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

CHAPTER IX.
DIAGNOSIS AND PROGNOSIS OF INJURIES OF NERVES.
— Diagnosis. In general,
it is of course easy to say whether
a nerve trunk has been directly injured or not. The wellknown
symptoitis, together with an obvious lesion having
a certain place or direction, usually tell us with sufficient
distinctness the nature of the hurt whenever the accident
has been seen in its earlier stages. Somewhat later, and
in rare cases, the diagnosis of the initial injury may be
difficult, owing to the reflex disturbance of remote nerves,
and the fact already dwelt upon, that a subacute inflammation
or a sclerotic state of nerve may pass centrally
from the nerve first in fault, and thus come to afl^'ect one
or more cords of the parent plexus. Whatever doubt I
may once have had as to this tendency of inflammatory
changes to travel inward, has been set at rest by the
repeated instances which I have recently encountered.
At the Hospital for Deformities and Nervous Diseases,
I have latelj' seen a girl who met with an injury which
aflected an elbow already anchylosed, in consequence
of which the nerves, especially the musculo-spiral, becoming
sore, the arm grew hypersesthetic, and severe
aching neuralgia set in from the middle arm region to
the finger-ends. This was entirely relieved by extensive
counter-irritation with strong liniments. Very soon afterwards
the circumflex nerve became involved, and the deltoid
rapidly wasted.
In this case, the local injury at the
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