Remarks on sciatica and morbus coxae senilis : especially with regard to their treatment / by Karl Petrén.

  • Petrén, Karl Anders, 1868-1927.
Date:
1909
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Licence: In copyright

Credit: Remarks on sciatica and morbus coxae senilis : especially with regard to their treatment / by Karl Petrén. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    18/57 (page 318)
    The arms are not affected, the muscles of the hypothenar being normally developed on both sides. There is no paresis of the inter- osseous muscles of the hands. No disturbance of sensibility to pain in hands or fingers. Sensibility of the left leg is quite normal in every respect. No disturbance of functions of bladder or rectum. Right Leg: Movements and Reflexes.—Circumference of the right thigh and leg is somewhat less than on left side. Consistency of muscles of right leg is good. Power of flexion of right knee-joint somewhat reduced, extension very slightly reduced. Dorsal flexion of right ankle-joint possibly shows very slight degree of weakness. Plantar-flexion does not show definite alteration in power. Gait is fairly good. Patient limps slightly on right leg. He cannot, however, stand on the right leg alone, even with the eyes open. He can stand on the left leg alone with his eyes closed. The patellar reflex is present on the right side, but is diminished. The Achilles-tendon reflex is absent on the right side, but present on the left. Plantar reflex is normal on both sides. Sense of Passive Position and Movement.—Passive movements of the right ankle-joint, even though slight, are correctly interpreted. Movements of the great toe are not recognised until they exceed 30°, movements of the other toes only when they are maximal. Sensibility to Pain is diminished on all the posterior aspect of the right lower extremity and on the external as well as the internal surface of the leg, painful impressions being correctly perceived only over a narrow portion of the skin of the anterior surface of the leg. Sensibility to pain has been tested both with a needle (January 1908) and with the algesimeter of Alrutz (August 1908, Dr Bergmark). This examination, carried out partly with a weight of 2, and partly with one of 6 grams, reveals the presence of a hypalgesia over the whole of the posterior surface of the thigh and leg, as well as over the anterior surface of the leg (with the exception only of a narrow strip along the anterior border of the tibia). Over the perineum, penis and scrotum pricks are felt with precision and equally on both sides, the weight used being 2 grams. Sensibility to Heat and Cold (Examination in October 1908 by Dr Bergmark).—'Over the whole posterior aspect of the right lower extremity, and over the external surface of the right leg, as well as over the whole of the right foot with the exception only of the internal border, temperatures of 25° and 27° 0. are not dif- ferentiated. Over the same areas a temperature of 45° 0. is not appreciated as warm. Over the greater part of this thermohypsesthetic area temperatures even of 90° 0. and 17° C. are not distinguished from each other. On the posterior part of the leg, however, this thermoansesthesia does not reach the internal border. The apprecia- tion of cold is somewhat better retained, the area over which 0° C is not appreciated as cold forming a comparatively narrow strip along the posterior aspeet of the thigh. The patient states that he does not feel anything when the right foot is burned. On the right side