

Lesions of Net ves of Upper Limb. 109 



can still be raised (deltoid and supraspinatus) and rotated 

 outwards, (infraspinatus) while the forearm can still 

 be flexed and supinated (brachialis anticus and biceps). 

 The serratus magnus can perfom its usual actions, almost 

 in their entirety, but the remaining muscles of the upper 

 extremity, i.e., those supplied by the other brachial nerves, 

 are, however, paralyzed. 



In Klumpke's Paralysis, i.e., involvement of the 

 first dorsal nerve only, there will be paralysis of the mus- 

 cles supplied by the ulnar nerve (flexor carpi ulnaris, 

 some of the muscles of the palm, etc.,) and, in addition, 

 certain ocular symptoms such as myopia on the side of the 

 lesion, sluggish contraction of the pupil, etc., due prob- 

 ably to implication of the sympathetic through the rami 

 communicantes from the first dorsal nerve. 



Individual Nerves. Posterior thoracic, here the 

 serratus magnus is affected with the result that there is 

 "angel wing" deformity and a lessening of the power of 

 raising the arm above the shoulder. Suprascapular, in this 

 the supra, and the infraspinati muscles are involved, so 

 that elevation of the arm is slightly affected and outward 

 rotation of the humerus interfered with. This may be 

 shown practically by the inability of the patient to carry 

 the arm, freely, from left to right as in writing. 



Circumflex. In the case of this nerve the deltoid and 

 the teres minor are affected and the patient is unable to 

 raise the arm. This inability to raise the arm might be 

 confused with impaired elevation due to ankylosis of the 

 shoulder joint, but may be diagnosed by the fact that, in 

 the latter case, movement of the humerus by the surgeon 

 would move the scapula also, whereas, in the former con- 

 dition, i.e., in paralysis of the deltoid, the humerus alone 

 would move when raised by the surgeon. 



