Acute brachial radiculitis / by J.W. Aldren Turner.

  • Turner, J. W. Aldren (J. William Aldren), 1864-1945.
Date:
[1944]
Catalogue details

Licence: Public Domain Mark

Credit: Acute brachial radiculitis / by J.W. Aldren Turner. Source: Wellcome Collection.

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    anti-typhus inoculation three days previously and 1' two weeks previously, while 3 ‘patients had had T.A.B., the interval between inoculation and onset of symptoms being 18 days, 4 weeks, and 5 weeks. Another man had had A.T.T. three weeks previously, while in the remaining cases no recent inoculations had been given. Onset of the Disorder The absence of general symptoms of fever and malaise is remarkable ; in only two cases was there slight malaise when the pain started. The presenting symptom is always pain ; it is across the back of the shoulder and down the outer side of the arm ; in bilateral cases it spreads to both shoulders and arms, and in cases in which the C.6 or C.7 root is affected it spreads to the outer side of the forearm. The pain is ' continuous and is usually of considerable severity ; in only 3 of the cases was it described as slight. The duration of the severe pain before muscle weakness first appeared has varied from a few hours to two weeks or possibly slightly longer, the usual length of time being three to four days. The severe pain tends to pass off as the weakness develops, and may be replaced by a dull ache; but in some cases severe pain has lasted for two to three weeks, although the paralysis has occurred within a few days of the onset of the pain. The onset of weakness in the majority of cases is sudden, with a maximum at the onset, but 4 patients said that the weakness had progressed over the course of two to three days. Sensory Changes No sensory impairment was found when a motor nerve, such as the long thoracic or suprascapular, was alone involved : in the cases of involvement of the circumflex and muscuk* cutaneous there was cutaneous impairment to all forms o* sensation in the area expected, and in 5 cases in which C.:> and 6 roots were affected there was impairment down the lateral side of the arm and forearm. Of the mixed cases only two (in which the deltoid was involved) showed some sensory impairment over the skin on the outer side of the arm, and the case previously mentioned in which there was impairment over the lateral side of both forearms. In the other patients no sensory impairment could be found. Special Investigations As many of these cases have been seen some time after the onset, detailed investigations in the acute stage have been infrequent, but when they have been possible the C.S.F., blood count, and E.S.R. have been normal, and Spillane also found this in his cases. The only exception was the finding of 10 lymphocytes per c.mm. in the C.S.F. in the case of glandular fever with radicular involvement. Prognosis is difficult to determine in view of the varying times after the onset at which these cases have been examined. The prognosis in the serratus magnus palsies is on the whole poor: of the 21 cases in which this muscle has been involved