The form of paralysis produced in this way is that known as Erb’s palsy, and the muscles particularly concerned are the deltoid, brachialis anticus, biceps, and the supinator longus. Sometimes the spinati are involved. Occasionally the paralysis is bilateral. A case has been reported in which there was a total lesion of the brachial plexus, including the muscles of the shoulder girdle.
The following facts serve to show that stretching rather than pressure is responsible for this class of paralyses. A patient had undergone a vaginal operation in the crutch position, when the assistant drew her along the table by means of his fingers hooked in the axillæ over the folds of the pectoral muscles: next morning both upper limbs were found to be paralysed, and they remained in this condition many weeks.
In some of the lighter forms the paralysis passes off in a few days, but cases are known in which it has persisted for many months, and as it renders the limb useless for a time it is a serious matter.
Halstead refers to a case of bilateral peroneal paralysis following salpingectomy in the Trendelenburg posture which disabled a patient for six months.
On the whole prognosis is favourable, and recovery the rule.
Büdinger has described a case in which the upper limb was paralysed after an abdominal operation. The patient died some weeks later, and a clot of blood was found pressing on the surface of the brain at a spot corresponding to the arm centre.
References
Büdinger. Über Lähmungen nach Chloroformnarkosen. Archiv f. klin. Chir., 1894, Bd. xlvii. 121.
Cotton, F. J., and Allen, F. W. Brachial Paralysis—Post-narcotic. Boston Med. and Surg. Journal, 1903, cxlviii. 499.