Wrist-drop from fracture of the humerus injuring the musculo-spiral nerve (N. radialis) : suture after 10 weeks, early restoration of sensation and later of motion / by W.W. Keen and William G. Spiller.

  • William Williams Keen
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Wrist-drop from fracture of the humerus injuring the musculo-spiral nerve (N. radialis) : suture after 10 weeks, early restoration of sensation and later of motion / by W.W. Keen and William G. Spiller. 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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    with the finger and thumb and a fortiori by any instrument would require more force and do more mechanical violence tlnan the method I adopted. The overlapping of the nerve also gav(i mo the measure of bow much F could remove. After removal, the piece exsected measunnl 3.7 cm. The nerve was then sutured with silk, passed directly through the nerve. After tying a few vessels, the wound was closed with a small drainage tube at each end. The only vessel that gave any ti’ouhle was the posterior circumflex. The patient’s highest temperature after the operation was 99° F. He left the hospital one week after the operation, the wound being entirely healed. On the next morning after the opei-ation, there was distinct improvement in the area of radial sensation. By the third day the light touch of a single hair over these fingers was felt. No motion, however had been acquired by the time he left. Soon after the operation, I went away for a long absence. Mr. R. came to Philadelphia on January 10th, 1902, nine months after the operation and saw Dr. Wharton Sinkler. At that date sensation was perfect but there w'as still complete wrist-di’op while flexion of the fingers and wrist, and pronation and supina- tion of the hand were perfect. There was no response to the faradic current. While the muscles responded to a strong gal- vanic current, thei'o was marked quantitative loss, Init no reac- tion of degeneration. Mr. R. was directed to use the galvanic current daily for 10 to 15 minutes with injections of 1/20 gr. of strychnine into the extensors three times a week. He consulted me again on February 10th, 1903, and I was quite astonished at the result. Sensation is perfect and as to motion, he has a perfectly useful hand (Figs. 1 and 2); the oidy defect is that while extension at the wrist alone is perfect, and normal in degree, and extension of the fingers alone is e(iually good, if he ti’ies to extend both fingers and wrist, he has only about 75 to cSO /„ of the full range of motion for the combined extension. He tells me that for about three or four months he ke])t up the use of the galvanic battery and For some time the injections of strychnine as recommended by Dr. Sinkler, but that he has not used either for a long while. Strange to say the electrical r<!actions at the present time are practically un-