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

TREATMENT. 303
Ti^eatment.— Cold-water dressings and means to relieve
burning, but all ineffectual. The joints became swollen
early, and the arm bent at a right angle. The hand, dependent,
lay across his chest during a long period. He
made some attempts at passive motion as he found the
hand becoming stitF, but no great good was thus gained ;
and, as the contractions took place and the joints grew
worse, the wrist became moulded to the curve of the chest,
on which it lav.
About the tenth day, burning pain began in the palm
and fingers, especially in the cushions of the fingers and
the knuckles. It was at its worst a month later, and
remained thus another month, after which it
grew less.
When at its height, he suffered from loud sounds, vibrations,
and dry contact. The rubbing of his boots on the
floor was the greatest annoyance, and this he relieved by
wetting his stockings. Since October, four months after
he was wounded, it has been unaltered. Sensation, little
affected at the outset, has undergone no change of moment.
Voluntary motion, which grew better for awhile,
suffered anew and increasingly as the nutritive changes
developed themselves. When they
first arose we have
been unable to determine.
Present state, December 17, 1863. Nutrition. — The
wounded arm is shrunken, generally with well-marked
atrophy of the supra- and infra-spinatus, deltoid, and
biceps, the loss in the last two being fully one-half. Triceps,
no wasting of moment. Supinator longus and radial
extensors, two-thirds loss. Flexors and extensors in forearm,
one-half loss. Thumb muscles almost absent. Little
finger and interosseal group, no loss.
Contractions.— The flexor carpi ulnaris, palmaris longus,
and flexor carpi radialis being strongly contracted, the
wrist is bent at a right angle to the arm and drawn to the
ulnar side ;
the extensor group
is in like manner con-