Shell-shock and other neuropsychiatric problems

Case 487. (Sollier, November, 1916.)

A patient suffered from a rupture of the peroneal nerve in its lower part, September, 1915, and had operation scars before and behind the external malleolus. He was immobilized for 45 days at first, and then for 30 days, with the foot in extension on account of the pain produced in the endeavor to put it into normal position. A 6 cm. atrophy was then found to affect the calf, and there was a fibrous retraction of the tendo Achillis and of the calf muscles. There was no anesthesia, the toes moved easily, the foot was fixed in equinus, with about 7 cm. of the heel above the ground. He was placed in various orthopedic institutions and was treated with mechanotherapy, but without result.

At the neurological center, however, in six weeks, he was got to walk, with his heel on the ground, by means of massage and manual mobilization. The atrophy diminished a centimeter and the foot became mobile in all directions.

According to Sollier, mechanotherapy by means of apparatus is apt to be ineffective, especially in contractures, because its action ceases the moment it ought to commence, namely, when the patient is beginning to react a little painfully after recovery from anesthesia. In cases of retraction, mechanotherapy with apparatus does not allow the proper combination of massage with progressive mobilization.

Re orthopedic cases, Jones classes the conditions that create an orthopedic case under four heads (note especially the fourth):

1. Mechanical injury to bone, joint, muscle, or nerve.

2. Atrophy and disease of these structures primarily due to the injury.

3. Incoördination of movement due to disease of the brain—a result of atrophy and disease of peripheral structures.

4. Psychological conditions which can be overcome by reëducational processes.