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.

    39/1480 (page 15)
    The paralysis is, however, made very evident by the loss of cei'tain movements and the anomalies of position thus produced. 1. In abduction of the arm to the horizontal, the shoulder blade is approximated to the spinal column, the inner border is raised from the thorax and pushes the trapezius and the rhomboids before it (Fig. 6). 2. The arm cannot be raised beyond the horizontal, owing to the absence of the external rotation of the shoulder blade, which is necessary for the completion of the movement. When the examiner carries out this movement by pressing the lower angle of the scapula outwards, the arm can be raised to the vertical position. 3. In the attempt to extend the arms forwards, the scapula is raised, especially in its uiner border, away from the thorax like a wing, so markedly in some cases that a hand can be placed between the scapula and the thorax (Fig. 7). Fig. 5.—Position of scapula with arms Fig. 6.—Position of scapula in senatus paralysis dependent in paralysis of right senatus during abduction of the arm (after Bruns.) magnus (after Baumler). In some cases of serratus paralysis the arms can, however, be forcibly raised as far as the vertical position (Baumler, Jolly, Bruns). It is thought that in such cases the middle portion of the trapeziiis effects the external rotation of the shoulder blade, either because it is specially well developed from birth (Souques), or because it has gradually become compensatory for the serratus. Some writers (Steinhausen ^ and others) have recently laid it down as the rule that even in complete serratus paralysis the arm can be raised slightly beyond the horizontal (even to an angle of 120-140°), as they attribute to the deltoid muscle a greater range of action than has hitherto been ascribed to it, or regard the usual form of this paralysis as a partial paralysis with integrity of its uppermost bundles. The latter view is, however, opposed by Bramwell and Struthers.2 Visible and palpable absence of the digitations of the muscle may also be a symptom of serratus paralysis, as it is usually associated with atrophy. The deltoid muscle moves the arm outwards, forwards, or backwards, according as its middle, anterior, or posterior bundle is contracted. The arm cannot, however, be elevated above the horizontal plane. The posterior bundle does not carry it by any means so far. The view that the deltoid abducts the arm to an angle of 90° and that further elevation is then produced 1 Z. f. N., xvi. 2 E. of N., 1903.