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

316 INJURIES OF NERVES.
February 19, 1864.—Admitted.
Nutrition. — Atrophy of pectoralis major great, of
shoulder muscles slight, wasting of biceps and other
anterior and internal arm muscles considerable. Arm
at the centre of biceps measures: left, ten inches; right,
eleven and three-quarter inches. Forearm, left, ten
inches; right, eleven inches. Left hand congested,
dark, and cold. It grows cold easily.
Sensation perfect.
— The neuralgia has nearly disappeared,
except in bad weather and about the insertion of the deltoid,
where there is great tenderness and a good deal of
hardening and deposit in the subcuticular tissues and
about the bone. The only muscle which is hypersesthetic
to any marked degree is the biceps. The course of the
musculo-cutaneous and the median nerves is acutely
tender upon pressure.
Motion.— None in the pectoralis major, scarcely perceptible
in the biceps, the supinator longus alone flexing
the forearm. Extension of forearm perfect. The lingers
act in flexion feebly, but are improving. The thumb motions
are also weak, but not lost. Motion is now most
limited by the state of the finger-joints, which, although
no longer tender, are stift' and enlarged. So much improvement
has taken place very recently that we cannot
be sure as to what motions were lost.
Probably the principal
nerves of the external cord of the plexus, namely,
the musculo-cutaneous and the median, were those chiefly
aftected; certain filaments of the posterior strand, as the
circumflex, also sharing in the diseased conditions. The
remainder of the case would be irrelevant here. It was
improving when admitted, and it
gained ground with increased
speed under a course of baths, gymnastics, and
faradisation.
We have here stated two strikins^ instances out of
several to show that a nerve being injured, it is possible for