Orthopædic surgery : a textbook of the pathology and treatment of deformities / by J. Jackson Clarke.

  • Clarke, J. Jackson.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Orthopædic surgery : a textbook of the pathology and treatment of deformities / by J. Jackson Clarke. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    74/496 (page 50)
    flex. sub. digit., tlie pron. rad. teres, and the \)ron. quadrat, never reacted at all. The supinator longus always reacted. iSensation returned coincidently Avith the muscle reactions. Under tliis treat- ment he got back considerable power in the forearm, but the thumb muscles were very obstinate. For some weeks he had fair use of the arm and hand, for he could grasp a knife or fork and even use dumb-bells. The whole arm then began to waste and stiffen, and became much more pronated, though sensation was perfect. A tendency to clawing of the hand was observed about four months after the original accident, and it increased in spite of regular massage. The evidence in this case pointed to secondary shrinking of muscle. As soon as the deformity, wliich is represented in Fig. 26, had ceased to increase, I divided the flexor tendons above the wrist through a short longitudinal incision. This operation removed the whole of the deformity. The various affections regarded as progressive myopathies —(1) pseudo-hypertrophic paralysis ; (2) hereditary (or Erb's) muscular atrophy; and (3) the various forms of progressive muscular dystrophy may occasion deformities such as club- foot, and, in exceptional cases, orthopoedic surgical measures may give temporary relief; but the full consideration of these conditions belongs to Avorks devoted to the diseases of nerves. Neurogenous Contractures. — Contractures which have their origin in abnormal conditions of the nerves fall into three different categories—(1) reflex; (2) spastic ; and (3) paralytic. Reflex Contractures.—The commonest conditions of this kind are contractures due to chronic joint-affiections—e.g. rheumatoid arthritis. In tubercular and other forms of arthritis, reflex contracture also plays a large part in the production of deformity. In some cases of spasmodic flat-foot the painful contraction of the muscles is also of a reflex character. Spastic Contractures are due in most cases to central nerve-lesions. Brain-lesions, whether hiymorrhage, syphilis, tumours, multiple sclerosis, or what not, are all frequently characterised by spastic conditions of the muscles, of Avhich the innervation is disturbed. Cord-lesions, whether liicningitis or myelitis, also ]:)roducc the same effects. It is in spastic