. Medical and surgical therapy. f the cases with injury to themusculo-spiral nerve shows certain details, whichshould be remembered. They are nearly always cases of fracture of th^,humerus in its middle third, which have necessitatedprolonged immobilisation of the arm, and which havesuppurated. Ankylosis becomes very gradually estab-lished. More rarely ankylosis was immediate, the elbowhaving assumed a right angle directly after thewound, and in those cases it can be found on carefulexamination that the biceps is contractured, itstendon is prominent, and its body may evenappear more excitable
. Medical and surgical therapy. f the cases with injury to themusculo-spiral nerve shows certain details, whichshould be remembered. They are nearly always cases of fracture of th^,humerus in its middle third, which have necessitatedprolonged immobilisation of the arm, and which havesuppurated. Ankylosis becomes very gradually estab-lished. More rarely ankylosis was immediate, the elbowhaving assumed a right angle directly after thewound, and in those cases it can be found on carefulexamination that the biceps is contractured, itstendon is prominent, and its body may evenappear more excitable to mechanical and electricalstimulation. It is not rare to see cases of injury to the musculo-spiral nerve with a fracture of the shoulder, whichhave suppurated for a long time, or resulted in pseud-arthroses, showing a certain degree of stiffness of theshoulder. Wounds of the median nerve are only rarely accom-panied by ankylosis of the elbow. When thisankylosis exists it is slight, and mainly affects the joi:nt affections 393. Fig. 54.—Painful form of wound ofthe median. State of the handtwenty months after the ankyloses and deformityof the terminal phalanges and of thenails. movements of supination ; occasionally, but far less, that of pronation. Exte nsion of the wristmay be limited ; at thesame time difficulty inflexing the phalanges oneach other is have just spokenof complete lesions ofthe me(fian or of incom-plete painless in causalgic formsof wounds of this nervejoint affections reachquite unexpected pro-portions. We have dis-cussed these conditionsat length elsewhere.^ These manifestations aiBfect the elbow joint (ankylosis in flexion), wTist joint (ankj^losis in flexion), and especially the finger joints. The articulations most affected are the metacarpo-phalangeal and then the interphalangeal. In the attenuated painful forms these last articulations are the only ones involved (figs. 54 and 55). In wounds of the ulnar we must d
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