« PreviousContinue »
atrophied, and the last two phalanges were rigidly flexed, and in the fourth and fifth fingers could not be mechanically extended, owing to the retraction of the cicatrix (A, fig. 44) to which their flexor tendons adhered. These bands were ruptured by gradual extension, but complete paralysis remained. Figs. 44 and 45 show the hand before treatment. The injury of the ulnar nerve caused atrophy of the interossei, and the last two lumbricales. The muscles of the forearm were unaffected, and being unopposed, the phalanges were drawn into a claw-like deformity (“main en griffe"). This deformity was still more pronounced when the patient endeavored to extend his fingers. For four years every sort of treatment was tried in vain. Faradization was then commenced on alternate days, and localized in the interosseous spaces, and the thenar and hypothenar emi
A powerful and painful current was used. After ten sittings the patient felt a burning sensation, the hand was observed to be less atrophied, and the interosseus spaces to be slightly filled in, the first phalanges less flexed, and the second begun to extend. Circumstances obliged him to suspend treatment for three weeks, and when it was resumed the improvement had been maintained. Cutaneous faradization was now added, and sensation greatly improved, and the cutaneous veins, which had not been visible, began to reappear. Development of the small muscles of the hand followed, with improvement in the attitude of the fingers. Next, the heads of the metacarpi ceased to project.
Reckoning on a gradual and spontaneous cure, the patient again discontinued treatment for two
months, at the end of which time he had made no further progress. Treatment was resumed, with steady improvement, and gradual return of voluntary power, until he was even able to write. Fig.
Hand after Treatment. 46 shows the hand after treatment, as the patient endeavored to place it in the deformed position (fig. 44) that it had before treatment. Fig. 47 shows the attitude of the hand when writing. It will be seen
from fig. 46 that he could not succeed in dislocating the first phalanges upon the metacarpi, their old deformity; that the heads of the metacarpi are now in their normal state; that the flexor tendons are no longer seen projecting in the palm ; that the thenar and hypothenar eminences are developed; and, finally, that the fingers have lost their bony appearance.
Faradization is only of use after the nerve has been reunited, a process requiring time; for it would be irrational to expect benefit as long as the ruptured nerve is physically incapable of transmitting the mandates of the will. Nature will not effect a cure spontaneously by mere lapse of time, for in the above case no less than four years had passed without improvement.
The next case is an example of the inutility in such cases of recent faradization.
A man was admitted into the Hôtel Dieu with a dislocation of the head of the humerus into the axilla. It was reduced under chloroform, when it was found that the muscles of the arm, forearm, and hand were completely paralyzed. Sensation was not affected. A month after, when Duchenne first saw the patient his state was unchanged, except that there was considerable atrophy of the paralyzed muscles, and sensation was lowered about one half. Farado - muscular contractility was abolished to either direct or indirect excitation in all the muscles of the hand, forearm, and arm. In the shoulder
muscles,the deltoid excepted, in which there was some diminution, it was intact. The muscles were regularly faradized on alternate days for about ten minutes. In spite of this, atrophy rapidly progressed, until at the end of the second month from the onset the muscular tissue was hardly discernible, the thenar and hypothenar eminences had disappeared, the flexor tendons projected into the palm, as shown in fig. 49, and
in the dorsal surface were deep hollows from wasting of the interossei. It was six months before flexion and extension of the forearm were regained, and four years before the development of the muscles again equalled those of the uninjured side. Although there was complete restoration of voluntary power, there was no return of farado-muscular contractility. Fig. 48 shows the arm one month after the accident, the deltoid is but slightly atrophied, but the arm and forearm are one third less in cir
cumference than on the uninjured side.
Fig. 49 is the palm of the hand two years after the accident. Fig. 50 the arm after the end of treatment. We see then that in traumatic paralysis the regular application of faradism from its onset does not prevent the muscles from almost complete atrophy, but its use, after repair of nerve lesion, will restore their development, nutrition, and voluntary movement.
But it is in these recent cases of traumatic paralysis that the interrupted voltaic current should be localized in the wasted muscles.