. Physical diagnosis . Fig. 48.—Spade Hand in Myxoedema. ments of the fingers, quite involuntary and always secondary toorganic cerebral lesions (hemiplegia, infantile cerebral paralysis). 5. Tetany (see Figs. 42, 43, 44, 45 and 46)—a peculiar spasm ofthe hands (oftenof the feet as well), occuring in the course of diseasesof the stomach and intestine in children, in nursing women, after THE HANDS 51 gastric lavage, and after thyroidectomy,1 usually lasting minutes orhours—rarely days. IV. Deformities of the Hands. i. Claw hand results from paralysis of the interossei and lumbri-cales with cont
. Physical diagnosis . Fig. 48.—Spade Hand in Myxoedema. ments of the fingers, quite involuntary and always secondary toorganic cerebral lesions (hemiplegia, infantile cerebral paralysis). 5. Tetany (see Figs. 42, 43, 44, 45 and 46)—a peculiar spasm ofthe hands (oftenof the feet as well), occuring in the course of diseasesof the stomach and intestine in children, in nursing women, after THE HANDS 51 gastric lavage, and after thyroidectomy,1 usually lasting minutes orhours—rarely days. IV. Deformities of the Hands. i. Claw hand results from paralysis of the interossei and lumbri-cales with contractures, and occurs when the median or ulnar nervesare paralyzed, and in progressive muscular atrophy, syringomyelia, andchronic Fig. 49.—a, Acromegalic Hand, b, Normal Hand. 2. Flipper hand (see Fig. 47), a common result of the contrac-tures in late cases of atrophic arthritis. Other deformities of thefingers are common in this disease and in gout (see below, page 472). 3. Hemiplegic hand, a result of the contractures following hemi-plegia from any cause. 4. Myxoedema results in thickening and coarsening of the tissuesof the hand (spade hand) without bony enlargement; but the spadehand is a fairly common type without myxoedema, and one needs to see 1 When the parathyroid glands are accidentally removed. 52 PHYSICAL DIAGNOSIS it rapidly develop in connection with other myxedematous lesionsbefore it can have diagnostic significance. (The same is true of themyxcedematous face.) (See Fig. 48.)
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