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

ILLUSTRATIVE CASES. 211
contractions of muscles and the state of the wrist-joint
check it.
The thumb has one-third flexion and extension,
owing to want of power.
The flrst joints of the fingers are in good order the
;
second a little swollen and stifi"; the third joints are rigid,
enlarged, and painful, especially in the index-finger.
The
first joints have prettj' fair mobility the second but little ; ;
the third none at all. As the fingers are semi-flexed, the
will can still act on the first phalanges, and slightly on the
second, but the third rest bent and motionless. The same
statement may be made as to the power to voluntarily extend
them.
The contracted state of the common flexors
has nowlessened, but the joint inflammations, which arose
early in the case, have fixed the fingers in the vicious
positions into which they were drawn by
the muscular
shortening.
Touch is
good in the arm; absent in the palm and
palmar face of the fingers, except
as to the thenar eminence.
It is
good on the dorsum of the hand, but defective
on the back of the last phalanx of the first finger,
the second and third phalanges of the second and third
fingers, and on the metacarpal bone of the fourth finger.
Electro-muscular contractility is lessened in the supinator
longus ;
absent in the common flexors, although
these have some voluntary power; nearly absent in the
thumb muscles, the muscles of the fourth finger, and
interosseal groups.
The marked feature of this case was the obstinate and
painful inflammation, and stiffness of the third joints of
the fingers and of the articulation of the wrist ; yet these
conditions were nearly entirely relieved by three months
of passive motion, electrization by induced currents, and
the dry wire brush, douches, and attention to the general
health.
Case 38.— Wound of left chest, causing paralysis of the