. Medical and surgical therapy. ower Limb Afnyotrophic paralysis of the quadriceps.—This isthe classical form of reflex atrophy which generallyfollows a femoro-tibial arthritis, but it may also beobserved after wounds of the thigh or in the region ofthe knee in the absence of any lesion of the joint orpatellar tendon {v. Fig. 6). The atrophy is sometimesassociated with an obstinate paralysis of the quadriceps,and may be accompanied by extreme hypotonus{v. Fig. 15); usually, but not invariably, the kneejerk is exaggerated. ConiraHure of the pelvi-trochanteric muscles associatedwith jjoresis of
. Medical and surgical therapy. ower Limb Afnyotrophic paralysis of the quadriceps.—This isthe classical form of reflex atrophy which generallyfollows a femoro-tibial arthritis, but it may also beobserved after wounds of the thigh or in the region ofthe knee in the absence of any lesion of the joint orpatellar tendon {v. Fig. 6). The atrophy is sometimesassociated with an obstinate paralysis of the quadriceps,and may be accompanied by extreme hypotonus{v. Fig. 15); usually, but not invariably, the kneejerk is exaggerated. ConiraHure of the pelvi-trochanteric muscles associatedwith jjoresis of the foot.—This variety of motor dis-turbani;e is almost always found after traumatism inthe region of the hip. In the dorsal decubitus thelower limb is in a position of very pronounced externalrotation ; the outer border of the foot being in contact S YMPTOMA TO LOG Y 519 with tlie surface of the bed, passive movements of thethigh are somewhat limited, especially movements ofinternal rotation, and pull the pelvis round more. Fig. 6. Figs. 5 and 6.—Amyoteophic paralysis of the right quadricepsASSOCIATED w^TH PARESIS OF THE FOOT, following a wound(November 4, 1914) of the outer aspect of the knee withoutlesions of the joint or patellar tendon. The reflex paralysis isaccompanied (June 1916) by the following signs : pronouncedand obstinate vaso-motor and thermal disorders with smallulcers of the foot, mechanical and faradic hyj^erexcitabilitv ofthe quadriceps and muscles of the antero-external region of theleg, and hyperexcitability of the small muscles of the amyotrophy of the thigh is considerable, and the hypotonusis marked. The paralysis is very pronounced. When thepatient is in the dorsal decubitus, with t-lie legs hanging overthe side of the bed (Fig. 5), and tries to extend them, he succeedson the sound side only. Jn the affected limb (Fig. (5) the thighis extended, but the leg, instead of being extended, becomesflexed. 520 REFLEX NERVOUS DISORDERS rapidly tha
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