. Médecine et chirurgie. doigts ; le thenarmuscles contrat partiellement, qui d'abord ont été paralysés, commencent. torecover Dans les deux cas qui nous illustrer il y avait des lésions vasculaires, anassociated compensatedfor assez bien dans la plupart des égards, et l'irritation de l'secretoryfibers ce qui a conduit à la transpiration excessive dans le medianarea (figs. 52-54). Lésions des nerfs CUBITAL ET MÉDIAN 115 Enfin, dans tous ces différents types le montant de l'ofparalysis interossei fléchisseurs et devrait être notedon l'une part ; et, d'autre part, la force des extenseurs lombaires, lésions vasculaires associées,

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. Medical and surgical therapy. fingers partially contract ; the thenarmuscles, which at first were paralysed, are beginning torecover. In the two cases which we illustrate there was anassociated vascular lesion, fairly well compensatedfor in most respects, and irritation of the secretoryfibres which led to excessive sweating in the medianarea (figs. 52-54). LESIONS OF MEDIAN AND ULNAR NERVES 115 Finally, in all these different types the amount ofparalysis of the interossei and flexors should be notedon the one hand; and, on the other, the strength ofthe extensors, associated vascular lesions, anastomosesof the nerve-trunks, and, finally, articular lesionsshould be taken into consideration. Articular lesions no doubt depend on individualsusceptibility to disease ; but we are inclined to thinkthat the lesion is related to those arthropathies whichset in early in some wounded men and result in greatdeformity. The retraction of the flexor tendons varies in dif-ferent individuals, though the site of lesion in the nerve. Fig. 54.—Partial paralysis of median and ulnar nervesfrom injury to the brachial plexus (fifth type). Con-comitant vascular lesion and retraction of tendons. may be identical. Is this due to predisposition on thepart of the patient or to degeneration of muscle ? Oris there any established equilibrium between the flexorsublimis, the flexor profundus, and the interossei, whichvaries with the individual, and the upset of whichpresents different features according to the type ofthe lesion ? In these partial palsies it may be as well also to takeinto consideration the progressive, though unequal, return of movement and tone to some of the muscleswhich, as they recover, cause twitchings and alter theequilibrium of the articular surfaces, but, when in-flammation of the soft parts supervenes, the lesion isestablished, and ankylosis and retraction set in. Onlyvigorous and prolonged treatment avail then to effectany change in the conditions. 116 CLINICAL FORMS OF

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