Injuries of nerves and their consequences - Reflex Sympathetic ...

100 INJURIES OF NERVES.
the head of the bone, and to meet with injury, the amount
of which is determined by the force with which the head
of the bone breaks loose from the glenoid cavity.*
Mr. Hilton has described a dislocation downward
into the axilla, in which the humerus, although reduced
with ease, was retained with difficulty.
At the thirteenth
week the man died from disease of the chest, when
the circumflex was found to have been torn and displaced.
I have seen a case in which, after a dislocation
easily replaced, the deltoid wasted, and then other muscles
suiiered, while neuralgia of severe type accompanied
the nutritive changes. Here the pathogenesis was, no
doubt, injury to the circumflex, atrophic alteration of the
deltoid, centripetal propagation of the neural changes,
secondary alteration of other branches of the brachial
plexus, and consequent neuralgia and muscular atrophies.
In grave cases of injur}' to the nerves during dislocation,
they are compressed, as ISTelatonf has pointed out,
between the clavicle, the first rib, and the head of the
dislocated bone. The degree of paralysis probably depends
upon the violence employed in the displacement
being sufficient to drive the dislodged part against the
tissues which lie on its inner side. The theory of direct
contusion is now generally held to explain the observed
results, and but one author, Empis,J has offered any other
He reports a
explanation than that which I have given.
case in which a man luxated his shoulder by a fall, and,
thirty-six hours later, before its reduction, was seized with
loss of power in the arm muscles without the least defect
of sensibility. Puzzled by this coincidence, he ofl'ers, in
explanation, the theory of the muscles having
lost their
* Hamilton, p. 561.
f Elem. de Pathol, chir., t. v. p. 170.
+ Empis, These de Paris, 1850. M. Debout also attributes these palsies
to contusion of the muscles,
— a strange conclusion.