Notes by dr Claudio Italiano
cfr diagnosi delle lesioni della mano
The wounds or the contusions of the three nerves that innervate the hand are
located more frequently at the forearm or wrist, sometimes the arm. These
traumas can also be treated by surgery:
- operative isolation of the radial nerve which causes transitory paresis
(incomplete paralysis);
- arm compression poorly arranged during an operation
-The falling hand is the obvious sign. The patient with radial nerve injury
presents the impossibility of straightening the hand or extending the fingers.
This is due to the fact that the posterior branch of the radial nerve innervates
the extensors of the hand and fingers, which are the muscles that determine the
extension of the hand and fingers. If there is an injury, there is no function.
-The last two fingers of the hand remain slightly bent, so they are bent like a
kind of claw; the flexion can be reduced. At an extreme stage the hand takes on
the appearance of the Gothic "blessing Christ", for which this condition is
referred to as the "blessing hand".
This characteristic deformation indicates the paralysis of the small intrinsic
muscles of the hand; the lesion hinders the grip. The patient is unable to open
and to bring his fingers closer together. This is more evident in correspondence
with the III interdigital space since the extensors of the II and V are capable
of impressing small lateral movements on the corresponding fingers. So only if
you ask the patient to tighten or leave a sheet of paper between the third and
fourth fingers, he does not have the strength to do so. This is the sign of the
sheet of paper. Trophic disorders are not very evident, despite the hypomyotropy
of interosseous spaces.
Finally there is the superficial anesthesia of the inner half of the hand
- In this case the hand has no characteristic attitude; however, some signs
indicate nerve involvement.
Insensitivity affects the outer part of the palm and the front face of the first
three fingers, together with the middle
The impossibility of flexing the thumb and the last two phalanges of the index
and of the middle indicates the paralysis of the flexors; that of the muscles of
the tenar eminence causes the loss of the opposition of the thumb so that the
grip is abolished.
It is due to nerve involvement of central and medullary origin; it is found in many affections. The characteristic aspect to remember is the "monkey hand", which dominates the atrophy of the two eminences tenar and ipotenar. A condition of this type was present in the past in patients suffering from flaccid polio outcomes