Medical and surgical therapy . mecondition can be observedin the tendons, ligaments,and aponeuroses. . We have seen musclesin which hypotonus andflaccidity were excessiverecover their contractilitywithout operation. Theflaccidity of the musclesmay be masked by con-comitant lesions in themuscles, tendons, or apo-neuroses, or by an cede-matous infiltration, whichis not uncommon, especiallyin the lower limbs. Wehave seen several caseswhere the flaccidity andatrophy of the muscles onlybecame apparent after thesubsidence of long-standingoedema; at the same timeappeared definite signs of sensory and
Medical and surgical therapy . mecondition can be observedin the tendons, ligaments,and aponeuroses. . We have seen musclesin which hypotonus andflaccidity were excessiverecover their contractilitywithout operation. Theflaccidity of the musclesmay be masked by con-comitant lesions in themuscles, tendons, or apo-neuroses, or by an cede-matous infiltration, whichis not uncommon, especiallyin the lower limbs. Wehave seen several caseswhere the flaccidity andatrophy of the muscles onlybecame apparent after thesubsidence of long-standingoedema; at the same timeappeared definite signs of sensory and electrical andthen motor recovery (Henry Meige).^ The attitude of the limb at rest is of still more de-batable diagnostic value. Hypotonus may be verymarked in the course of reflex paralyses and func-tional pareses (Babinski). It is sometimes very pro-nounced in severe injuries to nerves, which never-theless recover in a few months. We have oftenseen musculo-spiral paralyses with marked wrist-drop * Henry Meige, loc. Pig. 18,—Musculo-spiral paralysisin course of recovery. Greathypotonus of extensor musclesof wrist, despite fairly goodmotor and electrical recoveryin these muscles. SIGNS OF SEVERE LESIONS OF THE NERVES 289 (fig. 18) or paralyses of the external popliteal accom-panied by excessive equino-varus (due to ligamentousdistension) recover, both from the motor and electricalpoint of view, without either the attitude of the handor foot altering in any appreciable manner. What we have said of the variability of ulnar claw-hand 1 allows us to state that the existence of a claw-hand depends upon too many factors for one to beable to regard it as a definite diagnostic sign. The interpretation of the ape-hand seen inlesions of the median may be complicated by ananomalous nerve-supply. The absence of any pain on pressure of the muscles isa sign which Henry Meige and Pitres have is indeed a very uncertain phenomenon. Themuscles often present the same painl
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
