In an athetoid
hand, says Starr, the interossei and lumbricales, which flex the
metacarpo-phalangeal and extend the phalangeal joints, are
affected; rarely are the long extensors and the long flexors
affected. Therefore the hand is usually in the so-called
interosseal position, with flexion of the proximal and extension
of the middle and distal phalanges. The athetoid movements of the
toes correspond to those of the fingers in point of action. In a
great majority of cases the disease is confined to one side
(hemiathetosis), and is a sequel of hemiplegia. The differential
diagnosis of athetosis is generally easily made. The only nervous
affections with which it could possibly be confounded are chorea
and paralysis agitans. Attention to the twitching, spasmodic,
fibrillary movements, having a quick beginning and a quick
ending, which is characteristic in Sydenham's chorea, would at
once exclude that disease. These jerky movements peculiar to St.
Vitus's dance may be easily detected in a few or many muscles, if
moderate care and patience be exercised on the part of the
examiner. This form of chorea is almost always a disease of
childhood. So-called post-hemiplegic chorea is, in the opinion of
both Hammond and Gray, simply athetosis.
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