Is a brachial monoplegia always most marked in the hand? / by G. Bergmark.

  • Bergmark, Gustaf, 1881-
Date:
1910
Catalogue details

Licence: In copyright

Credit: Is a brachial monoplegia always most marked in the hand? / by G. Bergmark. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    muscles that showed the higher degree of contracture. This tallied with Darkschewitsch’s case 8, in which, before any signs of arthritis were present, pain was brought on when the contracted pectoral muscle was stretched ; and as in my case the pain disappeared in proportion as the “ early contracture ” diminished, I think myself justified in inferring that the pain was due to this cause, there being consequently no reason to regard it as a symptom of an arthritis. This disposes, there- fore, of the only possible justification of the opinion that an arthritis might have played the part of a direct or indirect cause of the restriction of the movements of the shoulder- joint. The fact that the paresis remained for a long time after the contracture and pain attending passive movements had dis- appeared from the shoulder-joint is a proof that the pain cannot have simulated paresis in this case. There was, in fact, intense paresis at the elbow-joint also, though no pain was felt there ; nor was contracture at any time so marked there. Hence there is no reason to suppose that an arthritis may be the cause of the restriction of the movements of the shoulder joint. The pain has, it is true, obviously been due to the con- tracture, but, on the other hand, it is equally obvious that it cannot possibly have been the cause of the restriction of the movements. I have not been able to find any other circum- stances that might have played a part in reducing the motor power of the shoulder joint so much more than that of the more distal parts of the arm; hence I think myself quite justified in drawing the conclusion that this is a case where a cortical lesion has caused a paresis more marked in the proximal than in the distal parts of the arm. As to the leg, no paresis was present there, but the rigidity which developed later affected only its proximal parts, whereas no spastic symptoms were present in the distal parts at the close of the time of observation, not even Babinski’s sign being then obtainable. The simplest explanation is unquestionably that of a lesion occupying the centre for the shoulder-joint, and affecting secondarily the nearest part of the centre for the leg, but not those parts situated at a greater distance from the first-named centre. As it is obvious that any case bearing on the question of whether a brachial monoplegia of cerebral origin may be more