Hamstring

“ The calf muscles are frequently painful and excessively tender and somewhat swollen or infiltrated; the hamstring tendons or the tendo Achilles may be sore and slightly swollen and the site of slight subcutaneous hemorrhages. ”

“ Hæmorrhage must then be stopped, and that as thoroughly as possible, by torsion, cold, and pressure, and the flap brought accurately together with sutures.
In some rare cases, it may be found necessary to divide the hamstring tendons to rectify spastic contraction of the muscles; but this can generally be done quite well from the original wound.
Holt makes a dependent opening in the popliteal space for drainage. This is unnecessary if the incisions are made sufficiently far back, and if the wound is properly drained. It is unsafe, as approaching so close to the artery and veins. ”

“ The cause of the flexed position, which is almost pathognomonic of knee disease, being preserved, seems to be that the limb is insensibly brought into it in order to take the pressure off the interarticular apparatus, the ligamenta mucosa and alaria,—these swell—the70 muscles of the hamstrings get contracted from habit, and a difficulty, even after the disease is completely subdued, is often enough experienced in procuring complete extension. ”

“ The limb is at first quite powerless, but the patient usually recovers sufficiently to be able to walk with a little support, and although the hamstrings are paralysed the knee can be flexed by the sartorius and gracilis. ”

“ Sensibility is usually altered over the medial side of the arm and forearm, and there is paralysis of the sympathetic.
_Infra-clavicular injuries_, as already stated, are most often produced by a sub-coracoid dislocation of the humerus; the medial cord is that most frequently injured, and the muscles paralysed are those supplied by the ulnar nerve, with, in addition, those intrinsic muscles of the hand supplied by the median. Sensibility is affected over the medial surface of the forearm and ulnar area of the hand. Injury of the lateral and posterior cords is very rare. ”

“ A lady, aged forty, who had been a great sufferer from rheumatism for many years, dreamt one afternoon, while sitting in her chair in front of the fire, that a boy threw a stone at her, which, striking her on the face, inflicted a very severe injury. The next day violent inflammation of the tissues around the facial nerve as it emerges from the stylo mastoid foramen set in, and paralysis of the nerve followed, due to effusion of serum, thickening, and consequent pressure. ”

“ In severe contusions associated with great tension of the skin--for example, over the front of the tibia or around the ankle--blisters often form on the surface and constitute a possible avenue of infection. When deeply situated, the blood tends to spread along the lines of least resistance, partly under the influence of gravity, passing under fasciae, between muscles, along the sheaths of vessels, or in connective-tissue spaces, so that it may only reach the surface after some time, and at a considerable distance from the seat of injury. ”

“ From section, disease, atrophy or degeneration of nerves or nerve centres, the muscles, which they normally innervate, waste, often to an extreme degree. As examples of this we see the atrophy of the triceps extensor cruris and other groups in hæmoglobinuria, of the intrinsic laryngeal muscles in roaring, of the muscles supplied in neurectomy, and of groups of muscles in myelitis, broken back, lead paralysis, and scapular muscular atrophy. True to the law of wasting of physiologically inert organs, the nerves are atrophied and degenerated, and often also the bones, joints and skin. ”

“ Extra-medullary Hæmorrhage—Hæmatorrachis.—The symptoms associated with extra-medullary hæmorrhage are at first of an irritative kind—muscular cramps and jerkings, radiating pains along the course of the nerves pressed upon, and hyperæsthesia. It is only when the blood accumulates in sufficient quantity to exert definite pressure on the cord that symptoms of paralysis ensue, and it is characteristic of extra-medullary hæmorrhage that the paralysis comes on gradually. ”

“ Some weeks or months after the injury, the patient complains of increasing hyperaesthesia and of neuralgic pains in the course of the nerve. The nerve is very sensitive to pressure, and, if superficial, may be felt to be swollen. The associated muscles are wasted and weak, and are subject to twitchings. There are also trophic disturbances. It is rare to have complete sensory and motor paralysis. The disease is commonest in the nerves of the upper extremity, and the hand may become crippled and useless. ”

“ Hæmophilic or Bleeder's Joint.—This is a rare but characteristic affection met with chiefly in the knee-joint of boys who are the subjects of hæmophilia. After some trivial injury, or even without apparent cause, a hæmorrhage takes place into the joint. The joint is tensely swollen, cannot be completely extended, and is so painful that the patient is obliged to lie up. The temperature is often raised (101° to 102° F.) , especially if there are also hæmorrhages elsewhere. The blood in the joint is slowly re-absorbed, and by the end of a fortnight or so, the symptoms completely disappear. ”

“ Symptoms.—The symptoms are largely dependent upon the seat and extent of the hemorrhage, as they are principally owing to the compression of the cord. A large clot may produce sudden paraplegia, accompanied with severe pain along the spine; usually, however, the paralysis of both motion and sensation is not very marked at first; on the second or third day fever is liable to appear, and increased or diminished sensibility along the spine posterior to the seat of the clot. When the bladder and rectum are involved in the symptoms it indicates that the spinal cord is compressed. ”

“ Sometimes the hæmorrhage takes place apparently spontaneously from the gums, the nasal or the intestinal mucous membrane. In other cases the bleeding occurs into the cellular tissue under the skin or mucous membrane, producing large areas of ecchymosis and discoloration. One of the commonest manifestations of the disease is the occurrence of hæmorrhage into the cavities of the large joints, especially the knee, elbow, or hip. The patient suffers repeatedly from such hæmorrhages, the determining injury being often so slight as to have passed unobserved. ”

“ It involves most frequently the lower end of the femur and the tibia, but occurs in connection with the humerus, the mandible, the scapula and other bones.47 The hemorrhage usually manifests itself as a swelling which appears suddenly at the lower end of the femur or femora. It is brought about by trauma, at times in the course of diapering, or by manipulation in testing for local tenderness. The swelling is very tender, and varies in size from an enlargement which is difficult to appreciate, to one which renders the leg fully twice its normal circumference (Fig. 18) . ”

“ So many men come to us with terrific bedsores to add to the distress of their shattered legs it takes much ingenuity to take care of them. We have one man who is practically slung in hammocks which are attached with counter{69} weights to the frame over the bed. These small hammocks, or slings, go, one under his shoulders, one under his lower back, and then his leg is in a frame with weights attached to the foot. Rubber tubes are run in and out of his thigh, and knee, and his wounds are irrigated through these tubes which are perforated. ”

“ Professor Hobday's description of the operation is as follows:
'A bold incision is made through the skin and aponcurotic portion of the pectoralis transversus and panniculus muscles, about 1 to 3 inches (depending on the size of the horse) below the internal condyle of the humerus, and immediately behind the ridge formed by the radius. This latter, and the nerve which can be felt passing over the elbow-joint, form the chief landmarks. The hæmorrhage which ensues is principally venous, and is easily controlled by the artery forceps. ”

“ The symptoms are referred to the joint, because it is there that the muscles are inserted and drag on the perichondrium when movement occurs; swelling is most marked in the vicinity of the joint, and it may be added to by effusion into the synovial cavity. The baby, usually under six months, is noticed to be feverish and fretful and to cry when touched. The mother discovers that the pain is caused by moving a particular limb, usually the arm, as the humerus, radius, and ulna are the bones most commonly affected ”

“ So large and resistent a body as the head of the humerus displaced forwards, and taking the natural position of these vessels and nerves, will accordingly be attended with other symptoms—such as obstructed circulation and pain or partial paralysis, besides those physical signs by which we distinguish the presence of it as a new body in its abnormal situation. ”

“ The complaint may be of vague pains, of occasional cracking on moving the joint, or of impairment of function--usually an inability to extend or flex the joint completely. In many cases a clear account is given of the symptoms which arise when the body is impacted between the articular surfaces, namely, sudden onset of intense sickening pain, loss of power in the limb and locking of the joint, followed by effusion and other accompaniments of a severe sprain. On some particular movement, the body is disengaged, the locking disappears, and recovery takes place. ”

“ Sprains are common in a limb with weak muscles; in a deformed extremity in which the muscles act in unnatural lines, and in a joint with relaxed ligaments.
A joint, once sprained, is very liable to a repetition of the damage from slight force.
Symptoms. The symptoms manifested in a sprain are as follows: severe pain in the joint; nausea and sometimes syncope; impairment, or loss of motion; severe pain upon motion; early swelling if hemorrhage is severe—in any case swelling begins in a few hours; movement of the joint becomes [Pg 177] difficult or impossible ”

“ These little muscles are slowly, but steadily, changing all through life, becoming stiffer and less elastic, less alive, in fact, until finally, in old age, they become stiff and rigid, turning into leathery, fibrous tissue, and may even become so soaked with lime salts as to become brittle, so that they may burst under some sudden strain. When this occurs in one of the arteries of the brain, it causes an attack of apoplexy, or a "stroke of paralysis." ”

“ The functions of the organs of nutrition are sometimes profoundly altered in the possessed, and these alterations are manifested by violent cramps, which show the extent to which the muscular system is affected. The hysterical lump in the throat is a frequent phenomenon in possession. A young girl in the Valley of Calepino had all her limbs twisted and contracted, and had in the œsophagus a sensation as if a ball was sometimes rising in her throat, and again falling to her stomach. ”

“ The occurrence of ulceration of cartilage and of articular caries is attended with the clinical signs of fixation of the joint from involuntary muscular contraction, wasting of muscles, and starting pains. These _starting pains_ are the result of sudden involuntary movements of the joint. They occur most frequently as the patient is dropping off to sleep; the muscles becoming relaxed, the sensitive ulcerated surfaces jar on one another, which causes sudden reflex contraction of the muscles, and the resulting movement being attended with severe pain, wakens the patient with a start. ”

“ Numbness of the right index- and middle-finger. Pain in the left wrist-joint. Deep-seated pain under the right breast. Pain at the right knee. 65. Deep-seated pain in the calves. Pain at the forepart of the left leg, for four days. Laming pain of the legs and thighs for several days. Deep-seated pain, first in the left, then in the right thigh. Numbness of the left leg and heel. 70. Shooting stitch in the right knee.
ARRANGEMENT ACCORDING TO HAHNEMANN.
Mental, Moral, Head: 1. Vertigo with fainting. Dizziness. Pain all over the head. Headache, at the vertex and at times at the occiput. 5. ”

“ The limb becomes powerless. At the seat of rupture there is tenderness and swelling, and there may be ecchymosis. As the swelling subsides, a gap may be felt between the retracted ends, and this becomes wider when the muscle is thrown into contraction. If untreated, a hard, fibrous cord remains at the seat of rupture.
_Treatment._--The ends are approximated by placing the limb in an attitude which relaxes the muscle, and the position is maintained by bandages, splints, or special apparatus. ”

“ Much commoner is it to meet with localised areas of necrosis due to the excessive _pressure of splints_ over bony prominences, such as the lateral malleolus, the medial condyle of the humerus, or femur, or over the dorsum of the foot. This is especially liable to occur when the nutrition of the skin is depressed by any interference with its nerve-supply, such as follows injuries to the spine or peripheral nerves, disease of the brain, or acute anterior poliomyelitis. ”

“ Sprains or Strains and Dislocations Sprains of various joints or parts occur which are more or less grave or serious, depending upon the extent of injury or the joint involved. If a bone is displaced it is termed a dislocation. The joint becomes painful, swelling soon ensues, and on comparing the joint with its fellow, we perceive the distortion; the limb is longer or shorter, and the animal moves it with great difficulty or not at all. If the bone is not moved from its position, but the ligaments are merely injured, or torn, or joints otherwise bruised, it is termed a sprain. ”

“ Sprains.—Every joint is held together by ligaments which are attached to the bones forming the joint. If these ligaments are subjected to a sudden twist in a direction in which the joint is not constructed to move, the resulting injury is known as a sprain. The ligaments are stretched, though they may be torn apart and even small pieces of the bone may be split off if the wrench is great enough. The injury is an exceedingly painful one and frequently renders the limb useless for some time. It is always accompanied with some degree of swelling and more or less inflammation. ”