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An attempt was made to ascertain whether physical exercise might cause increase of the conduction velocity of the nerve fibers in young adults. Experiments were carried out on 32 university student athletes and 6 professional athletes with controls of 30 ordinary university students. The ages of these subjects ranged from 20 to 36 years. For the purpose of measuring the conduction velocity of the ulnar nerve, square wave stimulation of 0.5 msec. duration was applied to the ulnar nerve at the axilla, elbow and wrist, and evoked myograms were picked up from the hypothenar eminence muscles. The spinal reflex time was measured as the latency of the H wave which was recorded from the gastrocnemius muscle by stimulating the posterior tibial nerve at the popliteal fossa. Room temperature was carefully kept at 30°C during the experiments. (1) The average maximum conduction velocities of ulnar nerve fibers were 67.0±2.5 meters per second in the forearm and 67.6±2.6 meters per second in the upper arm in the control group and 66.5±2.3 meters per second in the forearm and 67.2±2.6 meters per second in the upper arm in the athletes group. It was noticeable that any significant differences were recognizable neither between the data of the forearm and upper arm in the two groups nor between those obtained in the athletes group and the control group. (2) No significant difference as to the spinal reflex time and the spinal reflex index was seen between the two groups, judging from the patterns of their distribution depicted in the graphs. The spinal reflex index is an index which corresponds to the mean conduction velocity of the impulse over the reflex arc. (3) Distinct individual differences in the maximum conduction velocity of ulnar nerve fibers were observed in both groups. However, no factor was found which might be related to the individual differences from the viewpoint of anthropometric measurements and skillfulness in sport. From these results, it may be said that no kind of physical exercise increases in the conduction velocity of the nerve fibers in young adults.

A traumatic false aneurysm of the right palmar ulnar artery in a seventy-three year old man became evident eight months a neuroma in the hypothenar eminence was removed using a tourniquet. Injury to a vessel in a bloodless operative field is likely to occur, to be overlooked, and eventually to cause formation of an aneurysm. Recommendations are made concerning avoidence and management of this complication, which could be more serious in larger proximal vessels of the limbs.

A concept of finger motion and control, based on electromyographic observations in 868 muscles in 256 normal, adult subjects, is presented. This concept is a logical extension of the hypothesis previously reported10. Hand control depends on active contractile forces during both lengthening and shortening of the muscles, on the viscoelastic properties of all of the tissues of the hand and forearm, especially the muscles, and on the anatomical configuration of related structures. The control mechanism can be described in terms of the contributions of the several structures during the process of reaching or holding the four common, terminal positions of the fingers. 1. The fully extended finger: To reach or hold the position of full extension of all joints, contraction of both the extrinsic and intrinsic muscles is required. The extensor digitorum and lumbricalis actively contract of provide the extending force. The lumbricalis is particularly effective in interphalangeal extension since it pulls the flexor digitorum profundus tendon distally, relieving the interphalangeal joints of the passive flexing force produced by the viscoelastic properties of the profundus. 2. The clawed finger: To reach or hold the position of interphalangeal flexion and metacarpophalangeal extension, contraction of only the extrinsic muscles is required. The flexor digitorum profundus (and to a lesser extent the flexor digitorum superficialis) and the extensor digitorum are the active muscles. 3. The fully flexed finger: To reach or hold the position of full flexion of all joints, contraction of only the extrinsic muscles is required. The active muscles are the flexor digitorum profundus (and to a lesser extent the flexor digitorum superficialis) and the extensor digitorum. The actively contracting muscles are therefore the same here as in the clawed position. The ability of the finger to use these same muscles to reach the fully flexed position depends upon: the lengthening contraction of the extensor digitorum as the finger is fully flexed permitting controlled metacarpophalangeal flexion and the increased tension in the oblique track, primarily the result of stretching of the bi-articular interossei. 4. Metacarpophalangeal flexion with the finger straight: To reach or hold the position of interphalangeal extension and metacarpophalangeal flexion, contraction of the intrinsic muscles is required, and to a lesser extent contraction of the extrinsic extensor. The motion is performed by contraction of the lumbricalis and the interossei. Of the flexion-extension motions, only those reaching or holding this position are associated with action of the interossei as a group. Activity of the extensor digitorum, a frequent accompaniment of this motion, assists interphalangeal extension and prevents hyperflexion of the metacarpophalangeal joint. The lumbricalis emerges as an extremely consistent performer in all individuals and fingers. The interossei have certain group characteristics, but vary moderately from finger to finger and from subject to subject. This paper has described these variations and presented the supporting data; lumbricoid and pure metacarpophalangeal flexor variations of interosseus behavior are noted. The flexor digitorum profundus consistently overshadows the superficialis, except in the index finger where the superficialis sometimes predominates. The extensor digitorum and the extensors proprii appear to have identical functions. The muscles of the hypothenar eminence do not contribute significantly to flexion-extension motions of the small finger, but the opponens digiti minimi may participate as a depressor of the fifth metacarpal during closing motions.

To the Editor.— Nodular fasciitis was first described in the 1950s, and a number of important histologic and clinical features are now recognized. It is a benign disorder that almost certainly existed prior to 1955, but was undoubtedly mistaken for malignant neoplasms such as fibrosarcoma, angiosarcoma, liposarcoma, and malignant fibrous histiocytoma.1This tumor has only occasionally been documented in children. We describe a 5½ -year-old girl with nodular fasciitis of the palm. Report of a Case.— A 5½-year-old girl was referred for evaluation of an enlarging nodule on the left palm that had been present for approximately 2 weeks. She had been playing with safety pins in her home and was felt to have possibly broken off a small portion of a pin in her hand. On examination she had a 1.5-cm moderately painful, firm, movable nodule on the left hypothenar eminence. The surface was a flat calluslike plaque

The deep branch of the ulnar nerve (DBUN) was carefully dissected, using gross and microtechniques, in 21 fresh frozen cadaver upper extremities. This study emphasized branching patterns of the DBUN to the hypothenar muscles and the interrelationship of variations in hypothenar muscle anatomy and DBUN branching patterns. The DBUN generally passed between the abductor digiti minimi and the flexor digiti minimi, and then through the interval between superficial and deep layers of the opponens digiti minimi on its course to the deep palm. Innervation of the hypothenar muscles was by one to four branches of the DBUN. The most common distribution pattern was two major branches, which occurred in 14 (66%) of the specimens. Of these 14 specimens, nine exhibited normal hypothenar muscle anatomy, suggesting a prevalent relationship between three normal muscles and two nerve branches. One main branch occurred in four (19%) specimens, three branches occurred in two (9%) specimens, and four branches occurred in one (4%) specimen. Anatomic variations in the hypothenar muscles were significant, the most notable being the absence of flexor digiti minimi in eight (38%) of the specimens.

IT IS imperative that when a patient is seen with a traumatic hand laceration, if the instrument causing the laceration cannot be identified or is unknown, adequate x-ray films be obtained to ensure that potentially dangerous foreign bodies are not embedded in the tissue. These can migrate even after primary wound healing and cause delayed or secondary trauma exceeding the initial episode. The following case illustrates the tragic consequences of failure to include proper roentgenographic studies as part of the initial evaluation of hand trauma. Report of a Case A 20-year-old man was seen in the emergency room after falling on his outstretched right hand in a rock quarry. On initial examination, a laceration over the base of the hypothenar eminence from the pisiform bone to the hook of the hamate bone was noted. The patient complained of no neurological symptoms referable to the area, and the results of neurological

Trauma to the ulnar artery was first reported by Von Rosen in 1934. In more recent years this condition has been termed ulnar-artery thrombosis, hypothenar hammer syndrome or post-traumatic digital ischemia. Trauma to the ulnar artery is caused by the repeated use of the hand as a hammer in order to apply force to an object. Any person who presents with a history of trauma to the hypothenar eminence of the hand should be screened for ulnar artery thrombosis. This screening can easily and quickly be performed by the nurse utilizing the Allen test. Early detection of vascular insufficiency coupled with cessation of chronic trauma may help the client avoid reconstructive vascular surgery.

REPORT OF A CASE Thirteen months prior to seeking our care, a 70-year-old man underwent surgery for a lesion of the left hand that was diagnosed as squamous cell carcinoma (SCC). A 3.2 × 2.0-cm indurated, ulcerated plaque of the left palm in the hypothenar eminence was surrounded by a 5.4 × 4.9-cm area of erythema (Fig 1). The plaque was not adherent to the underlying fifth metacarpal bone. The ulcer discharged a greasy, serosanguineous exudate. There was no palpable axillary lymphadenopathy; however, a left epitrochlear node was palpable and soft. This was felt to be due to reactive hyperplasia. A biospy to adequate depth of the subcutaneous adipose tissue showed deeply invaginating strands of atypical keratinocytes, some of which had central crypts containing keratinous debris (Figs 2 and 3). DIAGNOSIS: Carcinoma cuniculatum recurrent after a previous surgical procedure. THERAPEUTIC CHALLENGE In this location, on the palm of

ACCORDING to a recently presented concept,1much of the symptomatology in patients with myasthenia gravis can be explained by a decreased acetylcholine synthesis. Amino acids2and proteins3were found to increase the acetylcholine synthesis in vitro. It seemed reasonable, therefore, to investigate the effect of the infusion of amino acids on patients with myasthenia gravis. METHOD Records of muscle action potential were taken from healthy subjects and from patients with myasthenia gravis by the following method: The forearm was firmly fixed in the supine position onto a padded board by means of broad strips placed across the arm near the elbow and the wrist. Of the two silver recording electrodes (0.5 sq. cm.), one was fixed with adhesive tape to the skin over the ventral surface of the first phalanx of the fifth finger and the other over the surface of the hypothenar eminence at a distance

There has been a good deal of literature devoted to injuries to the hand and their economic significance in industry. Discussions of infections, injuries to tendons and nerves and fractures form the bulk of the articles, but reports of injuries to blood vessels appear from time to time. There have been several cases of aneurysm 1 reported and one case of thrombosis of the ulnar artery 2 following a blow. No case of traumatic thrombosis of the deep veins of the palm of the hand could be found in the literature, so we felt it worth while to report such a case. The thrombosis was the result of a sudden severe jar at the base of the hand. A definite, firm, tender, oblong mass could be palpated at the base of the hypothenar eminence (fig. 1). It was thought to be a ganglion or chronic tenosynovitis, but exploration revealed a

Dr. W. M., an otorhinolaryngologist aged 58, consulted me on account of "cracked fingers" of several years' duration. The lesions consisted of deep longitudinal fissures, which started at the tip of each involved finger and extended to the base of the distal phalanx; the skin about the fissures was red, somewhat soggy and crusted. The left thumb and index and middle fingers, the tip of the right thumb and the right index finger were involved, and there was also a fissured longitudinal area of about 2 cm. on the left hypothenar eminence. The areas on the left hand were much greater in extent and in intensity. Washing and especially scrubbing of the hands caused a great deal of pain and inconvenience and played havoc with the patient's surgical schedule. He volunteered the information that after a day of rest from his work, as on a Monday morning, his fingers were