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Claude C. Coleman

sciatic nerve are not uncommon and frequently one of its main constituents may be divided by a projectile while the other escapes injury. In the study of loss of muscle function due to nerve paralysis, one must keep constantly in mind what is known as supplementary, substitutionary or “trick” movements performed by muscles supplied by the adjoining uninjured nerves when the muscles primarily responsible for the movement have been paralyzed. An interesting example of such a “trick” movement is elevation of the upper extremity to a right angle even though injury to the

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Andrew J. Akelaitis

neurological examination disclosed exaggerated reflexes in the right upper extremity, a slight clumsiness in the right hand on the finger-to-nose test with eyes closed and dysdiadokokinesis in the right hand which was more marked when performed with eyes open. By dynamometer, the strength in the right hand was 30 kg. and in the left 25 kg. Careful sensory studies revealed deep pressure, weight discrimination, and the recognition of two-dimensional forms to be disturbed in the right hand. Small objects and wooden letters were misidentified in the right hand but interpretation

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Robert C. L. Robertson

needle aspirations of fluid and blood from beneath the scalp flap were necessary for a time. He was returned to full field duty April 10, 1943. Case 10 . S.C.N., Brooke General Hospital. Skull Pathology . Compound comminuted depressed fracture of supraorbital region, rim of orbit, roof of orbit, right. Associated Injuries . Severe acid burns, left upper extremity and multiple lacerations, abrasions and contusions of body, limbs and face. Mode of Injury . November 20, 1942, the observation coach in which patient was riding was derailed, rolled down a high

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Daniel Weller

on discharge showed that she was comfortable and free from cough, respiratory crises, vomiting and nausea. The pupils reacted promptly to light and in accommodation, and the fundi were normal. The only persistent signs were the right-sided hemianesthesia and weakness of the right upper extremity. Interval Note . When seen in the follow-up clinic two months later she was able to walk, and felt well, except for a persistent headache and occasional bouts of respiratory difficulty. The cranial nerves were essentially negative. She was able to write her name, and the

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Paul C. Bucy and Ben W. Lichtenstein

seemed perfectly well. The following morning she experienced weakness in both lower extremities and was forced to use a cane for support. Two days afterwards she experienced weakness in the entire right upper extremity and had particular difficulty in moving her fingers. This was followed by tingling paresthesias in the right upper and both lower extremities as well as by sharp knife-like pains which were most severe in the calf of the right leg and in the region of the right elbow. The paresthesias persisted and the pain occurred intermittently. She developed a

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Kenneth E. Livingston

total reproduction of the amputated extremity. There is a definite patterning of the phantom limb which does not conform to the geography of the major peripheral nerves. In the upper extremity amputations the fingers are most prominent, although in many instances only the palmar surfaces of the finger tips are actually represented. The palm is less frequently felt, and the wrist and dorsum of the hand are usually not present. The forearm and upper arm are rarely perceived. Many patients give the impression that they feel “the whole thing,” but on careful questioning

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James C. White and Hannibal Hamlin

four months. PREVENTION OF REGENERATION OF CENTRAL CONNECTIONS OF DECENTRALIZED UPPER THORACIC GANGLIA IN PREGANGLIONIC SYMPATHECTOMY OF UPPER EXTREMITY When this operation through a posterior third rib approach was described by Smithwick, 8 he recommended covering the second and third thoracic sympathetic ganglia with a closed sleeve of fine silk gauze. The purpose of this manoeuvre was to prevent regeneration, which frequently occurred even when these ganglia were transplanted out of their normal bed and sutured to the second intercostal muscle

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Arthur B. Soule Jr.

. Roentgen examination of the spine, pelvis and hips had revealed no abnormality on admission. About six months later, an excretory urographic study was made, at which time ossifications were noted about both hips ( Fig. 1 ). On the right side, a large buttress of coarsely trabeculated bone extended outward from the pelvis above the acetabulum to surround the greater trochanter. The left hip joint and upper extremity of the femur down to a point 5 cm. distal to the lesser trochanter were completely encased in bone. No ossifications were discovered in the more distal

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Curt P. Richter and P. D. Malone

all. Third, they do not show any landmarks, without which it is very difficult to transfer the outlines of the affected areas to the chart with any degree of accuracy. During the past two years, while making skin resistance studies on patients with peripheral nerve lesions at the Walter Reed General and Johns Hopkins Hospitals, we experimented with a number of charts. A series of charts were finally designed which do not have the aforementioned shortcomings. Fig. 1 shows the chart for the right upper extremity. The central drawings give the front and rear views

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Emil Seletz

incisions of the extremities have for the most part been divided into three parts. This is especially true for incisions about the cubital and popliteal fossae. One part alone is usually sufficient for repair of the nerve, while two or all three parts may be used when rerouting as well as repair is necessary. INCISIONS IN THE UPPER EXTREMITY The Median Nerve . The median nerve in the arm, above the elbow joint, is easily explored through part 1, Fig. 1 ; this consists of a longitudinal incision over the mesial surface of the arm. It lies in the plane between the