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

ILLUSTRATIVE CASES. 213
and this was especially the case with the thumb and the
first and second fingers.
At the same time the shoulder
muscles became weak, flexion of the fingers grew feeble,
and the flexion of the forearm was affected. All of these
defects increased for several months, and the flexor group
in the forearm wasted so much as to attract attention.
The biceps, brachialis anticus, and coraco-brachialis were
in like manner atrophied. The pectoralis major was also
thus altered at a still earlier period. Up to the eighth day
the patient spat blood freely.
Then it ceased, and he has
had no pulmonary ditficulties of any kind since.
February 19, 1864.—Admitted.
Atrophy of pectoralis major is great, of the shoulder
muscles slight; wasting of biceps and other anterior and
internal arm muscles is considerable. The left arm at the
biceps measures ten inches; the right, eleven and threefourth
inches; the left forearm, ten inches; the right,
eleven inches. The left hand congested, dark, and cold ;
is easily chilled.
Sensation is perfect.
The neuralgia has nearly disappeared,
except in bad weather, and about the insertion of
the deltoid, where there is great tenderness, and a good
deal of hardening and deposit in the subcuticular tissues
and over the bone. The only muscle which is hypersesthetic
to any marked degree is the biceps.
The course of
the musculo-cutaneous and the median nerves is acutely
tender upon pressure.
There is no motion in the pectoralis major, and it is
— scarcely perceptible in the biceps, the supinator longus
alone flexing the forearm. Extension of forearm is perfect.
The fingers act in flexion feebly, but are improving.
but not lost. Motion
The thumb motions are also weak,
is now most limited by the state of the finger-joints, which,
although no longer tender, are stiff' and enlarged. So
much improvement has taken place very recently that we