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A Woman Whose Knuckles Are All Bent Far Backwards

A Woman Whose Knuckles Are All Bent Far Backwards

This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.



A 62-year-old woman admitted to behavioral hospital unit because of agitation complicating end-stage Parkinson disease. The disease has progressed over 20 years.

States that hand deformities arose more recently. Gives equivocal answer when routinely queried about remote or recent abuse by others; denies that interpersonal violence ever caused a fracture. Claims that a fall down stairs led to hand changes.


Profoundly dysphonic woman, polite but often unfocused in discussion. Hands as shown. Wrists cannot be passively extended; metacarpophalangeal joints cannot be flexed. Interphalangeal joints are somewhat mobile, distal more so than proximal; passive motion does not produce pain.

Hands warm and well perfused; pulses can’t be felt because of constant abnormal involuntary movements. Movements may be partly psychogenic. Forearms do not feel woody. Elbows show normal passive range of motion. Sensation testing intact.

Legs: atrophy of muscles. Right clubfoot deformity, left foot somewhat inverted and adducted.

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