by Mark Stoneham, M.D., Visiting Instructor
A rash of related injuries has struck the British anaesthetists in Ann Arbor. All of them involve the left thumb of the sufferer. First there was Paddy ‘Coma Victim’ Butler who reduced his thumbnail total by one and his Glasgow Coma Score by 12 in a high speed bicycling fracas. Then there was Mark ‘Miguel Indurain’ Stoneham - knocked off his bicycle by a hit-and-run driver on an ice sheet, sustaining a comminuted fractured distal phalanx of the left thumb. Finally there was Paul ‘Strong and Silent’ Innes with acute paronychia of the left thumb nail bed of uncertain aetiology (see figure). Further investigation has revealed other similar injuries: Brian Woodcock for example suffered a life-threatening knife wound to his left thumb. His graphic description of the event is included here to give added realism.
“I was cutting a piece of corn on the cob in half for the kids at my dad’s on Labor Day. He had a new knife, it went through the corn like a hot knife through butter and took a slice off the end of my thumb. There was an area of pulp showing 1.5cm x 1cm. The bit that came off was put aside for re-implantation but disappeared (down the waste disposal I think). When I got to the ER they said they would have sutured it back on. It took two months to epithelialize over. The thumb print is slowly growing back in but sensation is still missing over a 1 x 1 cm area.”
Of course the old ‘Dunkirk spirit’ which made Britain great (?) has shone through despite all this. These trivial ailments have not troubled our brave lads. They continue to work despite limb- (perhaps life-) threatening injuries to digits, even intubating patients with thumb encased in a really big bandage, and have got out of doing menial household chores with such old favourites as ‘I’m not allowed to get the plaster wet’, ‘It really hurts, darling’, ‘I’m going to the pub’ and ‘Shove it, do it yourself’.
Interestingly, ‘thumbing’ through an online Medline search revealed no less than 4,133 articles with the word ‘thumb’ as the focus. There were even 25 articles from the combined search strategy ‘thumb’ and ‘anesthesia’. Most of these last concerned the absolutely fascinating subject of ‘adductor pollicis responses to ulnar nerve stimulation’. However, one was rather alarmed by the number of papers from this search strategy correlating abnormalities of the thumb with mental retardation. ‘Severe mental retardation and absent nails of hallux and pollex’ (Am. J. Med. Genetics 41:173-5, 1991), ‘Surgical management of spastic thumb-in-palm deformity in adults with brain injury’ (J Hand Surgery 14:174-82, 1989) and ‘Congenital hydrocephalus and clasped thumbs: two cases of brothers in a family’ (Brain Development 3:407-9, 1981). What are they trying to tell us?
What will be next? Doug McLaren with a nasty case of Scrote’s nail? Allan Brown with a Gamekeeper’s thumb or perhaps Tony Doyle with a Bennett’s fracture after skiing? Whatever their particular choice of ailment, they can be reassured that they are joining a privileged and esoteric club. Watch this space for developments.