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The position of the upper limb is typical: the arm and forearm hang close to the side, with the forearm extended and pronated; the deltoid, spinati, biceps, brachialis, and supinators are paralysed, and in some cases the radial extensors of the wrist and the pronator teres are also affected. The patient is unable to supinate the forearm or to abduct the arm, and in most cases to flex the forearm.
He may, however, regain some power of flexing the forearm when it is fully pronated, the extensors of the wrist becoming feeble flexors of the elbow. There is, as a rule, no loss of sensibility, but complaint may be made of tickling and of pins-and-needles over the lateral aspect of the arm.
"If you mean pronated in relation to the arm, that is impossible, for the position of the egg-patches shows clearly that the bones of the arm were lying in the position of supination. Thus the dorsal surface of the arm and the palmar surface of the hand respectively were uppermost, which is an anatomical impossibility so long as the hand is attached to the arm."
"If you mean pronated in relation to the arm, that is impossible, for the position of the egg-patches shows clearly that the bones of the arm were lying in the position of supination. Thus the dorsal surface of the arm and the palmar surface of the hand respectively were uppermost, which is an anatomical impossibility so long as the hand is attached to the arm."
"Well, look at your drawings. The egg-patches are on the dorsal surface of the scapula, the humerus, and the bones of the fore-arm. But here you have shown six of the bones of the hand: two metacarpals, the os magnum, and three phalanges; and they all have egg-patches on the palmar surface. Therefore the hand was lying palm upward." "But the hand may have been pronated."
"Well, look at your drawings. The egg-patches are on the dorsal surface of the scapula, the humerus, and the bones of the fore-arm. But here you have shown six of the bones of the hand: two metacarpals, the os magnum, and three phalanges; and they all have egg-patches on the palmar surface. Therefore the hand was lying palm upwards." "But the hand may have been pronated."
The musculo-cutaneous nerve is very rarely injured; when cut across, there is paralysis of the coraco-brachialis, biceps, and part of the brachialis, but no movements are abolished, the forearm being flexed, in the pronated position, by the brachio-radialis and long radial extensor of the wrist; in the supinated position, by that portion of the brachialis supplied by the radial nerve.
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