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All the muscles of the arm, forearm, and hand are paralysed, and, as a rule, also the pectorals and spinati, but the rhomboids and serratus anterior escape. There is paralysis of the sympathetic fibres to the eye and orbit, with narrowing of the palpebral fissure, recession of the globe, and the pupil is slow to dilate when shaded from the light.
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.
In cases of long standing it is not so simple, because other muscles, the spinati, the clavicular fibres of the pectoral and the serratus, take its place and elevate the arm; there is always loss of sensation on the lateral aspect of the shoulder. There is rarely any call for operative treatment, as the paralysis is usually compensated for by other muscles.
When the supra-scapular nerve is contused or stretched in injuries of the shoulder, the spinati muscles are paralysed and wasted, the spine of the scapula is unduly prominent, and there is impairment in the power of abducting the arm and rotating it laterally.
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