CERVICO-BRACHIAL NEURALGIA. 



335 



than other forms. Among these are injuries of the peripheral branches 

 of the brachial plexus in the arm or hand from lancets and other 

 pointed instruments, pressure on the nerves from fragments of bullets, 

 contusions, neuromata, etc. The brachial plexus itself is occasionally 

 compressed in the axilla by swollen lymphatic glands, under the clavi- 

 cle by the callus of a fractured rib, by aneurisms of the subclavian or 

 arch of the aorta. Finally, the nerves forming the brachial plexus may 

 be pressed upon and irritated just at their escape from the spinal 

 canal, by diseases of the vertebrae. In other cases the irritation act- 

 ing on the brachial plexus or its branches cannot be perceived, and we 

 have to refer the neuralgia to a rheumatic affection of the neurilemma, 

 or to an imperceptible alteration in the nerves, from over-use of the 

 muscles in knitting, playing the piano, etc. Lastly, we must mention 

 that attacks of angina pectoris are usually complicated with pain in the 

 course of the brachial plexus. The transfer of the morbid excitement 

 from the nerves of the heart to those of the arm is best explained, 

 according to my idea, by the intervention of the nervus cardiacus mag- 

 nus and parvus, as they originate from the middle and inferior cervical 

 gangh'a which are connected by many twigs with the inferior cervical 

 nerves. 



In some cases the pains spread over a large part of the sensory 

 filaments of the brachial plexus, in other cases they are limited to the 

 axillary region and the upper part of the arm ; occasionally they fol- 

 low exactly the distribution of the ulnar, radial, or musculo-cutaneous 

 nerves. Vatteix most frequently found a point douloureux in the 

 axilla, and one for the ulnar nerve, the point between the inner con- 

 dyle and the olecranon, and another near the ulna above the hand 

 where the ulnaris becomes superficial ; and for the radial nerve the 

 point in the arm where this nerve winds around the humerus, and a 

 second one at the lower end of the radius just above the hand. The 

 lancinating pains, particularly those extending to the fingers supplied 

 by the affected nerve, are severe and recur very frequently, so that 

 the intervals of perfect freedom from pain are usually shorter than in 

 other neuralgias. The pain is generally accompanied by a sense of 

 formication and numbness in the fingers, which lasts longer than the 

 attack. Disturbances of nutrition in the parts supplied by the mor- 

 bidly-excited nerve occur in some cases of brachial neuralgia in the 

 shape of exanthemata (pemphigus, urticaria), or inflammations of the 

 fingers. There are very often complications with neuralgias of other 

 nerves, particularly with cervical, intercostal, and sciatic neuralgia. 

 The course, duration, and termination of cervico-brachial neuralgia are 

 about the same as in other neuralgias. 



If injuries of the finger, venesection, or similar injuries have in- 



