Diseases of the nervous system : a text-book of neurology and psychiatry . rt-carrying, telegraphy, writing, etc. At any rate, BRACHIAL NEURALGIA 2G1 arm and shoulder pains are frequent, in their mild grades at least,and very variable. (See Fig. 126 and Figs. 11, 12, 13, 14, 15, and 16.)The usual causative factors come into play here. The neuropathicconstitution is put in the foreground by Oppenheim; Bernhardt laysconsiderable stress upon the importance of bone injuries with callusformation in the causation of many arm neuralgias. Small puncturedwounds about the forearm, wrist, and arm are res
Diseases of the nervous system : a text-book of neurology and psychiatry . rt-carrying, telegraphy, writing, etc. At any rate, BRACHIAL NEURALGIA 2G1 arm and shoulder pains are frequent, in their mild grades at least,and very variable. (See Fig. 126 and Figs. 11, 12, 13, 14, 15, and 16.)The usual causative factors come into play here. The neuropathicconstitution is put in the foreground by Oppenheim; Bernhardt laysconsiderable stress upon the importance of bone injuries with callusformation in the causation of many arm neuralgias. Small puncturedwounds about the forearm, wrist, and arm are responsible for manysymptomatic neuralgias, as Weir Mitchell has so well shown. Moreremote cases are found in vertebral disease, tumor formation, aneu-risms, syringomyelia, multiple sclerosis, and tabes. The frank neuriticprocesses in their beginnings must be borne in mind, and cervicalrib should not be overlooked. FIFTHCERVICAU SIXTH SEVENTH TO SCALENI &LONGUS COLLI THI^RDPOSTERIOR -FROM FOURTH CERVICAL SUPRASCAPULAR XTERNAL ANTERIOR THORACIC NTERNAL ANTERIOR THORACIC. C/y CIRCUMFLEX ?S MUSCULO SPIRAL Fig. 126.—Plan of the brachial plexus. (Gerrish.) Symptoms.—Cervicobrachial neuralgias are extremely variable indistribution, extent, and severity. The onset is usually sudden, espe-cially in those patients in whom an antecedent history of exposure tocold and to wet is obtainable (motormen, policemen, etc.); at timesthe beginning is preceded by twinges and slight distress. On awakeningin the morning sharp pain is felt in the shoulder and arm. The painsin brachial neuralgia are less apt to be the sharp, shooting variety sodreaded in tic douloureux, but sudden accessions of sharp pains, vary-ing in their intensity, are frequent. As with most neuralgic pains,movement increases them. Toward evening the pains are apt to in- 262 AFFECTIONS OF THE PERIPHERAL NERVES crease and the patient, although obtaining relief by lying down, rarelysleeps well. Soreness of the skin, slight swelling,
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