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

254 INJURIES OF NERVES.
gained, except that of the iuterosseal muscles. To have
a prothetic apparatus, and be discharged.
Re-examined April 9, 1864.— The hand is now healthy
in
color, the neuralgia nearly entirely well.
April 22, 1867.
Visible condition of hands. — Trails of the
left hand slightly incurvated ; palm mottled, almost
normal.
3Ieasurements. — Biceps: right, ten and three-eighths
inches; left, ten and one-eighth. Forearm: right, ten and
five-eighths; left, ten and a quarter. The loss in the right
arm is
probably due to a change in his occupation, he
being now a stationer. The left arm has gained relatively.
Nutrition.— Flexors of left forearm, thumb muscles, and
interossei all slightly wasted. Flexors of fingers the onl}''
contracted muscles. Thumb has very nearly regained
its
normal position.
Sensation normal on dorsum of hand, perfectly localized,
but a little blunted on palm;
dull and rather imperfectly
localized on palmar surface of fingers.
Motion.— Flexion and extension of wrist natural when
the fingers are flexed, as they always are except when
passively extended. Extension is limited by the contracted
finger flexors. Pronation and supination entire.
Abduction of thumb lost; flexion weak; extension good.
ISo abduction or adduction of fingers; no extension of
last two phalanges, save tli
rough violent extension of the
first
phalanx; but there is some flexion of the first. It
is doubtful whether this fiexion is not merely a secondary
effect of the flexion of the last two phalanges. The clawhand
is
only manifest on extension of the fingers, the
first phalanges alone being extended, the last two flexed
one-half.
Electrical test.— Electro-muscular sensibility in left arm
and forearm the same as in the right ;
in the hand, diminished
nearly one-half. Electro-muscular contractility is not