Polite Dissent

Birds of Prey #78 “Hero Hunters, part three: Moondance” (cue Van Morrison)
Gail Simone, writer
Tom Derenick, penciller

There’s some interesting medicine in the latest issue of Birds of Prey. After a fight with the villain Harvest, Dinah Lance (Black Canary) has been mysteriously aged 20 years. The Huntress and Lady Blackhawk manage to get her back to the plane where Oracle (Barbara Gordon) runs some test on her.

Oracle: “Pupils, extra-ocular and accommodation are all good, and she aced the Romberg test.”
Oracle: “I can’t find anything wrong with you, Dinah.”
Black Canary: “Other than the fact that I aged twenty years for an hour, you mean?”
Oracle: “Other than that, yes.”

I’m assuming that Barbara ran more tests than the just the ones mentioned here because it would take more than a few neurological tests for me to declare a mysteriously aged patient healthy (even if she did return to her normal age fairly quickly). The conversation suggests that at least an hour has passed, so I suspect we’re just catching the tail end of the exam.

The pupillary exam looks at the pupils (duh), examining their size, shape, equality and behavior. The accommodation exam also looks at the pupils; they should constrict as a distant object moves nearer.

When a physician has you follow an object with your eyes without moving your head, he is checking your extraocular muscles. These are the muscles that control the movement of the eyes.

The Romberg test is easy way to test a patient’s sense of balance. The patient stands with their feet together and their arms at their sides. They then close their eyes. A positive Romberg test (which is a bad thing) means that the patient can’t keep their balance and is swaying or even falling over. Their can be many reasons for this including inner ear problems, certain brain tumors and strokes.

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Later in the issue, Dinah reminisces about her training days with Ted Grant (Wildcat). She mentions how she once suffered boxer’s knuckle.

Boxer’s knuckle is an injury to the metacarpophalangeal joint (the big joint between the hand and finger), most commonly the index finger. Repetitive trauma is the most common cause, though it has been known to occur after a particularly damaging punch. The injury most commonly involves the extensor tendons of the joint, although it may also involve damage to the sagittal bands or the joint itself. Surgical repair followed by several weeks of splinting is the best treatment. There should be no boxing, martial arts or punching for six months following the injury (sorry Dinah).

Boxer’s knuckle is different than a boxer’s fracture, which is a break in the neck of the fifth metacarpal (here’s a good x-ray). According to DeLee and Drez’s Orthopaedic Sports Medicine (2nd ed), trained fighters tend to suffer boxer’s knuckles, while untrained fighters suffer boxer’s fractures. The fits perfectly with what I have seen in practice because I have yet to see a boxer’s knuckle (and I’ve never seen a professional fighter) but I see 2-3 boxer’s fractures a year, almost always from guys punching a wall or a home appliance (and losing).