The thenar and hypothenar types of neural atrophy of the hand / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1911
Catalogue details

Licence: In copyright

Credit: The thenar and hypothenar types of neural atrophy of the hand / by J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Electrical Reactions. Strong faradic and galvanic currents passed through the median nerve fail to elicit any response in the atrophic muscles of the right thenar eminence. A strong faradic current applied directly to the thenar eminence produces a sluggish response, which apparently originated in the opponens pollicis. The direct galvanic current elicits a slow vermicular response in the thenar region, in which the A C C is > K C C. The electrical response, both direct and indirect, of the other intrinsic muscles of the hand, as well as those of the forearm, are practically normal. Comment. This case is interesting from a diagnostic point of view. The atrophy is well defined in the thenar region, and at the first glance appears limited to the distribution of the thenar branch of the median nerve (Fig. 8). The completeness of the reactions of degeneration, which are confined to the muscles of the thenar region, are also very suggestive of a neural origin. A more careful scrutiny of the case, however, shows a slight general wasting of the hypothenar, interossei, and along the ulnar side of the forearm, with fibrillations, exaggerated arm reflexes, both tendon and periosteal; so that the muscular atrophy must be interpreted as of spinal origin, an early stage of the Aran- Duchenne type. It is, of pourse, not impossible that the two conditions, neural and spinal, may be present in combination, as certain occupations requiring excessive use of the hands are recognized etiological factors in both groups of cases. It is certainly singular that atrophy and reactions of degeneration should be so circumscribed to the distribution of the thenar branch in a case of progressive muscular atrophy. Concluding Remarks. In addition to the atrophic paralyses of the intrinsic muscles of the hand, of myelopathic and of myopathic origin, I believe that a neural type should also be recognized. Those of neural origin may be separated into two well-defined clinical types, both due to a compression lesion of a motor branch of a mixed nerve. These may be appropriately designated as follows: A hypothenar type, which term indicates the site of the compres- sion at the base of the hypothenar eminence and its relationship to the ulnar nerve. A thenar type, which also indicates the site of the compression at the base of the thenar eminence, and the relationship to the median nerve.