Medical and surgical therapy . n themiddle third, and does notreach the shin. Round the zone of anaes-thesia we generally find aband of hypsesthesia of greateror less extent. Pressure onthe trunk of the nerve at theneck of the fibula does notcause pain, unless there arelocal lesions of the bone. Reflexes. — The knee- andankle-jerks are present. Wehave seen cases in whichthe latter was absent. Theplantar cutaneous reflex isalways flexor. Idiomuscular contraction isexaggerated in the earlierstages in the large musclesof the antero-external regionand in the peronei. It diminishes in intensitj^,an
Medical and surgical therapy . n themiddle third, and does notreach the shin. Round the zone of anaes-thesia we generally find aband of hypsesthesia of greateror less extent. Pressure onthe trunk of the nerve at theneck of the fibula does notcause pain, unless there arelocal lesions of the bone. Reflexes. — The knee- andankle-jerks are present. Wehave seen cases in whichthe latter was absent. Theplantar cutaneous reflex isalways flexor. Idiomuscular contraction isexaggerated in the earlierstages in the large musclesof the antero-external regionand in the peronei. It diminishes in intensitj^,and gets rather slower whenthe paralytic lesion is several ^iq. 77.—Distribution of sen months old. This slow mus- sory disturbance in lesions cular contraction is best seen in the extensor brevis digi- torum in the earlier weeks (Sicard) ; it is not long in disappearing completely as the muscular atrophy progresses. Vasomotor Disturbances —These are not rare cases there is a purple discolouration of the foot,. Fig. 76. — Zone of sensorychanges of the dorsum of thefoot in a case of lesion ofthe external popliteal nerve. of the external poplitealnerve. The black area re-presents anaesthesia, thedotted area hypaesthesia. 186 CLINICAL FORMS OF NERVE LESIONS which, is colder than the one on the opposite side.(Edema can never be detected. The skin is normal, and there is no important changein the nails or in the pilous system. Desquamationof the epidermis with diminution or disappearance ofsweating may sometimes be observed in the first twodorsal interosseous spaces. The subcutaneous tissue is slightly infiltrated on theexternal surface of the leg, as can be found by pinchingthe skin. Recovery.—Restoration (spontaneous or after sutureof the divided nerve) takes place only after severalmonths. The first favourable sign is the appearanceof subjective disturbance of sensibility, such as painon pressure of the nerve-trunk and on pinching the skinin the sensory regio
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
