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Intrinsic plus hand: A rare case of painful flexion and extension of his fingers.
Am J Emerg Med. 2020 May 22 [Online ahead of print]AJ

Abstract

Intrinsic plus hand describes a rare and painful contracture of the intrinsic hand muscles with excessive flexion at the metacarpophalangeal joints and extension at the interphalangeal joints. Resulting from many causes to include trauma and neurologic injury, intrinsic plus hand can involve any number of fingers. Emergency department (ED) assessment should include evaluation for cerebrovascular injury, infection, compartment syndrome, and deep vein thrombosis (DVT). Conservative splinting is generally unsuccessful and ultimately requires operative intervention. We highlight the case of a 61-year-old otherwise healthy male who awoke to a painful and mildly swollen left hand with his fingers held in a contracted position. Evaluation in the ED found no active range of motion in the digits, severe pain with any passive motion, and a negative upper extremity ultrasound for DVT. Ultimately, orthopedic and neurology consults in the ED agreed upon a diagnosis of intrinsic plus hand.

Authors+Show Affiliations

Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States of America; 121 Field Hospital, Camp Humphreys, Republic of Korea. Electronic address: brandon.m.carius.mil@mail.mil.Brian D. Allgood Army Community Hospital, Camp Humphreys, Republic of Korea; 502 Forward Surgical Resuscitation Team, Camp Humphreys, Republic of Korea.121 Field Hospital, Camp Humphreys, Republic of Korea.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32534874

Citation

Carius, Brandon M., et al. "Intrinsic Plus Hand: a Rare Case of Painful Flexion and Extension of His Fingers." The American Journal of Emergency Medicine, 2020.
Carius BM, Canine CR, Long B. Intrinsic plus hand: A rare case of painful flexion and extension of his fingers. Am J Emerg Med. 2020.
Carius, B. M., Canine, C. R., & Long, B. (2020). Intrinsic plus hand: A rare case of painful flexion and extension of his fingers. The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2020.05.041
Carius BM, Canine CR, Long B. Intrinsic Plus Hand: a Rare Case of Painful Flexion and Extension of His Fingers. Am J Emerg Med. 2020 May 22; PubMed PMID: 32534874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrinsic plus hand: A rare case of painful flexion and extension of his fingers. AU - Carius,Brandon M, AU - Canine,Curt R, AU - Long,Brit, Y1 - 2020/05/22/ PY - 2020/05/15/received PY - 2020/05/18/accepted PY - 2020/6/15/entrez PY - 2020/6/15/pubmed PY - 2020/6/15/medline KW - Hand KW - Idiopathic KW - Muscle contracture KW - Orthopedics JF - The American journal of emergency medicine JO - Am J Emerg Med N2 - Intrinsic plus hand describes a rare and painful contracture of the intrinsic hand muscles with excessive flexion at the metacarpophalangeal joints and extension at the interphalangeal joints. Resulting from many causes to include trauma and neurologic injury, intrinsic plus hand can involve any number of fingers. Emergency department (ED) assessment should include evaluation for cerebrovascular injury, infection, compartment syndrome, and deep vein thrombosis (DVT). Conservative splinting is generally unsuccessful and ultimately requires operative intervention. We highlight the case of a 61-year-old otherwise healthy male who awoke to a painful and mildly swollen left hand with his fingers held in a contracted position. Evaluation in the ED found no active range of motion in the digits, severe pain with any passive motion, and a negative upper extremity ultrasound for DVT. Ultimately, orthopedic and neurology consults in the ED agreed upon a diagnosis of intrinsic plus hand. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/32534874/Intrinsic_plus_hand:_A_rare_case_of_painful_flexion_and_extension_of_his_fingers L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(20)30385-5 DB - PRIME DP - Unbound Medicine ER -
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