Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.

by Alexis Thomson; Alexander Miles

When the lesion is confined to the sixth cervical segment, the arms assume a characteristic attitude as a result of the contraction of the muscles supplied from the higher segments. The upper arm is abducted and rotated out, the elbow is sharply flexed, and the hand supinated and flexed ([Fig. 206]). Sensation is retained along the radial side of the limb.

Fig. 206.—Attitude of Upper Extremities in Traumatic Lesions of the Sixth Cervical Segment. The prominence of the abdomen is due to gaseous distension of the bowel.

Total lesions of the lower cervical segments are usually fatal in from two to three days to as many weeks, from embarrassment of respiration and hypostatic pneumonia.

When the lesion is confined to the first thoracic segment, the attitude of the arms is usually that of slight abduction at the shoulder and flexion at the elbow, the forearms lie semi-pronated on the chest or belly, and there is slight flexion of the fingers. There is complete anæsthesia as high as the level of the second interspace, and along the distribution of the ulnar nerve ([Fig. 205]); the respiration is entirely diaphragmatic; and the ocular changes depending on paralysis of the cervical sympathetic are present.

Thoracic Region.—In injuries of the thoracic region—second to eleventh thoracic segments inclusive—the anæsthesia below the level of the lesion is complete and its upper limit runs horizontally round the body, and not parallel with the intercostal nerves. Above the anæsthetic area there is a zone of hyperæsthesia, and the patient complains of a sensation as if a band were tightly tied round the body—“girdle-pain.”

The motor paralysis and the anæsthesia are co-extensive. The intercostal muscles below the seat of the lesion and the abdominal muscles are paralysed. The respiratory movements are thus impeded, and, as the patient is unable to cough, mucus gathers in the air-passages and there is a tendency to broncho-pneumonia. As the patient is unable to aid defecation or to expel flatus by straining, the bowel is liable to become distended with fæces and gas, and the meteorism which results adds to the embarrassment of respiration by pressing on the diaphragm. There is retention of urine followed by dribbling from overflow. As the reflex arc is intact there may be involuntary and unconscious micturition whenever the bladder fills.