Gunshot wound of left forearm: PARALYSIS of the arm gradually INCREASING IN DEGREE and extent and associated with pains and anesthesias.
Case 405. (Oppenheim, July, 1915.)
A reservist sustained, October 2, 1914, a gunshot wound of the left forearm from a distance of about 1400 meters. He fainted, lost much blood, and was treated surgically, October 7, in hospital (at this time no complete paralysis of the arm).
In November, however, an incomplete paralysis at first developed. November 12, the patient was able to flex his thumb but showed some anesthesia.
Transferred to nerve hospital in December, the patient said that at the first change of dressings, October 10, he had not been able to move his arm, and said that pains and paresthesia had existed in the arm ever since the injury. There was still some evidence of suppuration at the exit orifice of the bullet. The left arm was now completely paralyzed and atonic, and hung down in walking, without swinging. The supinator phenomenon, though present on the right side, was absent on the left. The triceps reflex was present. The shoulder acted like a flail joint. On passive elevation of the left arm, the deltoid seemed to contract slightly at first; later it failed to contract. Fibrillary tremor of the left thumb.
Suggestive therapy was unsuccessful. There was an anesthesia of the left arm and the left trunk. The disorder diminished proximally, being most severe in the hand and the arm. The legs were normal. The electrical irritability of the left arm was only slightly diminished. There was a well-marked hypertrichosis of the left forearm, the skin of which was slightly purple and discolored. The patient himself made an attempt to burn his arm with a lighted cigar, to see if he could feel the pain. He showed the scar but had felt nothing. The pectoralis major muscle did not contract. If the left arm was started actively swinging, it kept on swinging inertly. The left hand showed hyperidrosis. The small hand muscles were emaciated but electrically normal.