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By Brooks A. Mick, M.D.
Apr. 6, 2006 Well now, folks, this is a bit different type of article. It's a bit of medical research, in effect, but I hope you find it interesting even if you are not in the medical field. About thirty years ago I noticed that an occasional patient would come in with a complaint of a hand that was not working right, or was weak, or was just feeling "funny." It was always the non-dominant hand. That is, it was usually the left hand in a population of right-handed people. The patient would sit with the hand quietly in the lap or resting on the left thigh or knee, and the hand would be in a supinated position. "Supinated," by the way, means with the ventral side (front side of the human) turned upward. When you are lying on your back, you are supine, NOT prone. Pronation is the turning of the ventral side DOWNWARD. That is, a prone person is lying face down. So the hand was held palm up. But there was more to the position. It was cupped as if holding a little liquid in the palm. It was somewhat the posture of the hand of a beggar, or supplicant, as if waiting for something to be dropped in it. And so I named it the Mick Soup Sign. The patient had "soupinated" the hand; the patient appeared to be a "souplicant;" and the patient appeared to be holding a puddle of soup in the palm. What else could I have named it? But then, after describing the recurring sign, I had to assign a meaning to it. I noticed that, despite the complaints, the neurologic exam was always normal in these patients. There was nothing to indicate a stroke, nerve damage, multiple sclerosis, or any other cause. Nor did the position of the hand correspond to the position assumed by the hands of patients with known neurologic disease. I therefore concluded that this was a sign of a psychological disorder. The patient was apparently under such stress that, in order to avoid the stress or in order to have an excuse to see a physician and be treated, the mind was playing a trick on them and giving them that excuse they needed. Discussing life situations, it usually became clear that there was a boss at work who was intolerable, a husband who couldn't be dealt with, or other family or job stress. The psychological nature of the illness was made even more clear when a lady came in complaining, as she had many times, of a paralyzed hand, and she was holding her right hand in the "soup sign." After I checked her out and talked about it for a while, I mentioned that in the past it had always been her LEFT hand which had been the "paralyzed" hand, which had indeed been the case. She denied this, though I showed her in the records where, on all prior visits, it was clearly stated that her left hand was the one which had "become paralyzed." The next visit, sure enough, it was her left hand held in the "soupinated" position. I have subsequently noted another sign of a false hand weakness, but this occurs in patients who are deliberately faking a weakness to collect disability payments or insurance. When getting a rough estimate of hand strength, I always extend two fingers of my same-side hand (when testing right strength, I hold out two fingers of my right hand) and ask the patient to "grab my fingers." Most people will do that, and then I ask them to squeeze as hard as they can. A patient who is faking weakness will occasionally show what I call the "Lobster Claw Sign:" They will hold their thumb opposite their four other fingers, which they hold together, and then they make weak pinching movements with the tips of the thumb and fingers, as of a lobster claw pinching an object. This also is not a motion one sees from any known neuromuscular disorder. One can also note that, when they are making other spontaneous movements, they will be capable of closing the hand into a fist. These signs are useful, for if one sees a patient with the "Soup Sign," one doesn't need to spend thousands of dollars on tests for strokes and brain tumors. And if one sees the "Lobster Claw Sign," one can correctly fill out the disability papers indicating no neurologic damage from that car wreck last year. ------------ About the author Brooks A. Mick: Physician, still practicing medicine but retired from the US Army. Write just for the fun of it, but working on novel in the vein of Tom Clancy's politico-military genre. Email: brooks15@cox.net Comment on this article here! ------------ All articles are EXCLUSIVE to Useless-Knowledge.com and are not allowed to be posted on other websites. ARTICLE THIEVES WILL BE PROSECUTED! |
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