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

TREATMENT. 283
Next the nerve should be examined with the utmost
care, in order to ascertain how far up
it is hardened and
enlaro^ed. The examination in these cases is far more
easy than might be supposed, because in many instances,
owins: to muscuhar wasting-, the nerve trunks can be
readily felt. B3' rolling or compressing the diseased
nerve under the finger-tips, an attentive observer can very
often learn whether or not it has undergone inflammatory
or sclerotic change.
It is, as a rule, desirable that the section should be
made a short distance above the point at which the nerve
ceases to feel enlarged and hard. If it be practicable
to find even a little farther up the limb a spot where the
nerve is neither swollen nor tender upon pressure, the
operation should be done at that point. Usually, however,
nerves long diseased are sensitive up to and into
their parent plexus, so that in practice the surgeon must
content himself with a division some distance above
the point where the nerve is obviously diseased. When
it lies too deep for examination, it will be safest to
operate high up in the limb, and, indeed, as a rule, the
older the neuralgia, if of traumatic origin, the wiser it
is to divide the ofiending nerve as near to the body as
possible.
The necessity for making section of the nerve at a
point where its tissues are sound, arises out of the fact, so
often insisted upon in these pages, that subacute neuritis
and sclerosis inevitably travel inward along the nerve
attacked, and that if above the line of division the surgeon
should leave any considerable amount of diseased
tissue, his operation may be useless,
change continue to ascend the nerve, inflicting
and the morbid
new tortures,
and perhaps calling for further operative interference.
The popular medical view attributes the return of
pain after neurotomy to a reunion of the nerve ends;