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

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262 INJURIES OF NERVES.
and the peculiar flattening of the hand are perhaps owing
to this and to the long rest and disuse, the arms meanwhile
lying crossed on the chest, the lingers in extension.
Disuse alone might have caused some stiffness, but never
to such a degree as occurs when the joints have been subacutely
inflamed at the same time. The loss of the lateral
palmar arch is owing to both causes, and the monkeylike
appearance of the hand, the thumb rotated outward,
its nail looking upward and even toward the forefinger,
is caused, first, by the subluxation of the metacarpophalangeal
articulation, and secondly, by the weakening
and atrophy of the adductor and short flexors of the
thumb. The nerve lesion, affecting the muscles and the
general nutrition of the part, has so relaxed the unused
tissues of the limb as to make the pressure of its own
weijj-ht effective in thus altering its form.
Sensation.— Tactile sense enfeebled equally in both arms,
worse in the left. Feeble in both legs, worse in the left.
Confused power of localizing sensation in the legs. Mistakes
rio;ht for left, but not left for right.
There is muscular hypersesthesia of the upper members,
shoulders and neck; none in the legs.
The left brachial
plexus is sensitive to pressure, and this causes pain in the
left arm and hand. The palms tingle, and burn a little,
the feet not at all.
Every attempt at passive motion causes exquisite pain
in the arms, hands, and shoulders, but most of all in the
back of the neck, about the first and second vertebrae.
This is due, first, to the hyper?esthesia of the muscles, and
secondly, to the state of false anchylosis, owing to rest in
one fixed posture. He either is too weak to move the
body or is really paralyzed in, the spinal muscles. The
biceps, flexors, and wrist muscles are very rigid, as well
as the trapezius, and the atrophj' of the muscles throughout
the upper limbs is singularly well marked.