Volume 1

A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.

Date:: 1893-1894

Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.

865/962 (page 845)

$AFFECTIONS OF THE THORACIC AND DORSAL NERVES. ^45 fourth iingcrs this can he performed 1)V the ulnar lialf of the flexor profundus. When the sensation is involved it f )llo\vs the distribution of the fibres, as already nieutioned. The wasting of the thunib-muscles forms a striking cha- racteristic in this f )rni of jtaralysis. The skin may be glossy and the nutrition of the nails impaire(h Thoracic and Dorsal Nerves. The anterior liranches of the twelve dorsal nerves supply the intercostal muscles, the levatores eostarum, the abdominal muscles, and the serrati postici. The sensory branches supply the skin in the antero-lateral region of the thorax and abdomen. The jwsterior branches of the dorsal nerves supply the deep mus- cles of the back and the skin over the same. Affections of these branches are not very frequent, except of the intercostal nerves, which are the subject of an intractable form of neuralgia. Intercostal nou'dh/id occurs most commonly in women, and involves the nerves from tlie third to the ninth, most frequently the seventh, eighth, and ninth on the left side. The cases are most common in ansemic, overworked women. The nerves may be involved by aneui'ism or tumor, occasionally in chronic pleiu'isv, or in the adhesions of long-standing tuberculosis, or in caries of the spine. Though usuallv constant, the pain is subject to marked exacer- bations, and may be very severe; movements such as coughing and deep inspi- I'ation aggravate it very greatly. Tender points are usually present at the intervertebral foramen, one near the sternum, one over the rectus muscle, and a third midway between these. The neuritis causing neuralgia is often accom- panied with an eruption of herpes zoster, forming the so-called shingles. The pain may be most intense prior to the outljreak of the rash, and in some instances persists long after its disappearance. The diagnosis of intercostal neuralgia is usually easy, though special care must be taken to ex<'lude the presence of spinal caries, of aneurismal tumor, and of ])leurisy. Many cases ])rove very intractable. A siM^cial form is the neuralgia of the branches passing to the breast— raastodynia. It is seen mcjst commonly shortly after puberty in anaemic and hysterical girls. The pain may be very severe, either localized or involving the entire breast. Occasionallv small hard nodules are felt beneath the skin. The condition may f »l!ow ]>rolonged lactation. Paralysis of the muscles supplied by the thoracic and dorsal nerves is rarelv seen alone, and in cases of hemi])legia they are not involved, the mus- cles of both sides being innervated from either hemisjtlicre (Broadbent). Tn the forms of primarv muscidar atro]»hy tlie weakness of the back muscles is very striking, and the attitude of the child, with marked arching of the lum- bar vertebrfe, prominence of the abdomen, and arching backward of the liack, forms a verv characteristic picture. In getting up from the floor the child has to lift his body on the arms and gradually climb up his legs, as in the familiar picture in Gowers' work.'$