Text-book of nervous diseases for physicians and students / by H. Oppenheim.

Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by H. Oppenheim. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    30/1480 (page 6)
    been found that excision in itself may cause changes in the muscular tissue. The most important and exact method of testing the nutritive con- dition of the muscles is electrical examination, which, without doubt, forms one of the most valuable aids to diagnosis (see below). Muscle Tonus.—Before passing on to test the power of active move- ment, it is well to form an opinion as to the condition of tonus of the muscles, since changes in it material^ influence active motor power. Muscle tonus may be exaggerated or diminished. We find this from examination of the poiver of passive movement and of the tendon phenomena. In order to carry out passive movements, we take hold of the ex- tremities of the patient and endeavour to move them at each separate joint in ever}^ direction and to the maximum extent, where the mechanical condition of the joints permit of movement. This offers no difficulty when the muscle tonus is normal and there is no muscular tension to be overcome. Exaggeration of muscle tonus does indeed, even under phj^sio- logical conditions, follow passive movement, i.e. there is a reflex increase of tension from the associated stretching of the muscle (Westphal, Hering, Foerster), but this is so slight that a palpable resistance only sets in when the passive movement is at its ultimate limit. Further, pathological tension may be simulated when the patient stretches the muscle actively, either intentionally or, as is usually the case, unconsciously—from awk- wardness caused by ignorance of what he should do, or from anxious expectation and excitement. He should be instructed to leave his limb, entirely to the examiner and to avoid all tension. He should be taught that relaxing of the tension subjects the passively raised hmb to the force of gravity, so that it falls down, etc. When this does not succeed, his attention should be engaged in other directions, by occupying his mind, setting him a mental sum, etc. It is only when the passively lifted limb falls b}^ its own gravity back on to the bed that this disturbing factor can be assumed to be set aside and the further results of the examination duly taken into consideration. Pathological Conditions of Tension, Hypertonus of the muscles is, firstly, revealed by difficulty of passive movements. When the hyper- tonus is great, the difficulty is felt in every attempt at movement. If we try to abduct the leg at the hip-joint, tension of the adductors at once becomes visible and palpable—it is not the leg that is moved outwards, but the whole pelvis. A certain, often a great, effort of strength is re- quired on the part of the patient to overcome this tension, and as soon as he relaxes it, the extremity returns to its original position. The same resistance caused by the examination makes itself felt in the other joints, and opposes a more or less serious obstacle to passive movement. As a rule we have not to deal with these most marked degrees, but with a slighter increase of muscle tonus, which becomes manifested by a reflex increase during the passive movement. In such cases passive movements if executed sloivly can be carried to their full extent and with- out special resistance. But as soon as the attempt is made more abruptly, and the limb moved rapidly and forcibly, muscular tension appears. This tension becomes marked, especially in abduction of the leg at the hip or its extension at the knee-joint. Attention should be specially paid to this at the commencement of the examination, as it usually diminish(>s and there is no further opposition to the movement.