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a, Extensor carpi radialis; g, brachialis; g', anterior superficial pectoral; c, common digital extensor; e, ulnaris lateralis. The fascia and the ulnar head of the flexor carpi ulnaris have been removed. 1, Distal end of humerus; 2, median vessels and nerve. Motion is that of flexion and extension; slight rotation is possible when the position is that of flexion.
B. Unwin, aged 40, washerwoman, applied to me on July the 10th, 1820, with severe inflammation and ulceration of the middle finger, arising from a puncture by a pin or needle some time before; there was much painful tumefaction, and the integuments had burst along nearly half of the length of the finger, on the ulnar side, and over the middle joint on the radial side; the probe did not however pass to the bone or into the joint.
According to Head and his co-workers, Sherren and Rivers, the afferent fibres in the peripheral nerves can be divided into three systems: The fibres of this system run with the motor nerves, and pass to muscles, tendons, and joints. Even division of both the ulnar and the median nerves above the wrist produces little loss of deep sensibility, unless the tendons are also cut through.
Subcutaneous rupture of the tendon of the extensor pollicis longus at the wrist takes place just after its emergence from beneath the annular ligament; the actual rupture may occur painlessly, more frequently a sharp pain is felt over the back of the wrist. The prominence of the tendon, which normally forms the ulnar border of the snuff-box, disappears.
It frequently occurs to surgeons to receive slight wounds upon the hands which prove very troublesome. Of this kind is the following. Mr. L.C. had an irritable and inflamed sore on the ulnar side of the third finger, occasioned by a bruise a fortnight ago. Many applications had been made during this fortnight but the sore had no disposition to heal.
When time has been lost, the case is very different as will appear hereafter; but even in these cases, the caustic proves an invaluable application. Mrs. Middleton, aged 40, wounded her wrist, on the ulnar side, by the hook of a door post; there was a considerable flow of blood at first, but this ceased suddenly and the arm immediately became affected with great pain and swelling.
Sometimes also specimens of fatty and earthy deposits in the arteries occur, in which exact similarity is shown in the plan, though not in the degree, with which the disease affects severally the humeral and femoral, the radial and peroneal, the ulnar and posterior tibial arteries." Dr. William Budd gives numerous instances of symmetry in disease, both lateral and serial.
On the forearm are tatued eight bold zigzag bands, one-eighth of an inch broad, which do not completely encircle the arm, but stop short of joining at points on the ulnar side of the middle line on the flexor surface. The series of lines is known as BETIK TISU, the hand pattern. The legs are tatued on the back of the thigh, on the shin, and sometimes on the knee-cap.
In the first of these the brachial artery bifurcated almost at its origin, the two halves re-uniting at the elbow-joint, and then dividing into the radial and ulnar arteries in the usual manner. In the second case an aberrant artery was given off from the radial side of the brachial artery, again almost at its origin.
They drain the ulnar side of the hand and forearm, and pour their lymph into the axillary group. The epi-trochlear gland is sometimes enlarged in syphilis.
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