. A text-book of medicine for students and practitioners . ly diseasedin the trunk and the up-per extremities: the pec-toral is major and minor,the trapezius, the latissi-mus dorsi, the serratusanticus major, the rhom-boidei, the sacro-lumbalisand longissimus dorsi, andlater the triceps. Thefollowing, however, al-most always remain nor-mal ; the sterno-mastoid,the levator anguli scapu-lae, the coraco-brachialis,the teres major and mi-nor, the deltoid, the su-praspinatus and infraspi-natus, and, as must bementioned especially indistinction from spiiudmuscular iilropliy, thesmall muscles of the
. A text-book of medicine for students and practitioners . ly diseasedin the trunk and the up-per extremities: the pec-toral is major and minor,the trapezius, the latissi-mus dorsi, the serratusanticus major, the rhom-boidei, the sacro-lumbalisand longissimus dorsi, andlater the triceps. Thefollowing, however, al-most always remain nor-mal ; the sterno-mastoid,the levator anguli scapu-lae, the coraco-brachialis,the teres major and mi-nor, the deltoid, the su-praspinatus and infraspi-natus, and, as must bementioned especially indistinction from spiiudmuscular iilropliy, thesmall muscles of the muscles of the forearm, too, except the supinator longus, remain intactfor a long time, if not permanently; but exceptions also occur: for example,the accompanying illustration (Fig. 181) shows two brothers with juvenilemuscular atrophy which in other respects is characteristic, but the muscleson the extensor side of the forearm are also completely atrophied. In thelower extremities the atrophy attacks chiefly the ghitaM and the quadriceps, more. Fig. 182.—Juvenile muscular dystrophy. Prominence of thescapulic when the arms are raised in consequence of atrophyof tile serratus and rhoniboidei. (Personal observation.) 390 DISEASES OF THE NERVOUS SYSTEM rarelyof the the peronei and tlie tiltialis anticus, while the sartorius and the musclescalf are usually wholly exempt. Fibrillary twitchings in the affected nmscles are generally absent, and there ishardly ever any reaction of disturbances of function due tothis condition are self-evident, so that afull descri])tion of them may be arms \isually suffer first, as we havesaid. The marked indjcction of thescai)ula\ from the paralysis of tlie ser-ratus, is especially characteristic (). If we try to take the patientunder the shoulders and lift him, theshoulders are peiMVclly limp. They aretherefore immediately raised so high thatthe head comes between the shoulders(loose shoulders). The mos
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