and paresthesia in the median nerve distribution. He underwent excision of the tumor, which revealed a well-encapsulated lesion encompassing the median nerve, involving the first, second, and radial aspect of the third web space as well as recurrent branches of the median nerve. Following excision of the tumor, a thorough metastatic workup was negative for metastatic disease. He was staged as III, T2b, N0, M0—poorly differentiated monophasic synovial sarcoma of the right median nerve. Postoperatively the patient was started on chemotherapy and radiation. Intraneural synovial sarcoma is extremely rare. Our case is the youngest with the longest follow-up. He is currently at a status of 3 years posttreatment with no signs of recurrence and excellent use of his right hand. This case is of particular interest due to the rarity of the disease along with this being the best outcome reported in the literature to-date.

Choice Reaction Times for Structural Relationships between Possible Response Sequences

1993 ◽  
Vol 77 (3_suppl) ◽  
pp. 1203-1212 ◽  
Author(s):  
Kazunori Shidoji
Keyword(s):  
Index Finger ◽  
Ring Finger ◽  
Reaction Times ◽  
Middle Finger ◽  
Left Hand ◽  
Right Hand ◽  
Structural Relationships ◽  
Middle Ring ◽  
The Right ◽  
Choice Reaction Times

To investigate human motor programming, choice reaction times were measured on tasks for which subjects made choices between two alternative finger-tapping-movement sequences. The total-number-of-responses and the hierarchical editor models were tested. In Exp. 1 the choice was carried on the situations with the same total numbers of possible responses and different structural relations between alternative sequences. The right-hand reaction times in mirror choice (e.g., subject chose between the middle, index, and ring finger sequences of the left or right hand) were shorter than those in nonmirror choice (e.g., subject chose between the middle, index, and ring finger sequence on one hand and the middle, ring, and index finger sequence on the other hand); the total-number-of-responses model was not supported. In Exp. 2 two conditions had the same operation numbers of the hierarchical editor model. In Condition 1 subjects chose between the index finger of the right hand and the ring, index, and middle finger sequence of the left hand. In Condition 2 subjects chose between the index, ring, and middle finger sequences of the left or right hand. The reaction time in the former condition was shorter than that in the latter condition. Exp. 2 exhibited a counterexample of the hierarchical editor model that had been fairly robust in previous studies.

scholarly journals Primary Side Sclerosis, Case Report and Bibliographic Review

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Motor Neuron ◽  
Rare Disease ◽  
Clinical History ◽  
Middle Finger ◽  
Motor Neuron Diseases ◽  
Left Limb ◽  
History Of ◽  
Low Incidence ◽  
The Right ◽  
And Function

Introduction: Primary lateral sclerosis is a rare disease that involves the upper motor neuron, producing a bulbospinal spasticity. The course of the disease is insidious and progressive, usually beginning with the lower extremities, and subsequently becoming a tetrapyramidal syndrome. Being a rare disease, the diagnosis in most cases is exclusion, having to study the patient extensively, in a clinical manner, including a thorough clinical history, laboratory and with relevant cabinet studies. Clinical Case: This is a male patient who started his clinical picture about a year ago with weakness in the left pelvic limb, later accompanied by pain and paraesthesia, manifesting the same symptoms later in the contralateral leg and upper left limb. Currently, hypoesthesia of the index and middle toes of the right foot is added, moderate tremor in the left arm, with overlapping of the middle finger over the ring of said hand. He has an inability to lift light objects for short periods of time, as well as fatigue in short periods of time when performing daily activities, which greatly limits his daily life. Conclusions: Motor neuron diseases are divided into two groups, and in the case studied, the upper motor neuron is exclusively affected. Being a rare disease, with a low incidence, multiple differential diagnoses will be considered before concluding this, considering a diagnosis of exclusion. The natural history of the disease will always have a bleak outcome, with a poor prognosis for life and function, despite the measures taken to modify its course.

scholarly journals Extra-Articular Tenosynovial Chondromatosis of the Finger: A Case Series Study of Three Cases, One Including Excessive Osseous Invasion

2017 ◽  
Vol 11 (1) ◽  
pp. 417-423 ◽  
Author(s):  
Akio Sakamoto ◽  
Takahiko Naka ◽  
Eisuke Shiba ◽  
Masanori Hisaoka ◽  
Shuichi Matsuda
Keyword(s):  
Index Finger ◽  
Case Series ◽  
Ring Finger ◽  
Middle Finger ◽  
Synovial Chondromatosis ◽  
Fatty Tissue ◽  
Complex Anatomy ◽  
Case Series Study ◽  
History Of ◽  
Tenosynovial Chondromatosis

Background: Synovial chondromatosis is characterized by cartilaginous metaplasia in synovial tissues. Extra-articular tenosynovial chondromatosis is considered to be an anatomical counterpart of articular synovial chondromatosis. Extra-articular tenosynovial chondromatosis occurs preferentially in the hand, although its frequency is low. Results: We report three cases of extra-articular tenosynovial chondromatosis. A 65-year-old female presented with a history of symptoms over 40 years related to the dorsum of her index finger (Case 1), A 46-year-old female presented with a 6-month history of symptoms at the volar surface of her middle finger (Case 2), and a 66-year-old male presented with a 3-month history of symptoms in a dorsal ring finger. Case 2 had evidence of ossification, which could be classified as osteochondromatosis. Interestingly, the index finger lesions (Case 1) were accompanied by excessive bone involvement. The signal intensity of T2-weighted magnetic resonance imaging varies from low to high, possibly reflecting histological variations, such as ossification and fatty tissue changes. All lesions were resected without complications. Conclusion: Variations in anatomical sites suggest that overuse or mechanical overloading was not causative. Extensive involvement of the nearby tendon and joint capsule, as well as the bone, would require attention during the resection. Preoperative analysis of images is important, not only for the diagnosis, but also to assess the extent of the lesion, particularly given the complex anatomy of the finger.

scholarly journals Estimation of Tactile Discriminatory Fitness in Hands of Public Transport Drivers

2020 ◽  
Vol 16 (1) ◽  
pp. 1-5
Author(s):  
Ojashwi Nepal ◽  
Samjhana Thapa ◽  
Roshan Kasti ◽  
Reena Kumari Jha ◽  
Mrigendra Amatya
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Public Transport ◽  
Middle Finger ◽  
Left Hand ◽  
Palmar Surface ◽  
Significant Difference ◽  
The Mean ◽  
The Right ◽  
Two Populations

Background: Public transport drivers are constantly being exposed to stimuli and are at risk of disorder of peripheral nervous system which can be further complicated by comorbidities. Thus, we wanted to examine intactness of tactile discriminatory ability in healthy drivers by comparing it to healthy samples of non-driving population. Since two point discrimination (TPD) test is frequently used for neurological assessment of tactile stimulation we determined and compared various locations in hands of two populations. Methods: Participants were asked to answer whether they feel one point or two points touch by blunted end of simple compass divider in their hand. The minimum distance between the points at which the participants could answer correctly was noted as two point discrimination value. Results: Drivers had TPD range of 2-4mm with mean 2.53±0.62 and, 1-4mm with mean 2.6±0.72 at middle finger of right and left hand respectively. Following t-test between drivers versus students, significant difference in the mean TPD value in the proximal palm supplied by median nerve (p=0.016) and proximal palm corresponding to ulnar nerve (p=0.032) on the right hand was found. On the left hand, significant difference in the mean TPD value is found in the proximal palm corresponding to median nerve (p=0.008) and ulnar nerve (p=0.043) respectively.   Conclusion: Healthy public transport drivers have less tactile discriminating prowess at proximal palmar surface of hand. Examined distal phalanges and distal palm showed no significant difference in mean of TPD values for healthy drivers versus students.

Sign in / Sign up

Export Citation Format

Share Document