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

SENSORY LESIONS. 189
Case ol*.— Shell wound affecting
the miiseulo-spiral nerve ;
trivial loss of tactility ; entire motor paralysis in the ultimate
distribution of this nerve. B. Graham, aged twenty-two,
enlisted September, 1861, 5th Battery, Massachusetts
Artilleiy. He was previously healthy. On May 12,
1864, he was struck on the back and outside of the right
arm by a piece of shell, which denuded, but did not break
the humerus. The wound lay immediately below the deltoid
insertion, and was five inches wide as it stretched
across the arm, and three inches in diameter from above
downward. The arm dropped, and he had sharp pain in
the wound, so that he cried aloud. The after-pain was
trifling.
As he went to the rear, he examined the limb,
and found that he could move his fingers a little, but that
there was no notable loss of feeling.
The wound healed
rapidly, and is now, June l-O, 1864, level with the skin.
Nutrition is
unimpaired. The right forearm measures
nine and three-eighths inches; the left, nine and a half
inches.
Sensation.— Outside of the elbow, for a short space, tactility
is enfeebled. In the radial distribution touch is
slightly less perfect than usual elsewhere there is no
;
lesion of sensation. The supinator longus muscle, supplied
by the musculo-spiral through the branch given off
above the wound, acts pretty well. The extensors of the
wrist and thumb and the extensor communis are completely
paralyzed. The interossei act well. The triceps
extensor is healthy.
Electric tests.— The muscles above named as paralyzed
influence may go very far before causing any notable motor indications,
while as regards spasm, a nerve of double function may be slowly and
gradually compressed to the utter loss of all function without any such
muscular convulsion as may at any time originate under sudden variations
in the amount of pressure.
* Mitchell, Morehouse, and Keen, op. cit.