258 SURGICAL APPLIED ANATOMY, [chap. xv. 



and the tendons of the flexor sublimis and flexor carpi 

 radialis. The tendons of the flexor profuiidus and 

 flexor longus pollicis are usually cut short close to the 

 bones. 



Amputation of the thumb at the carpo-m eta- 

 carpal j oint by flaps. In the palmar flap would be cut the 

 adductor, the short and long flexor, the opponens, and 

 abductor pollicis. The extensores ossis and primi 

 would be cut short in the posterior angle of the flap. 

 The extensor secundi and a considerable portion of the 

 abductor indicis would be found in the dorsal flap. 

 The vessels divided would be the two dorsal arteries 

 of the thumb and the princeps pollicis. There is great 

 danger, in this operation, of wounding the radialis 

 indicis and the radial artery itself where it begins to 

 dip into the palm. 



Injuries to the main nerves of the upper 

 limb* The entire brachial plexus has been ruptured, 

 leading to complete paralysis of the upper limb. In 

 these cases, it would appear that the nerves are torn 

 away from their attachments to the cord rather than 

 broken across at some distance from it. In several 

 instances the biceps muscle has retained some of 

 its functions, while the whole of the other muscles 

 have been paralysed, a circumstance difficult to 

 explain. 



Paralysis of the musculo-spiral nerve. 

 When complete, the hand is flexed and hangs flaccid 

 ("drop wrist"), and neither the wrist nor the fingers 

 can be extended. The latter are bent and cover the 

 thumb, which is also flexed and adducted. When 

 attempts are made to extend the fingers, the interossei 

 and lurnbricales alone act, producing extension of the 

 last two phalanges and flexion of the first. Supi- 

 nation is lost, especially if the elbow be extended 

 so as to exclude the action of the biceps muscle. 

 Extension at the elbow is lost, and sensibility is 



