Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Apart from the medical treatment, measures must be taken to prevent deformity, especially when the legs are affected.  The bedclothes are supported by a cage, and the foot maintained at right angles to the leg by sand-bags or splints.  When the disease is subsiding, the nutrition of the damaged nerves and muscles should be maintained by massage, baths, passive movements, and the use of the galvanic current.  When deformity has been allowed to take place, operative measures may be required for its correction.

NEUROMA[5]

[5] We have followed the classification adopted by Alexis Thomson in his work On Neuroma, and Neuro-fibromatosis (Edinburgh:  1900).

Neuroma is a clinical term applied to all tumours, irrespective of their structure, which have their seat in nerves.

A tumour composed of newly formed nerve tissue is spoken of as a #true neuroma#; when ganglionic cells are present in addition to nerve fibres, the name ganglionic neuroma is applied.  These tumours are rare, and are chiefly met with in the main cords or abdominal plexuses of the sympathetic system of children or young adults.  They are quite insensitive, and their removal is only called for if they cause pain or show signs of malignancy.

A #false neuroma# is an overgrowth of the sheath of a nerve.  This overgrowth may result in the formation of a circumscribed tumour, or may take the form of a diffuse fibromatosis.

The circumscribed or solitary tumour grows from the sheath of a nerve which is otherwise healthy, and it may be innocent or malignant.

The innocent form is usually fibrous or myxomatous, and is definitely encapsulated.  It may become cystic as a result of haemorrhage or of myxomatous degeneration.  It grows very slowly, is usually elliptical in shape, and the solid form is rarely larger than a hazel-nut.  The nerve fibres may be spread out all round the tumour, or may run only on one side of it.  When subcutaneous and related to the smaller unnamed cutaneous nerves, it is known as a painful subcutaneous nodule or tubercle.  It is chiefly met with about the ankle, and most often in women.  It is remarkably sensitive, even gentle handling causing intense pain, which usually radiates to the periphery of the nerve affected.  When related to a deeper, named nerve-trunk, it is known as a trunk-neuroma.  It is usually less sensitive than the “subcutaneous nodule,” and rarely gives rise to motor symptoms unless it involves the nerve roots where they pass through bony canals.

A trunk-neuroma is recognised clinically by its position in the line of a nerve, by the fact that it is movable in the transverse axis of the nerve but not in its long axis, and by being unduly painful and sensitive.

[Illustration:  FIG. 85.—­Amputation Stump of Upper Arm, showing bulbous thickening of the ends of the nerves, embedded in scar tissue at the apex of the stamp.]

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Manual of Surgery from Project Gutenberg. Public domain.