Part I

) The X-ray as a diagnostic aid may be invaluable.

In obstructions to the =musculo-cutaneous= nerve, the power to flex the forearm upon the arm is greatly impaired. The lesion is most likely to be found between the fifth and sixth cervical vertebræ.

Clinically, the =median nerve= is of special interest from the fact that atrophy of the muscles of the ball of the thumb, which is pathognomonic of progressive muscular atrophy, may be caused by an affection of this nerve. The lesion is usually from the third to the seventh cervical vertebræ.

Lesions of the =ulnar nerve= may arise between the sixth and seventh cervical vertebræ, but are oftentimes found as low as the fifth dorsal, especially at the fifth rib on the side affected.

Lesions of the =circumflex nerve= may be found in the lower cervical vertebræ, but are commonly caused by dislocations of the humerus and clavicle.

Lesions of the =suprarscapular nerve= occur most frequently from the fifth to sixth cervical vertebræ.

The =posterior thoracic= may be lesioned at the fifth or sixth segments, or by pressure injuries to the serratus magnus.

=Dorsal Nerves.=—The essential osteopathic points of the dorsal nerves have been considered under intercostal neuralgia. It might be stated that the posterior fibers of the sixth and seventh dorsal nerves supply the skin of the pit of the stomach. This is of value, clinically, as severe pains in the epigastric region which may result from impingement of these nerves, are supposed by the patient to be due to stomach disorder.

Diseases of the =liver= may be manifested by =pains= in the region of the right scapula. It has been suggested that the stimulus passes from the liver up the pneumogastric to the spinal accessory and down the spinal accessory to the trapezius muscle and thus causes the “liver pain.”

=Intercostal neuralgia= is more common on the left side of the body. The intercostal veins of the left side empty into the left superior intercostal vein or the left azygos. Thus the blood, to reach the vena cava, is obliged to take a circuitous route and stagnation is more likely to occur than on the other side.

The glandular structure of the =mammary glands= is supplied by intercostal nerves from the third to the sixth interspace. Lesions here will cause various diseases of the breasts and adjustment will cure many of them.

=Lumbar Nerves.=—The lumbar nerves may not only be deranged by various growths, inflammatory processes and abscesses in the abdomen, but by lesions, infections, parturition, and developmental defects of the lumbar vertebræ. Tuberculosis of spine, sacro-iliac and hip joints, is not rare. In doubtful cases utilize the X-ray plate.

Lesions in the region of the =first lumbar= may affect the =iliohypogastric= and =ilio-inguinal= nerves and causes various irritations of the penis, scrotum, labium and thigh. Also, the perineal region may be involved, as well as connecting branches of these nerves to various visceral nerves underneath.

The =genital organs= may be affected by lesions to the =genitocrural= and =external cutaneous= nerves, caused by vertebral lesions of the second and third lumbar vertebræ. The latter nerve may be irritated by pressure underneath Poupart’s ligament.

Lesions at the third and fourth lumbar vertebræ and sacro-iliac articulation may affect the =obturator nerve=.

=Sacral Nerves.=—Lesions to the sacral nerves are especially liable to occur when an innominatum is subdislocated, as that changes the relative position of the femur with the body and causes impingement to the sacral nerves. Contraction of the pelvic and thigh muscles also affect sacral nerves. Other lesions to the sacral nerves may be located at the fifth lumbar and sacrum. It should be remembered that the centers of the sacral nerves are in the lower dorsal and upper lumbar region. Various lesions to the sacral nerves may be caused by pelvic inflammation, compressions by growths, and injuries and contractions of muscles within the pelvis. Sciatica has been described under neuritis.

FOOTNOTES:

[114] See Osteopathic Lesion—Journal of American Osteopathic Association. May, 1906, and Deason’s Physiology.

[115] Nervous and Mental Diseases, p. 622.

[116] See Diseases of the Eye, Part I .

[117] See Ear Section,