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The head must balance on the cervical vertebra and not call upon the muscles of the neck to keep it from rolling off; the weight of the shoulders must be thrown back off the thorax; the spine be erect to allow the abdomen free action; the joints of the thigh extended; the hand and arm supinated, etc. Bones must relieve muscles and nerves.
The position is this: the elbows are bent, the forearms, and hands advanced, the knuckles turned downwards, the ends of the branches come out between the thumbs and roots of the forefingers, the hands are supinated, the inner side of each is turned towards its fellow, as they are held a few inches apart.
There is pain and tenderness in front of the upper end of the humerus, the patient is unable to abduct or to elevate the arm, and he may be unable to flex the elbow when the forearm is supinated. The long axis of the muscle, instead of being parallel with the humerus, inclines downwards and outwards. When the patient is asked to contract the muscle, its belly is seen to be drawn towards the elbow.
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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