Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare.

  • Hare, H. A. (Hobart Amory), 1862-1931.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare. Source: Wellcome Collection.

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    no degenerative reactions occur, there may be some pain, and crepi- tation on moving the arm. The cause of these symptoms lies in tlie fact that there has been a separation of the epiphyses from the shafts of the bones with consequent helplessness. Sometimes general par- alysis of the extremities arises from the extension of the disease to other limbs. The prognosis as to life is bad. It yet remains for us to discuss the paralysis of several important groups of the muscles of the arm. If the forearm cannot be flexed, there is loss of power in the biceps aud brachialis anticus, and to some extent in the supinator longus; and as the first two muscles are supplied by the musculo-cutaneous and the third by the musculo- spiral, such a failure in flexion shows paralysis of these fibres. Paralysis of the extensors of the forearm, wrist, and hand, and of extension of the elbow with wrist-drop in consequence, and flexion of the tips of the fingers is due to disease affecting the musculo- spiral nerve, but the fingers can still be partly extended through the action of the interossei and lumbricales, provided the tips are flexed. The back of the hand and wrist become unduly prominent after a short time because of the forced flexion of the hand aud rapid wast- ing of the extensors. In most cases the supinator lougus, which supinates the forearm after it is pronated, is paralyzed. When the ability to pronate the forearm is greatly impaired, and the thumb is extended and abducted, so that it cannot be brought in contact with the tips of the fingers, the trouble is probably paralysis of the median nerve, and this is confirmed if all the phalanges are paral- yzed except the first. If the arm cannot be moved outward, away from the body, there is paralysis of the deltoid supplied by the circumflex nerve. In this connection attention should be called to the loss of power with wasting of the muscles seen after direct blows on the muscle or after injuries to the joint, sometimes called joint-palsies. Brachial Pareesthesia. Disturbances of sensation in the hand and arm consist in anaesthesia, analgesia and numbness, tingling, aud pain. The area of these sensations depends upon the nerve-trunks involved, and to some extent upon the degree of involvement. Thus, if the function of the nerve is merely impaired, the sensation may be that of tingling or pain; if still further impaired, the seusation may be that of numbness; and if the sensory fibres be totally destroyed or paralyzed, absolute anaesthesia and analgesia may be present (see chapter on Skin Anaesthesia).