1. Forty-eight cases of causalgia are reviewed and the clinical features are briefly described. 2. Multiple nerve injuries are common and the pain is often associated with all the injured nerves. In the upper limb there was always an incomplete lesion of the lower trunk or medial cord of the brachial plexus, or of the median nerve. In the lower limb there was always an incomplete lesion of the medial popliteal division of the sciatic, the medial popliteal, or the posterior tibial nerve. These nerves carry most of the sympathetic fibres to the hand and foot. With two exceptions all the nerve lesions were at or above the level of the knee or elbow. 3. Sympathectomy gives marked relief of pain in most cases of causalgia. Prompt treatment is essential to prevent the crippling deformities which follow prolonged voluntary immobilisation of the painful limb. The results of preganglionic are superior to those of postganglionic sympathectomy. 4. The possible pain pathways are discussed, and an explanation is offered for the successful results of sympathectomy in the treatment of causalgia.
1. Sixty-three traction injuries of the brachial plexus in adults are reviewed. Most of the patients were seen at regular intervals for more than three years after injury. 2. The mechanism of injury is described. Forcible separation of the head and shoulder is the essential factor, but the type of lesion is determined by the position of the upper limb at the time of the accident. 3. In traction injuries the main damage is intraneural, and the lesions are of considerable extent. Extraneural scarring is a conspicuous feature of old injuries, but it does not cause any damage to uninjured parts of the plexus. 4. The prognosis of each type of lesion of the plexus is discussed. Satisfactory recovery occurs in most lesions of the upper three roots. Degenerative lesions of the whole plexus never recover completely. Cases with Horner's syndrome always have severe residual paralysis. 5. Conservative treatment is advocated for traction injuries of the plexus and evidence is cited against early or late operations on the plexus. Reconstructive surgical procedures are sometimes indicated.
Twenty-two cases of paraplegia complicating injury of the cervical column have been reviewed. The vertebral injury may be due to flexion or hyperextension violence.
