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The prognosis is less favourable in the supra-clavicular lesions than in those below the clavicle, which nearly always recover without surgical intervention. In the brachial birth-paralysis met with in infants, the lesion is due to over-stretching of the plexus, and is nearly always of the Erb-Duchenne type.
During the healing process an excess of fibrous tissue is formed, which may interfere with regeneration. Post-anæsthetic paralysis occurs in patients in whom, during the course of an operation, the arm is abducted and rotated laterally or extended above the head, causing over-stretching of the plexus, especially of the fifth, or fifth and sixth, anterior branches.
The lower-arm type of paralysis, associated with the name of Klumpke, is usually due to over-stretching of the plexus, and especially affects the anterior branch of the first dorsal nerve. In typical cases all the intrinsic muscles of the hand are affected, and the hand assumes the claw shape.
He was still too distant to reach the peccary with a single spring; and he appeared to be considering how he might get a little nearer without being discovered. "All at once, his eyes rested upon the over-stretching branches a sudden change took place in his attitude; and, turning slowly and silently, he crawled back among the weeds.
Phoebe at this redoubled her laugh, and whilst I expected a very serious solution of my doubts and apprehensions in this matter, only told me that "she never heard of a mortal wound being given in those parts, by that terrible weapon, and that some she knew younger, and as delicately made as myself, had outlived the operation; that she believed, at the worst, I should take a great deal of liking; that true it was, there was a great diversity of sizes in those parts, owing to nature, child-bearing, frequent over-stretching with unmerciful machines, but that at a certain age and habit of body, even the most experienced in those affairs could not well distinguish between the maid and the woman, supposing too an absence of all artifice, in their natural situation: but that since chance had thrown in my way one sight of that sort, she would procure me another, that should feast my eyes more delicately, and go a great way in the cure of my fears from that imaginary disproportion".
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