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CHAPTER 24
In analysing certain phenomena appearing in connection with these phantom
sensations, the following may be mentioned:
1.
Posture of the phantom limb
Varieties of posture of phantom limbs have been repeatedly described but the most
common posture is one of flexion, although the paralysed limbs may actually be lying
extended on the bed. Riddoch's case of complete lesion below T9 had the feeling 'as if
someone were pulling my legs, trying to get them straight. The more they pulled the
tighter the strings became and soon I had to cry out with pain.' Other postures described
are 'my legs are floating in the air' or 'curled underneath me'. The intensity of phantom
sensation may be influenced by change of posture. Furthermore, the posture of a phantom
limb may be influenced by the position of the limb immediately prior to the occurrence
of the paraplegia, if the pre-paraplegic's posture was associated with an experience of
violent stress and emotion, as shown in the following observation of one of our patients
with a complete lesion below Tn due to gunshot injury.
In 1943, a soldier at the age of 28, when leaving his tank during a battle in Italy,
sustained a gunshot injury of his right knee and fell to the ground. He noticed that the
right leg was lying useless in an extremely internally rotated position and he experienced
a violent cramp-like sensation in this leg around the knee. A few minutes later, he
received a gunshot injury in the back and immediately became paralysed below his
waist. Soon after admission to hospital, his right leg was amputated at mid-thigh level.
For the following six months, he had phantom sensation in the paralysed, amputated
side only, and the position of the phantom limb was always the revivification of the posi
tion of the right leg as experienced immediately after his primary injury, before receiving
his spinal injury. The phantom sensation gradually disappeared. It may be noted that
this patient, who, since 1948, has been full-time employed in his former job as a bank
clerk, was readmitted in June 1951, with a fracture of his left tibia below the knee,
which occurred when his caliper gave way and he fell to the ground. This fracture did
not elicit any sensory effects nor were phantom sensations of any kind experienced.
2.
Effect of late amputation on phantom limb
An interesting question is whether a phantom sensation occurring as a result of para
plegia may be influenced by a later amputation, and the following case may be quoted.
An A.T.S. girl, aged 25, sustained a complete spinal cord lesion below T8 following
fracture dislocation of the spine in May 1945. After the injury, she had phantom sensa
tions and felt her legs to be lying in extended position. It may be noted that, in this case,
the intensity of the phantom sensation increased when the patient was changed from
the supine on to the lateral position. This phantom sensation did not alter, although she
developed a septic bedsore in another hospital, penetrating into the left knee-joint and
leading to a profound internal rotation of the left leg, resulting in contracture.
In May 1949, the left leg had to be amputated above the knee. No change of phantom
sensation was experienced after the amputation. It still persisted on both sides, as before.
