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  • Hand/finger ? for SCI Nurse/anybody

    Hi All,

    I've been meaning to ask about this for a while, but have only just got round to it.

    This isn't a problem as such with my hands/fingers, but for some reason my fingers always curl up into a fist shape. It's not a clenched fist, I stil have relative freedom of movement, but I have lost a certain amount of co-ordination/dexterity in both hands over the past few years.

    I have Hereditary Spastic Paraplegia, and all the neuros I've seen have said this is unrelated to that, and haven't shown a great deal of interest in giving me a explanation tbh, they've been more curious than anything. Complicated HSP could maybe account for this, but I'm told I don't have that.

    My present neuro thinks it's likely I have a secondary neuro disorder (due to other symptoms besides this) albeit undiagnsed atm, and I'm just wondering if this finger problem could be indicative of any other neuro disorders.

    Any info/suggestions greatly appreciated.

    Ian

  • #2
    I'll have to ask the doc or nurse to take a look at this Ian.

    I know I sometimes sleep with my fists clenched at night, from stress. I wonder if it's time for some splints at night or .. ?
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

    Comment


    • #3
      Ian,

      As you know, hereditary spastic paraplegia is due to degeneration of the corticospinal tract. It usually causes progressive loss of leg function and most of the time, it is associated with spasticity. While the arm gets corticospial tracts, loss of those tract and should cause extensor rigidity. That is why your doctors have been telling out the the HSP is not causing your hand.

      Did you have some kind of trauma before you noticed the symptoms on your on hand? Is the hand problem bilateral?

      Wise.

      Comment


      • #4
        Originally posted by lynnifer
        I'll have to ask the doc or nurse to take a look at this Ian.

        I know I sometimes sleep with my fists clenched at night, from stress. I wonder if it's time for some splints at night or .. ?
        Hi lynnifer,

        No, it's not stress related, I'm almost sure of that, nor is it bad enough to need splints.

        Originally posted by Wise Young
        Ian,

        As you know, hereditary spastic paraplegia is due to degeneration of the corticospinal tract. It usually causes progressive loss of leg function and most of the time, it is associated with spasticity. While the arm gets corticospial tracts, loss of those tract and should cause extensor rigidity. That is why your doctors have been telling out the the HSP is not causing your hand.

        Did you have some kind of trauma before you noticed the symptoms on your on hand? Is the hand problem bilateral?

        Wise.
        Hi Wise,

        It's my understanding that HSP in it's complicated form, can/does affect the arms, and in my case I do get arm spasms, but they're not as pronounced as those in my legs. This is why I mentioned complicated HSP.

        No, there is no trauma involved, and yes, it is bilateral.

        I can fully open my hands/fingers, but doing so makes my hand/fingers feel tense/stretched, almost like the tendons are short. As soon as I relax them, the fingers on both hand slowly curl up to form a 'loose' fist. Each finger moves by small degrees till a fist shape is formed.

        In retrospect, I first noticed something wasn't quite right about 30 years ago, when I found I didn't have the same dexterity/co-ordination when playing a guitar, but it was something I didn't fell like asking my doc about at the time as it seemed such a trivial thing. I'm assuming the finger curling is somehow related to that.

        Although my hands and fingers are somewhat weaker now, this isn't a problem as such, at least it doesn't really prevent my doing anything, I just need to do things slowly now/take care when handling things. I'm just curious as to why it happens.

        Ian

        Comment


        • #5
          Ian B,

          In that case, you may have the beginning of the "complex" form but, to tell you the truth, I hate these labels. In my experience, the rubrospinal and the corticospinal tracts tend to oppose each other in the arms. The corticospinal tracts may have more of a role in extension while the rubrospinal tract mediates flexion responses. These are just phenomenological observations that I recall from examining patients. Anyway, regardless of the cause, the phenomenon that you describe suggest that something that normally balance the finger flexion is now missing.

          Flexion of the fingers is very common in people with cervical spinal cord injury. That is why many patients require physical therapy and devices that keep their fingers spread out. Because people with higher cervical spinal cord injuries (C5 or higher) don't seem to have these problems and it is mostly in people who have C6/7 injuries, this suggests to me that the flexion muscles for the hands are higher (C8) compared to the extension muscles (T1) of the hands. This may be another explanation. However, since you have no weakness of your hand and you still voluntary control, this doesn't seem to apply to you.

          Wise.





          Originally posted by Ian B
          Hi lynnifer,

          No, it's not stress related, I'm almost sure of that, nor is it bad enough to need splints.

          Hi Wise,

          It's my understanding that HSP in it's complicated form, can/does affect the arms, and in my case I do get arm spasms, but they're not as pronounced as those in my legs. This is why I mentioned complicated HSP.

          No, there is no trauma involved, and yes, it is bilateral.

          I can fully open my hands/fingers, but doing so makes my hand/fingers feel tense/stretched, almost like the tendons are short. As soon as I relax them, the fingers on both hand slowly curl up to form a 'loose' fist. Each finger moves by small degrees till a fist shape is formed.

          In retrospect, I first noticed something wasn't quite right about 30 years ago, when I found I didn't have the same dexterity/co-ordination when playing a guitar, but it was something I didn't fell like asking my doc about at the time as it seemed such a trivial thing. I'm assuming the finger curling is somehow related to that.

          Although my hands and fingers are somewhat weaker now, this isn't a problem as such, at least it doesn't really prevent my doing anything, I just need to do things slowly now/take care when handling things. I'm just curious as to why it happens.

          Ian
          Last edited by Wise Young; 09-07-2007, 05:19 AM. Reason: coorect typos

          Comment


          • #6
            Originally posted by Wise Young
            Ian B,

            In that case, you may have the beginning of the "complex" form but, to tell you the truth, I hate these labels. In my experience, the rubrospinal and the corticospinal tracts tend to oppose each other in the harms. The corticospinal tracts may have more of a role in extension while the rubrospinal tract mediates flexion responses. These are just phenomenological observations that I recall from examining patients. Anyway, regardless of the cause, the phenomenon that you describe suggest that something that normally balance the finger flexion is now missing.

            Flexion of the fingers is very common in people with cervical spinal cord injury. That is why many patients require physical therapy and devices that keep their fingers spread out. Because people with higher cervical spinal cord injuries (C5 or higher) don't seem to have these problems and it is mostly in people who have C6/7 injuries, this suggests to me that the flexion muscles for the hands are higher (C8) compared to the extension muscles (T1) of the hands. This may be another explanation. However, since you have no weakness of your hand and you still voluntary control, this doesn't seem to apply to you.

            Wise.
            Hi Wise,

            I guess that, not for the first time I might add, I'm some sort of medical enigma, as I also have other neurological symptoms that just don't fit HSP, and from what the neuros have told me, they simply can't explain why they are present as nothing has shown up on the various scans/tests I've had done. My present neoro suggests I may have a secondary neorological disorder, which so far, is a mystery to them.

            The 'problem' with my hands and fingers, while a nuisance for me, is just a curiosity to the docs as it doesn't overly affect me at present. I assume the only time they will investigate further is if it gets any worse, but as it's taken so long to get to this stage, I can't see it progressing much more, nor being the start of complex HSP.

            Thanks for your input, even via a message board, you've provided me with more info than all the neuros I've actually seen and spoken to put together.

            Ian

            Comment


            • #7
              Ian

              Are you using a wheelchair a lot... I have the same problem with my fingers.. while I was in the hospital for 4 months it was just my thumbs... doctors say its caused by using the wheelchair alot thru the day.. i now wear splints at night... seems to be helping..

              Comment


              • #8
                Originally posted by bartles99
                Ian

                Are you using a wheelchair a lot... I have the same problem with my fingers.. while I was in the hospital for 4 months it was just my thumbs... doctors say its caused by using the wheelchair alot thru the day.. i now wear splints at night... seems to be helping..
                Hi,

                No, I don't need a wheelchair at all, and if my neuro is correct, nor will I need to in future.

                The 'worst' aspect of this problem with my fingers curling into a fist, is that coupled with my arm spasms, I tend to 'thump/hit' myself in the face, tho' this almost always happens at night when I'm either asleep, or just about to drift off to sleep. During the day when I'm wide awake I have more or less total control, that is I know when a spasm is going to occur and keep my hand away from my face, tho' this isn't 100% successful by any means. It's more embarrasing than anything.

                Ian

                Comment


                • #9
                  Originally posted by Ian B
                  Hi,

                  No, I don't need a wheelchair at all, and if my neuro is correct, nor will I need to in future.

                  The 'worst' aspect of this problem with my fingers curling into a fist, is that coupled with my arm spasms, I tend to 'thump/hit' myself in the face, tho' this almost always happens at night when I'm either asleep, or just about to drift off to sleep. During the day when I'm wide awake I have more or less total control, that is I know when a spasm is going to occur and keep my hand away from my face, tho' this isn't 100% successful by any means. It's more embarrasing than anything.

                  Ian
                  OK, having smacked myself quite a few times with my right contracted hand has your neuro had an MRI of the C5 to T1 areas done? Do you still play guitar? A woman I met in rehab round 2 was rapidly acquiring contractures in both her hands, C6 complete, but her fingers all were turning toward the respective thumbs. Seems she did a lot of sailing and the rope pulling for the sails had tightened and turned her tendons. Obviously with normal muscle strength the fingers would right themselves. The C5 area is the bicep. Even now when I get real sick or very tired and yawn my right arm flexes. That was all the face smacking early on as the 2 heads of the tricept was slowly getting stronger to balance my much stronger bicep. Maybe a bit of stenosis or something in that area?

                  I hear you on embarassing. It so rarely happens that I can't even think of what causes the arm spasm. But I once threw soup in my own face with the spoon I had just filled.
                  Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                  Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                  Comment


                  • #10
                    Originally posted by Sue Pendleton
                    OK, having smacked myself quite a few times with my right contracted hand has your neuro had an MRI of the C5 to T1 areas done? Do you still play guitar? A woman I met in rehab round 2 was rapidly acquiring contractures in both her hands, C6 complete, but her fingers all were turning toward the respective thumbs. Seems she did a lot of sailing and the rope pulling for the sails had tightened and turned her tendons. Obviously with normal muscle strength the fingers would right themselves. The C5 area is the bicep. Even now when I get real sick or very tired and yawn my right arm flexes. That was all the face smacking early on as the 2 heads of the tricept was slowly getting stronger to balance my much stronger bicep. Maybe a bit of stenosis or something in that area?

                    I hear you on embarassing. It so rarely happens that I can't even think of what causes the arm spasm. But I once threw soup in my own face with the spoon I had just filled.
                    Hi Sue,

                    My neuro has shown next to no interest in my arm spasms, or the problem with my fingers flexing, so more MRI's are pretty much out of the question, tho' to be fair, the number of scans I've had done already, if anything was wrong it would surely have been seen.

                    To be honest, I personally think he's completely out of his depth regarding Hereditary Spastic Paraplegia, what little he now knows he's learned thro' me. He specialises in MS, and I'm only on his list because I insisted he took me on.

                    As for playing the guitar, yes, I still do, but in a limited fashion. I simply don't have the dexterity/flexibilty I used to have.

                    I'm a 'drink chucker' mainly, tho' thankfully this usually only happens at home, so the embarrassment is kept down a bit.

                    Ian

                    Comment


                    • #11
                      I have HSP too, and my fingers are weak, and tend to curl naturally. It's the complicated form of HSP. My description sounds like a spinal cord injury, incomplete, at around C8. My fingers are weak, and I drop stuff all the time, I push my wheelchair with my thumbs and the heels of my hands, but I can't push it with my fingers. My fingers curl easily, but are hard to open. I'm also very weak from the upper chest down, and can only walk a few steps at a time. So, my finger weakness matches those of my chest, breathing, and legs.

                      Comment


                      • #12
                        hi,

                        I realize his is an old post but anyway just thought I'd comment:

                        I dont know this has any relevance or not to this post but in regard to what Dr. Wise said regarding cervical injuries and finger flexion. I have a cervical injury not traumatic, incomplete, c56 6/7 and my right pinky and ring finger, mostly pinky seem to be falling into flexion and I cannot seem to spread my fingers apart the way I can on my left hand.

                        I started noticing I was having problems writing about 12/08 when my gait went and my cord was decompressed 9 months ago. the problem with my hand seems to be getting worse for some reason.

                        Mostly my pinky cant seem to be held in adduction without drifting into abduction, I try to control it and it shakes.

                        I just had an OT eval and she said there was intrinsic weakness and something about flexion, so now i will be going to OT 2x/week along with PT still 2x/week. More therapy I just cant wait.

                        Was wondering though if this can be helped through OT exercises or it is just part of perhaps the deficits that I have that at this point look somewhat permanent. Anyone have any thoughts or have anything like this? thankyou

                        Comment


                        • #13
                          I don't know if this is even close, but I have cubital tunnel syndrome & your described symptoms are similar. I hope you have some relief.

                          Comment


                          • #14
                            You know I thought about that but the problem with my handwriting started when my gait started to "go" in 12/08 and since I was dx with cervical spondylotic myelopathy my neurosurgeon told me before surgery when I told him about it that I could get "clumsy hands, writing problems etc."

                            This kind of explains a little

                            Many pathologic processes of the spinal cord can resemble cubital tunnel syndrome, all of which may present with a predominance of motor signs and symptoms. When patients complain of "numb and clumsy hands," consideration must be given to intrinsic cord lesions such as intramedullary tumors, syringomyelia, amyotrophic lateral sclerosis, and extrinsic cord lesions such as]cervical spondylotic myelopathy[/B]. Other causes of hand dysfunction and pain include (1) cervical radiculopathy from osteophytes or herniated disc

                            thanks for your response coleen, hope u feel better as well

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